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Male infertility

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Infertility is defined as the inability to conceive after one year of normal sexual intercourse. At least 1 in 10 married couples is infertile and surprise, surprise, it is not just a feminine problem. In 3 in 10 cases, it is the man alone to blame, in 5 in 10 cases, the woman alone, and both of them in 2 in 10 cases. In other words, the man has a part to play in 5 of the 10 (or half) cases of infertility.{{more}} Unfortunately, in this country, the woman is usually blamed for most infertility and is usually sent by her husband or partner to see “why she can’t get pregnant”. Primary infertility is when the man has never had children, whilst secondary infertile men have fathered children before, but can no longer do so. Again, women automatically assume that once the man has had children, then the cause of the infertility in the relationship must be her, especially if she has never had children or she has “fibroids or blocked tubes”.

A basic understanding of the function of the testicle in producing sperms is important. The testicle or balls have two main functions. They produce sperms and the hormone testosterone. Sperms are the microscopic carriers of life, so without them, we would all be non-existent; that’s why sexual intercourse is necessary for normal reproduction. These sperms are produced in the testicles by a different set of cells than those producing the hormone testosterone. These cells are called germ cells and are very sensitive to environmental toxins and are easily damaged from toxins from smoking, alcohol and other recreational drugs, while leaving the hormone producing cells totally untouched. These cells can also be damaged from infections, heat, some medications, pesticides and petroleum products. It takes about 75 days for a mature sperm to be made, therefore its takes about this time to begin replacing damaged sperm. So, if treatment is started immediately, do not expect to see any changes in the semen count for another 3-4 months. Incidentally, before the sperm is ejaculated, it spends 2/3rds of its 75 days in the epididymis maturing before it is ejaculated. After it leaves the testicle, it has to be activated outside the body by seminal and prostatic fluid.

If we regard the making of sperms as an automated procedure where the factory is the testicle, the raw materials come from the brain through the blood stream and the finished product is deposited in the female vagina, after passing out through the sperm tubes (vas deferens). The causes of male infertility can therefore be classified as pre-factory (a raw material or brain problem), factory (a testicular) or post factory (a delivery or tubular).

Prefactory causes affect the hormones that either stimulate or inhibit sperm production. Too many inhibiting hormones (prolactin or estradiol) or too few stimulating hormones (follicle stimulating hormone, testosterone and leutinising hormone) will reduce sperm formation. Problems like brain tumors, brain injury, liver damage, use of anabolic steroids, diabetes, some medications, chemotherapy, certain types of foods and supplements can affect these hormone levels, as can stress, smoking and alcohol. A condition called hypogonadism or low hormone levels is an important cause of pre-factory male infertility. Most of the above problems affect the hormone levels either by reducing their production or by preventing their release from the brain or pituitary.

Factory causes affect the formation and maturation of the sperm cells in the testicle. Congenital genetic problems, which affect the development of the testicle, like Down’s syndrome and undescended testicles, are minor causes. Major causes are testicular infections especially from gonorrhea and chlamydia, trauma, torsions or twisting and tumors. Varicoceles or varicose veins around the testicle keep the testicles too warm and are a major cause of infertility, as are tight clothing and excessive underclothing. Surgical removal of the testicles, due to cancer or trauma, will also cause infertility, only if both are removed. I have several patients with one testicle, who have fathered many children.

Post factory causes include blockage of the vas deferens from infection, trauma or surgery. Infection from gonorrhea or chlamydia blocks both the male vas deferens and the female fallopian tube. Infections of the epididymis alone, called epididymitis or the testicle called orchitis, even without blockage can cause transient or permanent infertility, but these are testicular causes. However, infections of the prostate and seminal vesicle will cause infertility, as this prevents the activation of the delivered mature sperms. Blockage of the urine passage, called a stricture, can cause infertility, as can removal of the prostate, seminal vesicles or vas deferens. As you would expect, retrograde ejaculation, no ejaculation, impotence and coitus interuptus (pulling out) will lead to delivery infertility, as will no or infrequent sex. You will be surprised at how often infrequent sex, contraceptive use and pulling out can cause infertility and couples are not aware of it! If you note, unlike females, male age has not been used as a cause of infertility, because a man can have children well into his 80s or 90s, once he can get it up and shoot! Next week we look at the diagnosis of male infertility.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com

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