Male Infertility Causes

For normal pregnancy to occur both male and female must be healthy. Male factor is solely responsible for  about 20%  of infertile couples. Unfortunately, everybody has a misconception that females are solely responsible for infertility. Traditionally, females are blamed for barrenness . So, females are subjected to unnecessary interventions. For the fertility process to proceed smoothly, both the man and woman should be healthy and normal. Identifying any underlying conditions that may affect a man's fertility prior to initiating any treatments can help spare couples the distress of attempting ineffective treatments.

It is important to note that infertility and impotence are quite different entities. Impotence means an inability to attain or sustain erection for satisfactory sexual intercourse. So, it has nothing to do with the fertility status of a man. It is thus possible for an impotent man to be fertile.
A number of clinical conditions and disease entities can render a man infertile.
Just like dilated veins in the legs, there may be dilatation of veins in the scrotum causing swelling . This causes increased blood supply and increased temperature resulting in decreased sperm production.
 Acute infections like small pox, mumps, sexually transmitted diseases and chronic infections like tuberculosis, leprosy, cause negative impact on sperm production and may lead to antibody formation with seminal fluid abnormalities.
 Direct or indirect injuries like trauma, heat, radiation, chemotherapy, toxins, recreational drugs
Alcohol causes negative impact on sperm production and normal morphology.
like scrotal, inguinal,retroperitoneal and vasectomy can lead to obstruction of semen  ejaculation.
In undescended testes where testes fails to descend from its  normal pathway and might be found in the abdomen . Since, testes is sensitive to temperature it will affect the normal sperm production. These individuals have high rate of malignancy too. Hence, it has to be corrected surgically.
like Klinefelters Syndrome,Cystic fibrosis , Youngs syndrome, Adrenal hyperplasia either cause abnormal  quality, quantity  and  motility.

Male Infertility Evaluation

The male factor evaluation is normally done by a male infertility specialist or a urologist. Adequate history taking and general physical examination is of paramount importance. The main goal of evaluation is to identify the correctable causes, irreparable causes and most appropriate method of correcting them.
History taking:
o    Sexual history
o    Social history
o    Previous children
o    Childhood diseases
o    Injury, radiation, chemotherapy, toxins
o    Drug history
o    Medical or surgical problems
 General and local examination :
1.     Height, weight
2.     Features of Hypoganadotrophic hypoganadism
3.     Hormonal imbalance
4.     Varicocoele
5.     Hydrocoele
6.     Undescended  testes
7.     Anatomical abnormalities

Prevention and treatment :

As the saying goes prevention is better than cure. Avoiding the risk factors like, smoking, recreational drugs, alcohol, excessive heat and protection to testicles while into sports may prevent or reduce the risk of infertility.

Male Infertility Treatment:

Some of the cause can be correctable by medications to improve the count, treating the infections.  Surgical correction is needed in some cases of obstruction.
In cases where the above treatments are unsuccessful, or when the cause for male infertility is unknown or untreatable, IUI treatment or IVF treatment may be suggested.
Obstructive causes of post-testicular infertility can be overcome with advanced techniques like

  • Sperm retrieval
    • Testicular Sperm Extraction/Aspiration (TESE/TESA)
    • Microscopic Epididymal Sperm Aspiration (MESA)
    • Percutaneous Epididymal Sperm Aspiration (PESA) 
    • Electroejaculation (EEJ)

Drugs of some help:
Clomiphene citrate
Vitamin E
Low dose estrogen testosterone combination
Gonadotrophins :
Though the therapeutic use of antioxidants appears attractive, antioxidant benefits by various commercial supplements for fertility purposes are still to be investigated .
Despite the availability of so many treatment modalities and advanced techniques some of the patients remain untreatable, and for some it may be expensive. Then there is no alternative but to recommend donor insemination (AID).

Male Infertility Investigations

The first test in the evaluation of the infertile male is the semen analysis. This test is inexpensive, easy to perform and gives valuable information. A perfectly normal semen analysis report generally indicates a healthy man. Often, in the case of male infertility, the semen analysis is abnormal .
Almost all laboratories will conduct tests and report on the following information, using values established by the World Health Organization :

  • Concentration (sometimes referred to as the count):  Average sperm concentration is more than 60 million per milliliter (>60 million/cc). Counts of less than 20 million per milliliter (<20 million/cc) are considered sub-fertile.
  • Motility (sometimes referred to as mobility): This describes the percentage of sperm that are moving.  Fifty percent or more of the sperm should be moving.
  • Morphology: This describes the shape of the sperm.  Thirty percent of the sperm should be normal by WHO criteria .
  • Volume: This is a measurement of the volume of the ejaculate. Normal is two milliliters (two ccs ) or greater. 
  • Total Motile Count: This is the number of moving sperm in the entire ejaculate. It is calculated by multiplying the volume (cc) by the concentration (million sperm / cc) by the motility (percent moving). There should be more than 40 million motile sperm in the ejaculate.
  • Standard Semen Fluid Tests: Color, viscosity (how thick the semen is) and the time until the specimen liquefies should also be measured. Abnormalities in the seminal fluid may adversely affect the sperm.
Oligospermia  ( low count)
Azoospermia ( no  sperms  seen in the sample)
Asthenospermia (decreased sperm motility)
Necrospermia (dead and immotile sperms)
Abnormality can be a combination of anyone.
 Additional investigations may be necessary to find the cause are semen culture, anti-sperm antibody estimation, scrotal ultrasound, hormonal assays, karyotyping , vasography .