Causes
Factors relating to male infertility include .
Pre - testicular causes
Pre - testicular factors refer to conditions that impede adequate support of the testes and include situations of poor general health including .
- Hypogonadism due to various cause
- Drugs , alcohol , smoking
- Strenuous riding ( bicycle riding , horseback riding )
- Medications , including those that affect spermatogenesis such as chemotherapy , anabolic steroids , cimetidine , spironolactone ; those that decrease FSH levels such as phenytoin ; those that decrease sperm motility such as sulfasalazine and nitrofurantoin
- Genetic abnormalities such as a Robertsonian translocation
Testicular factors
Testicular factors refer to conditions where the testes produce semen of low quantity and /or poor quality despite adequate hormonal support and include :
- Age
- Genetic defects on the Y chromosome
- Abnormal set of chromosome
- Neoplasm , e.g .seminoma
- Idiopathic failure
- Cryptorchidism
- Varicocele
- Hydrocele
- Mumps
- Malaria
- Testicular dys genesis syndrome
- Defects in USP 26 in some cases
- Acrosomal defects affecting egg penetration
- Idiopathic oligospermia - unexplained sperm deficiencies account for 30 % of male infertility .
Post - testicular factors decrease male fertility due conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation :
- Vas deferens obstruction
- Lack of Vas deferens , often related to genetic markers for Cystic Fibrosis
- Infection , e.g. prostatitis
- Anti - sperm antibodies
- Retrograde ejaculation
- Ejaculatory duct obstruction
- Hypospadias
- Impotence
Some strate gies suggested or proposed for avoiding male infertility include the following
- Avoiding smoking as it damages sperm DNA
- Avoiding heavy marijuana and alcohol use .
- Avoiding excessive heat to the testes .
- Sperm counts can be depressed by daily coital activity and sperm motility may be depressed by coital activity that takes place too infrequently ( adstinence 10- 14 days or more
Treatment
Treatment vary according to the underlying disease and the degree of the impairment of the male fertility . Further, in an infertility situation , the fertility of the female needs to be considered
Pre- testicular conditions can be addressed by medical means or interventions .
Testicular - based male infertility tends to be resistant to medication . Usual approaches include using the sperm for intrauterine insemination ( IUI ), in vitro fertilization ( IVF) with intracytoplasmatic sperm injection ( ICSI ) . With IVF - ICSI even with a few sperm pregnancies can be achieved .
Obstructive causes of post - testicular infertility can be overcome with either surgery or IVF ICSI . Ejaculatory factors may be treatable by medication , or by IUI therapy or IVF /
The off - lable use of clomiphene citrate , an anti - estrogen drug designed as a fertility medicine for women , is controversial . Vitamin E helps counter oxidative stress , which is associated with sperm DNA damage and reduced sperm motility . A hormone - antioxidant combination may improve sperm count and motility .
