MALE INFERTILITY (Part 2)

Last week, we started a discussion on Male Infertility. We mentioned and explained some of the causes of Male Infertility. This week, we will continue on more causes and diagnosis of male infertility.

MORE CAUSES OF INFERTILITY

Varicocele: These are swollen enlarged veins inside the scrotum. Varicocele looks like bunch of worms intertwined in the scrotum. Research studies suggest that 40% of men with infertility problems are due to the presence of varicocele. These enlarged veins block blood drainage in the testicles making the testicles too hot for sperm growth

Undescended Testicles: In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition

Problems with Sexual Intercourse: These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.

Genetic Factor: The gene that determines the male sex is called the Y-chromosome while the female sex is called the X-chromosome. Under normal conditions, the gene of a man is XY chromosome while a woman’s gene has the XX chromosome. In some cases of male infertility, irregular changes (mutations) may occur in the gene of the man. One condition of such irregularities is called the Klinefelter’s syndrome (XXY) in which the male gene tends to have an extra copy of the female-sex determining genes, that is, the X chromosome leading to abnormal sperm.

Tumors: Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.

Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.

Infection: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.

Dietary deficiencies: Lack of vitamin C, folic acid or zinc can also affect sperm production.

DIAGNOSIS FOR MALE INFERTILITY

Male infertility may be difficult to diagnose with just our eyes because the sperm cells are very tiny (microscopic) in nature. After the first 12months of trying to conceive, couples are advised to visit their fertility specialist. The clinician would first start with a full general history of your family traits to check if the case of infertility is an inherited condition and then a physical examination of your male reproductive organ. One or more of the diagnostic procedures would be recommended to identify the cause of infertility. These include:
• Hormone testing: Your hormones play an important role in the sexual development of a man and his sperm production. Usually, the brain sends signals for the anterior pituitary gland to be stimulated to produce the follicle stimulating hormone (FSH) which induces sperm production and the luteinizing hormone (LH) which regulates testosterone that aids in male sexual development. Abnormalities in these hormones may also contribute to infertility. A blood test is used to measure the level of hormones in the body.
• Semen Analysis: This is the most widely used routine lab test that helps to show the level of sperm produced and ascertain if the sperm is alive or can move. Semen is collected and analysis is done to determine the following:
• Sperm volume: Amount of sperm per ejaculate.
• pH: A measurement of acidity or basicity.
• Sperm concentration: Number of sperm per millimeter of semen.
• Total sperm count: Number of sperm in your whole ejaculate.
• Linearity: How straight your sperm moves.
• Morphology: Size and shape of your sperm.
• Colour: abnormal colour may indicate underlying medical issues
• Viscosity: How fast your semen liquefies
• Velocity: How fast your sperm travels
A low sperm number or no sperm in the semen test does not mean the man is permanently infertile because treatment may be possible using various advanced cutting edge technologies now available in the country
Transrectal Ultrasound – this involves the use of ultrasound in the form of sound waves to get the picture of the organ. The probe of the ultrasound is placed in the rectum to see if the ejaculatory duct is blocked or the seminal vesicles are poorly formed.
………………TO BE CONTINUED