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Most common causes of infertility in men
January 12, 2021
Infertility in men is a medical condition characterized by the inability to achieve conception by natural methods for some male alteration. It can occur in a large number of pathologies, so it could be considered a symptom rather than a disease.
We have prepared the following article in which you will find the main causes of male infertility, as well as other interesting aspects. Keep reading!
Main signs and symptoms of infertility in men
Male infertility is the result of a pre-existing medical condition. Therefore, the associated symptoms depend on the cause. In some cases, no other manifestations may be present, except for infertility itself.
When there are hormonal problems that lead to an inadequate functioning of the testicles, there may be difficulty in the development of sexual characteristics. This results in delayed pubic hair, high-pitched voice, and scant muscle mass.
Some infectious conditions in the testicles cause local pain, swelling, and redness. Other causes are more evident, such as cryptorchidism, which occurs congenitally and is characterized by the lack of descent of the testicles to the scrotum.
What are the common causes of infertility in men?
Fertility depends directly on the ability of sperm to fertilize eggs. In the specific case of men, there are several hormonal, anatomical and functional factors that can influence the reproduction process.
The correct functioning of the testicles is influenced by several factors, one of them being hormonal. As for the sperm, they are released from these organs and directed outward through the spermatic pathways, made up of the epididymis, the vas deferens, the ejaculatory ducts and the urethra.
These types of conditions are characterized by the alteration of the endocrine system, in particular of the hypothalamic-pituitary-testes axis. The hormones secreted by the pituitary (pituitary) involved in this process are luteinizing (LH) and follicle-stimulating (FSH).
Direct damage to the hypothalamus and pituitary gland can decrease the degree of secretion of these substances, which causes a picture known as hypogonadotrophic hypogonadism. The presence of tumors (inside or outside these organs), exposure to radiation and, in rare cases, some neurosurgery, could lead to this type of infertility in men.
This kind of hypogonadism can also be caused by genetic diseases. Kallman's syndrome is an example of this and is also characterized by the absence of sense of smell (anosmia).
The increased secretion of the hormone prolactin leads to the inhibition of this hormonal pathway and other symptoms, such as erectile dysfunction. Known as hyperprolactinemia and can be triggered in cases of pituitary tumors.
When patients with diabetes do not receive treatment and maintain very high blood glucose levels, microscopic lesions can develop in the testicles. This leads to a decrease in the quality of sperm.
This category includes a group of diseases characterized by a malfunction of the testicles. Klinefelter syndrome stands out among congenital testicular disorders. It is a condition characterized by the presence of two X chromosomes and one Y chromosome. From a clinical point of view, patients often suffer from tall stature, cognitive or behavioral disorders, tendency to develop genetic malformations (especially cardiovascular) and, of course, infertility.
Among the most frequent acquired conditions, the following stand out:
Cryptorchidism: It is the lack of descent of the testicles towards the scrotum. It occurs from birth and requires surgical treatment.
Varicocele: It is the pathological dilation of the veins that drain blood from the testicles. It is usually related to severe pain and the treatment is surgical as well.
Orchitis: this term means 'inflammation of the testicles'. It can occur based on a sexually transmitted infection (STI) or as a result of trauma.
Find out more: Varicocele complications: what you need to know
When obstruction occurs in any part of the sperm passages, the sperm cannot get out. These conditions are independent of the quality of the sex cells and their production, so the problem is mechanical.
Retrograde ejaculation is a representative example of this group. In this condition, when the semen is released, it goes towards the bladder and not towards the outside. This phenomenon occurs as a result of poor activity of the bladder neck muscle.
Infection of any part of the sperm ducts could lead to blocked ducts, which represents a complication that generates infertility. Prostatitis and epididymitis are important examples, in which the prostate and epididymis are affected.
Other patients may suffer from an abnormal development of these anatomical structures, so they are not patent at any time. This is the case of those who suffer from cystic fibrosis. This disease is characterized by an exaggerated production of mucus.
This final group refers to set of microscopic disorders that affect the number, activity and viability of sperm. They are usually the result of many of the aforementioned disorders, such as cryptorchidism and orchitis.
Depending on the defect, there are various classifications. The most important are the following:
Alterations in the number of sperm: it can vary from oligozoospermia to azoospermia, the latter term being used to define the total absence of these cells.
Mobility problems: is known from a medical point of view as asthenozoospermia and there may be total or partial commitment.
Existence of abnormal forms: is called teratozoospermia.
Problems with semen volume: sperm are suspended in this fluid, which in turn is produced in the seminal vesicles. When it is scarce, these cells cannot be transported correctly and achieve fertilization of the ovum.
Presence of dead sperm: is known as necrospermia.
Of course, there may be situations in which several of these anatomical and functional disorders are combined.
Risk factors for male infertility
Risk factors are all those conditions that increase the likelihood of a person suffering from a certain condition. In the specific case of male infertility, the following have been identified:
Use of recreational drugs.
The diseases mentioned in the previous sections are also risk factors, especially cryptorchidism, varicocele, Klinefelter syndrome, and orchitis.
Keep reading: The influence of diet on sperm
When to see a doctor?
As usual, it is recommended to see a reproductive medicine specialist when attempts to have children are unsuccessful. Unless the cause of infertility is evident, a comprehensive evaluation of the couple is usually required to determine which of the two has the pathological condition.
Because some medical-surgical conditions such as varicocele, cryptorchidism and orchitis can cause infertility in men as a permanent complication, it is recommended to go to a specialist doctor as soon as possible to solve the problem.
Although there are specific professionals who are dedicated to the area of fertility, in principle it is advisable to go to a urologist or endocrinologist, as the case may be. For many patients it is convenient to go to a family planning consultation.
Treatments available for infertility in men
Surgical resolution of anatomical problems is the solution for some causes of infertility. The same principle applies to disorders of the endocrine system, in which certain hormonal treatments could improve reproductive capacity.
If the spermogram determines that it is a mild case, there are natural approaches based on lifestyle changes designed to reverse some risk factors. It also implies dietary changes that make up a balanced diet, rich in antioxidants and essential micronutrients.
For the rest of the cases, assisted reproductive techniques are usually required. Some of the most frequent are the following:
Artificial insemination: it is based on the placement of sperm in the uterus.
Fertilization in vitro: involves the extraction of eggs and sperm so that they interact by themselves in a liquid medium and fertilization occurs spontaneously. When this happens, a structure known as zygote, which is implanted in the uterus.
Intracytoplasmic sperm injection: It is similar to the previous technique, but manipulates the sperm with the help of a pipette and introduces them into the ovules manually.
Prevention and recommendations to take into account
In case of suffering any symptoms or conditions mentioned throughout this article, it is advisable to go to the doctor as soon as possible. Prompt treatment greatly reduces the likelihood of future infertility. Further, avoiding modifiable risk factors (smoking, obesity, and sedentary lifestyle) is important to prevent reproductive problems.
Infertility is a multicausal phenomenon that requires medical support to be solved. In the specific case of assisted reproduction techniques, although they do not permanently solve the problem, they provide couples with the opportunity to have offspring.
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