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Male infertility refers to a male’s inability to cause pregnancy in a fertile female. In humans it accounts for 40–50% of infertility.It affects approximately 7% of all men.Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male measure of male fecundity. fecundity.


Factors relating to male infertility include :

infertility – Antisperm antibodies (ASA) have been considered as infertility cause in around 10–30% of infertile couples

Risk factors for the formation of antisperm antibodies in men include the breakdown of the blood‑testis barrier, trauma and surgery, orchitis, varicocele, infections, prostatitis, testicular cancer, failure of immunosuppression and unprotected receptive anal or oral sex with men

Chromosomal anomalies and genetic mutations account for nearly 10-15% of all male infertility cases

Pre-testicular causes
Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including:

Varicocele, is a condition of swollen testicle veins.It is present in 15% of normal men and in about 40% of infertile men.It is present in up to 35% of cases of primary infertility and 69-81% of secondary infertility

Tobacco smoking
There is increasing evidence that the harmful products of tobacco smoking may damage the testicles and kill sperm,but their effect on male fertility is not clear

DNA damage
Common inherited variants in genes that encode enzymes employed in DNA mismatch repair are associated with increased risk of sperm DNA damage and male infertility. As men age there is a consistent decline in semen quality, and this decline appears to be due to DNA damage.

Post-testicular causes
Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation

  • Infection, e.g. prostatitis
  • Retrograde ejaculation
  • Ejaculatory duct obstruction
  • Impotence

Male Infertility – Diagnosis

Tests for male infertility attempt to determine whether any of these processes are impaired.

Physical examination:
This includes examination of your genitals and questions concerning your medical history, illnesses and disabilities, medications and sexual habits

Semen analysis:
This is a very important test for the male partner. Your doctor may ask for one or more semen specimens. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A laboratory analyzes your semen specimen for quantity, colour and presence of infections or blood.

Hormone Testing :
A blood test is conducted to determine the level of testosterone .

Doppler evaluation of the testis and Trans rectal Ultrasound:
Doppler/Ultrasound can help your doctor look for evidence of conditions such as retrograde ejaculation and ejaculatory duct obstruction.

Male Infertility – Treatments

Treatment of male infertility depends on the cause, period of infertility, age, your partner’s age and many personal preferences.

Simple Lifestyle changes:
Abstaining from alcohol, tobacco and illicit drugs can improve male fertility. A healthy diet, sufficient (not excessive) exercise, proper amounts of vitamin B12, vitamin C and zinc also improve fertility.

General Sexual Problem:
Addressing impotence or premature ejaculation can improve fertility. Treatment for these problems often is primarily with medication or behavioural approaches, though mechanical and surgical treatments are sometimes effective. Artificial insemination with an ejaculate could be deployed to overcome infertility.

Low Sperm Count:
Hormonal treatment is needed usually in 5% of the men. Other treatments include surgical treatment of varicocele, ejaculatory duct incisions and sperm concentration methods through electro ejaculation.

In Absent Sperm:
Microsurgical bypass operations, micro-epididymal sperm aspiration (MESA) and bilateral testicular biopsies are the treatment procedures that are commonly deployed.

Surgical Management:
Surgical sperm retrieval is indicated when there is no sperm in the ejaculate (azoospermia). This can result from an obstruction in the reproductive tract (obstructive azoospermia) or due to lack of sperm production (non-obstructive azoospermia). Obstructive azoospermia may be due to a blockage of the tubes transporting the sperm (due to infection or due to surgical blockage of the vas following the male sterilization). Surgical sperm retrieval techniques enable the urologist to recover sperm directly from the epididymis or even the testes of men with obstructive azoospermia so that the sperm can then be used to fertilize eggs by ICSI. The extra sperm and testicular tissue can be frozen for future attempts.

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