Why does male infertility occur?
What are the symptoms of male infertility?
Diagnosis of infertility in men
What is male infertility?
Male infertility refers to the inability of spermatozoa to fertilize a viable egg, following regular and unprotected intimate relations with the partner, carried out over 12 months.
Why does male infertility occur?
Male infertility is due to the quantity and quality of spermatozoa, the main factors involved in the occurrence of the condition being represented by:
- Decrease in the number of spermatozoa per ejaculate – oligospermia
- Absence of spermatozoa from the seminal fluid – azoospermia
- Malformations of the sperm that prevent movement inside the female reproductive tract and fertilization of the ovum – asthenozoospermia
- Antisperm antibodies in semen
Spermatogenesis is influenced by excessive heat, genito-urinary infections, endocrine imbalances (anomalies of the hypothalamic-pituitary-gonadal axis, adrenal cortex disorders, hypothyroidism, hyperprolactinemia, hypogonadism), or genetics, administration of certain drugs, chronic alcohol and narcotic consumption, exposure to radiotherapy.
Prostate disorders and neurological dysfunctions can cause retrograde ejaculation in the bladder, while congenital obstruction or absence of the vas deferens significantly affects sperm emission and is an important cause of male infertility.
What are the symptoms of male infertility?
The main symptom of male infertility is represented by the impossibility of fertilizing an egg and can be accompanied by sexual dysfunctions, decreased libido, depression or behavioral changes.
Diagnosis of infertility in men
The diagnosis of male infertility is established with the help of anamnesis, the clinical examination of the patient and paraclinical laboratory investigations:
- spermogram, spermoculture, computer-assisted semen analysis CASA, Sperm Mar test for the determination of anti-sperm antibodies in sperm, Halosperm for determining the degree of DNA fragmentation of spermatozoa
- determinations of serum hormonal values for testosterone, free testosterone, prolactin, thyroid hormones
- DNA identification for Chlamydia trachomatis and Neisseria gonorrhoeae in urine
- identification of Mycoplasma hominis and Ureaplasma urealyticum in urine
- genetic testing
- Imaging investigations of the male reproductive system to establish the causes of infertility are represented by transrectal or scrotal ultrasound, nuclear magnetic resonance and vasography to highlight the structure of the deferent vessels
Testicular biopsy is used in case of impossibility of ejaculation and can provide important aspects on the quality and quantity of sperm.
Treatment of male infertility
The treatment of male infertility is etiological and addresses the cause that induced its appearance, for this purpose, the following are used:
- antibiotics for treating urogenital infections
- hormonal preparations for increasing the number and mobility of spermatozoa
- immunomodulatory treatments in the presence of antisperm antibodies
- surgical interventions to correct developmental anomalies of the deferent duct and treat varicose testicular dilatations
- intrauterine insemination (the artificial insemination procedure involves the introduction by the doctor of spermatozoa through the woman’s cervix to obtain a pregnancy) and in vitro fertilization (the fertilized egg is obtained in the laboratory by artificial insemination of the genetic material from the partner’s sperm sample)
References:
- Genetic causes of male infertility – https://www.sciencedirect.com/science/article/abs/pii/S0003426614000237
- Frequency of altered male factor in an infertility clinic – https://europepmc.org/article/med/12908338
- Masculinity, infertility, stigma and media reports – https://www.sciencedirect.com/science/article/abs/pii/S027795360400019X
