Category: Reproductive Health

Azoospermia

  August 9, 2020
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Azoospermia means there’s no sperm in a man’s ejaculate. Its causes include a blockage along the reproductive tract, hormonal problems, ejaculation problems or issues with testicular structure or function. Many causes are treatable and fertility can be restored. For other causes it may be possible to retrieve live sperm to be used in assisted reproductive techniques.

What is azoospermia?

Azoospermia is a condition in which there’s no measurable sperm in a man’s ejaculate (semen). Azoospermia leads to male infertility.

How common is azoospermia?

About 1% of all men and 10% to 15% of infertile men have azoospermia.

What are the parts of the male reproductive system?

The male reproductive system is made up of the following:

Testes, or testicles produce sperm (male reproductive cells) in a process called spermatogenesis.

Seminiferous tubules are tiny tubes that make up most of the tissue of the testes.

Epididymis is the structure on the back of each testicle into which mature sperm are moved and stored.

Vas deferens is the muscular tube that passes from the epididymis into the pelvis then curves around and enters the seminal vesicle.

Seminal vesicle is a tubular gland that produces and stores most of the fluid ingredients of semen. The vesicle narrows to form a straight duct, the seminal duct, which joins with the vas deferens.

Ejaculatory duct is created when the seminal vesicle duct merges with the vas deferens. The ejaculatory duct passes into the prostate gland and connects with the urethra.

Urethra is the tube that runs through the penis to eliminate urine from the bladder and semen from the vas deferens.

During ejaculation, sperm move from the testes and the epididymis into the vas deferens. Tightening (contraction) of the vas deferens moves the sperm along. Secretions from the seminal vesicle are added and the seminal fluid continues to move forward toward the urethra. Before reaching the urethra, the seminal fluid passes by the prostate gland, which adds a milky fluid to the sperm to form semen. Lastly, the semen is ejaculated (released) through the penis through the urethra.

 

A normal sperm count is considered to be 15 million/mL or more. Men with low sperm counts (oligozoospermia or oligospermia) have a sperm concentration of less than 15 million/mL. If you have azoospermia, you have no measurable sperm in your ejaculate.

Are there different types of azoospermia?

There are two main types of azoospermia:

Obstructive azoospermia:

This type of azoospermia means that there is a blockage or missing connection in the epididymis, vas deferens, or elsewhere along your reproductive tract. You are producing sperm but it’s getting blocked from exit so there’s no measurable amount of sperm in your semen.

Nonobstructive azoospermia:

This type of azoospermia means you have poor or no sperm production due to defects in the structure or function of the testicles or other causes.

What are the causes of azoospermia?

The causes of azoospermia relate directly to the types of azoospermia. In other words, causes can be due to an obstruction or nonobstructive sources.

Obstructions that result in azoospermia most commonly occur in the vas deferens, the epididymus or ejaculatory ducts. Problems that can cause blockages in these areas include:

  • Trauma or injury to these areas.
  • Infections.
  • Inflammation.
  • Previous surgeries in the pelvic area.
  • Development of a cyst.
  • Vasectomy (planned permanent contraceptive procedure in which the vas deferens are cut or clamped to prevent the flow of sperm).
  • Cystic fibrosis gene mutation, which causes either the vas deferens not to form or causes abnormal development such that semen gets blocked by a buildup of thick secretions in the vas deferens.

 

Nonobstructive causes of azoospermia include:

  • Genetic causes. Certain genetic mutations can result in infertility, including:
  • Kallmann syndrome: A genetic (inherited) disorder carried on the X chromosome and that if left untreated can result in infertility.
  • Klinefelter’s syndrome: A male carries an extra X chromosome (making his chromosomal makeup XXY instead of XY). The result is often infertility, along with lack of sexual or physical maturity, and learning difficulties.
  • Y chromosome deletion: Critical sections of genes on the Y chromosome (the male chromosome) that are responsible for sperm production are missing, resulting in infertility.
  • Hormone imbalances/endocrine disorders, including hypogonadotropic hypogonadism. hyperprolactinemia and androgen resistance.
  • Ejaculation problems such as retrograde ejaculation where the semen goes in to the bladder
  • Testicular causes include:
  • Anorchia (absence of the testicles).
  • Cyptorchidism (testicles have not dropped into the scrotum).
  • Sertoli cell-only syndrome (testicles fail to produce living sperm cells).
  • Spermatogenic arrest (testicles fail to produce fully mature sperm cells).
  • Mumps orchitis (inflamed testicles caused by mumps in late puberty).
  • Testicular torsion.
  • Tumors.
  • Reactions to certain medications that harm sperm production.
  • Radiation treatments.
  • Diseases such as diabetes, cirrhosis, or kidney failure.
  • Varicocele (veins coming from the testicle are dilated or widened impeding sperm production).

 

How is azoospermia diagnosed?

Azoospermia is diagnosed when, on two separate occasions, your sperm sample reveals no sperm when examined under a high-powered microscope following a spin in a centrifuge. A centrifuge is a laboratory instrument that spins a test sample at a high speed to separate it into its various parts. In the case of centrifuged seminal fluid, if sperm cells are present, they separate from the fluid around them and can be viewed under a microscope.

As part of the diagnosis, your healthcare provider will take your medical history, including asking you about the following:

  • Fertility success or failure in the past (your ability to have children).

  • Childhood illnesses.
  • Injuries or surgeries in the pelvic area (these could cause duct blockage or poor blood supply to the testicles).
  • Urinary or reproductive tract infections.
  • History of sexually transmitted diseases.
  • Exposure to radiation or chemotherapy.
  • Your current and past medications.
  • Any abuse of alcohol, marijuana or other drugs.
  • Recent fevers or exposure to heat, including frequent saunas or steam baths (heat kills sperm cells).
  • Family history of birth defects, mental retardation, reproductive failure or cystic fibrosis.

 

Your healthcare provider will also conduct a physical examination, and will check:

  • Your entire body in terms of signs of/lack of maturation of your body and reproductive organs.

  • Your penis and scrotum, checking for the presence of your vas deferens, tenderness or swelling of your epididymis, size of the testicles, the presence or absence of a varicocele, and any blockage of the ejaculatory duct (via exam through the rectum) as evidenced by enlarged seminal vesicles.

Your healthcare provider may also order the following tests:

  • Measurement of testosterone and follicle-stimulating hormone (FSH) levels.
  • Genetic testing.
  • X-rays or ultrasound of the reproductive organs to see if there are any problems with the shape and size, and to see if there are tumors, blockages or an inadequate blood supply.
  • Imaging of the brain to identify disorders of the hypothalamus or pituitary gland.
  • Biopsy (tissue sampling) of the testes. A normal biopsy would mean a blockage is probable at some point in the sperm transport system. Sometimes, any sperm found in the testes is frozen for future analysis or can be used in assisted pregnancy.

 

How is azoospermia treated?

Treatment of azoospermia depends on the cause. Genetic testing and counseling are often an important part of understanding and treating azoospermia. Treatment approaches include:

  • If a blockage is the cause of your azoospermia, surgery can unblock tubes or reconstruct and connect abnormal or never developed tubes.
  • If low hormone production is the main cause, you may be given hormone treatments. Hormones include follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, anastrazole and letrozole.
  •  
  • If a varicocele is the cause of poor sperm production, the problem veins can be tied off in a surgical procedure, keeping surrounding structures preserved.
  • Sperm can be retrieved directly from the testicle with an extensive biopsy in some men

If living sperm are present, they can be retrieved from the testes, epididymis or vas deferens for assisted pregnancy procedures such as in vitro fertilization or intracytoplasmic sperm injection (the injection of one sperm into one egg). If the cause of azoospermia is thought to be something that could be passed on to children, your healthcare provider may recommend genetic analysis of your sperm before assisted fertilization procedures are considered.

How can azoospermia be prevented?

There is no known way to prevent the genetic problems that cause azoospermia. If your azoospermia is not a genetic problem, doing the following can help lessen the chance of azoospermia:

  • Avoid activities that could injure the reproductive organs.
  • Avoid exposure to radiation.
  • Know the risks and benefits of medications that could harm sperm production.
  • Avoid lengthy exposure of your testes to hot temperatures.

 

What is the long-term outlook for those with azoospermia?

Every cause of azoospermia has a different prognosis. Many causes of azoospermia can be reversed. You and your healthcare team will work together to determine the cause of your azoospermia and treatment options. Hormonal problems and obstructive causes of azoospermia are usually treatable and fertility can potentially be restored. If testicular disorders are the cause, it’s still possible to retrieve live sperm to be used in assisted reproductive techniques.

 

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What is a prolactinoma and how can it affect a person’s sexual function?

  November 3, 2018
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What is a prolactinoma and how can it affect a person’s sexual function?

A prolactinoma is a benign (noncancerous) tumor of the pituitary gland, which is located at the base of the brain. The pituitary gland is sometimes called the “master gland” and is responsible for producing a number of important hormones involved with growth, metabolism, blood pressure, and reproduction.
One of these hormones is prolactin. In women, prolactin helps with the production of breast milk. Men’s bodies make prolactin, but the hormone doesn’t have a known purpose for them.
Prolactinomas make excessive amounts of prolactin. High levels of prolactin in the blood can reduce levels of the sex hormones estrogen and testosterone.
While the tumor itself is benign, the high levels of prolactin it produces can cause serious problems for both men and women.
A woman with a prolactinoma may start having changes in her menstrual periods. Her breasts might start to produce milk, even if she is not pregnant or nursing. She might become less interested in sex. Vaginal dryness may also occur, as estrogen is important for vaginal lubrication. Some women with prolactinomas have trouble becoming pregnant.
A man with a prolactinoma might develop erectile dysfunction.
Other symptoms include headaches and vision problems. These may occur if the tumor grows large enough to compress the optic nerves, which are close to the pituitary gland.
Prolactinomas can often be treated with medication. If this doesn’t work, surgery to remove the tumor is another option. In rare cases, radiation might be used. Sexual problems usually get better once the tumor is treated and prolactin levels return to normal.
Prolactinomas are the most common type of pituitary gland tumor, but it’s not common for them to cause symptoms.  Women are more likely to get prolactinomas than men are. Scientists aren’t sure exactly why prolactinomas develop.
Men and women who are concerned about prolactinomas should see their healthcare professional. Diagnosing a prolactinoma usually involves a blood test to measure prolactin levels. Imaging tests, such as magnetic resonance imaging (MRI) or a computerized tomography (CT) scan are usually ordered so that the doctor can get a closer look at the pituitary gland and the surrounding area. Sometimes, a vision test is also done.

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What are prostatic calculi (prostate stones)? Do they affect sexual function?

  August 1, 2018
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What are prostatic calculi (prostate stones)? Do they affect sexual function?

Prostatic calculi (also called prostate stones) are small brownish-gray stones that form in the prostate. Each stone, or calculus, is roughly the size of a poppy seed. A man may have one calculus, or he could have hundreds of calculi.
Most of the time, prostatic calculi themselves don’t cause any symptoms, and they often aren’t found during routine medical exams.
However, prostatic calculi can become infected and, in turn, lead to urinary tract infections and prostatitis (inflammation of the prostate gland).
Some men with prostate stones experience pain in the lower back, penis, or perineum (the area between the anus and the scrotum). They might also have trouble urinating.
Prostate stones are more common in men who are middle-aged or older, and especially in men with an enlarged prostate, prostate cancer, chronic prostatitis/chronic pelvic pain syndrome.
Prostatic calculi that don’t cause symptoms usually don’t require treatment. Sometimes, they pass on their own in a man’s urine.
If stones are causing symptoms or contributing to other prostate conditions, they might be treated with antibiotics. In more severe cases, they can be removed surgically.
The direct effects of prostatic calculi on a man’s sexual function have not been widely researched. Some studies have suggested that ejaculatory pain and erectile dysfunction (ED) might be associated with prostatic calculi, but more information is needed.
Men who have questions about prostatic calculi are encouraged to see their andrologist.

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What is chronic prostatitischronic pelvic pain syndrome (CPCPPS)?

  June 25, 2018
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What is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)?

Prostatitis is inflammation of the prostate gland, the walnut-sized gland located below a man’s bladder. The prostate gland secretes fluid that, along with sperm, forms semen.

There are different types of prostatitis, one of which is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This is the most common type. Young and middle-aged men are more likely to develop CP/CPPS, but it can happen at any age.

CP/CPPS may be classified as inflammatory or non-inflammatory.

In inflammatory cases, urine, semen, and fluid secreted by the prostate contain infection-fighting cells. But these fluids don’t contain bacteria.

When CP/CPPS is non-inflammatory, no infection-fighting cells and no bacteria are found in the fluid.

Men with CP/CPPS can experience chronic discomfort or pain in the groin, genitals, perineum (the area between the anus and the genitals), or bladder. They may have pain with urination and ejaculation as well. Many feel anxious about the situation.

But symptoms don’t happen to every man with CP/CPPS. Also, symptoms may come and go on their own.

CP/CPPS can be hard to diagnose because its symptoms are similar to other medical conditions, like kidney and bladder problems. Also, some researchers believe that CP/CPPS is not related to the prostate gland but may be caused by pelvic floor muscle strain instead.

Men usually undergo a digital rectal exam, during which their doctor inserts a lubricated, gloved finger into the rectum. By doing this, the doctor can feel any abnormalities in the prostate gland.

Doctors may also analyze urine and prostatic fluid. In some cases, blood tests, ultrasounds, MRIs, or biopsies are ordered to rule out other conditions.

CP/CPPS can also be difficult to treat and, unfortunately, it cannot always be cured. It can also take some time to find what best relieves a man’s symptoms. Some strategies for treating CP/CPPS symptoms include the following:

Medications.

Anti-inflammatory, pain medications, and muscle relaxants may be recommended. Alpha-blockers, which help relax muscles around the prostate, may also help. Some doctors prescribe antibiotics for CP/CPPS, but this treatment option is controversial.

Heat.

Some men find relief by taking a hot bath or by applying a heating pad or hot water bottle to the affected area.

Changes in diet.

Spicy foods and caffeinated or acidic drinks can aggravate symptoms for some men.

Lifestyle changes.

Activities that make symptoms worse, like bicycle riding, may need to be avoided.

Pillows.

Experimenting with different pillows or cushions may help a man who is uncomfortable while seated.

 Prostatic massages.

These massages can help release some pressure around the prostate.

Counseling.

Psychological issues among men with CP/CPPS are common. Men with the condition have considerably higher levels of anxiety than those without it. Some experts believe that psychological problems are part of the cause of CP/CPPS. Such problems could also develop as a result. In either case, talking to a counselor may help men cope with this aspect of CP/CPPS.

Men with severe CP/CPPS may require surgery.

Sometimes, CP/CPPS gets better on its own.

Most men with CP/CPPS can have sex as they did before. However, it may be uncomfortable at times, especially during a pain flare-up. Couples may need to take a break from sex until the discomfort passes.

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Microsurgical Testicular Sperm Extraction (Micro-TESE)

  April 4, 2018
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Microsurgical Testicular Sperm Extraction (Micro-TESE)

Advances in reproductive medicine over the last 10 years have allowed men who were previously considered absolutely sterile to father biological children.

Those advances have come on two fronts. The first was the advent of In-Vitro Fertilization (IVF) with Intra-Cytoplasmic Sperm Injection (ICSI).

This technological breakthrough reduced the requirement of the number of sperm needed to fertilize an egg from millions to just one sperm per egg. It meant that men with very low sperm counts who could not be improved with other means had a new way of effectively conceiving. It also led us to reexamine our understanding how the testicles function.

It turns out that men who have no sperm in the ejaculate because of problems with sperm production, a condition called Non-Obstructive Azoospermia (NOA), actually may have small pockets of sperm production within the testicle. In fact, greater than 60% of men with NOA actually do produce small amounts of sperm inside the testicle that can be used with IVF/ICSI to create a baby.

Sounds like great news all around, right? Well, the challenge for experts has been to develop techniques that improve the chances of finding sperm inside the testicle and then to create effective strategies to best harvest that sperm IN THE SAME PROCEDURE, for use with IVF.

 

Extracting that single sperm takes skill and technology

A new surgical technique, called Microsurgical Testicular Sperm Extraction or “Micro-TESE” has been developed to detect sperm in the testicles of men who have poor sperm production.

Because the testicular tubules are microscopic structures, they cannot be distinguished by the naked eye. However, by using an operating microscope to examine the tubules at the time of testicular biopsy, So that the Andrologist can selectively remove the “better” or more normal appearing tubules. He is very aware that there is a higher chance that he will find sperm in “fuller,” more normal tubules than in scarred or fibrotic tubules.

Once the specimens are removed, the tubules are opened in a Petri dish containing sperm wash media and the search for sperm begins by examining the specimens under the microscope. It can take up to five hours to search for sperm in the specimens. This is a very involved and tedious process, but very thorough and important. Once they are found, the sperm are then either incubated and injected into awaiting eggs or frozen for future injection.

This advanced technique allows us to direct the biopsy to the best areas and increase the chance of finding sperm while removing smaller amounts of tissue then a random biopsy, causing less damage.

Micro-TESE can be performed as a diagnostic procedure and if usable sperm are found, then they can be frozen and the couple is recommended to proceed with ICSI. It can also be performed and timed with an egg retrieval/IVF cycle so that the sperm are injected into the eggs without freezing. Freezing the sperm from men with sperm production problems can be difficult since these sperm are usually few in number and don’t thaw well. Therefore the best chance of pregnancy is to use fresh sperm obtained just prior to IVF.

The chance of finding sperm with Micro-TESE is better than 60%. This is twice the chances of finding sperm by non-microsurgical or needle biopsies taken by general urologists.

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What is pre-ejaculate or precum?

  March 26, 2018
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What is pre-ejaculate or precum؟

Pre-ejaculate, sometimes called precum, is a clear fluid that is released when a man becomes sexually aroused, but before he ejaculates. Sometimes, it can be seen at the tip of the penis, but many men don’t even notice it.

The fluid is produced by a pair of pea-sized glands called the Cowper’s glands, located near the urethra, a tube in the penis with a dual purpose: allowing urine and semen to exit the body.

Pre-ejaculate fluid neutralizes any acidity left by urine in the urethra, protecting sperm that flows through.

Men produce differing amounts of precum, from a few drops to about a teaspoon. Generally, the amount is nothing to worry about.

In rare cases, men produce much more fluid, and there have been reports of men whose clothes are soiled when they become aroused. Medications might help, and men in this situation are advised to see their doctor.

Many people wonder whether a woman can get pregnant from pre-ejaculate fluid. The answer is yes – although this is not common.

Typically, precum does not contain any sperm. However, if a man has ejaculated recently, sperm cells might still be found in the urethra and mix with the pre-ejaculate fluid. When this happens, it is still possible for a woman to become pregnant. For example, if a man removes his penis from his partner’s vagina before ejaculating (“pulling out”), sperm in the precum can still travel up the vagina and fertilize an egg.

For this reason, couples who do not wish to become pregnant should use condoms during all sexual activities.

It’s also important to know that sexually-transmitted infections, like HIV and chlamydia, can be transmitted through precum. For instance, if a person gives oral sex to a man, he or she could become infected through contact with pre-ejaculatory fluid. This is another important reason to practice safe sex.

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Does long term anabolic androgenic steroid use lead to heart problems?

  February 23, 2018
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Does long term anabolic androgenic steroid use lead to heart problems?

THE USE (abuse) of anabolicandrogenic steroids (AAS), such as synthetic testosterone and other androgens, has increased markedly in recent years.

The majority of AAS users do so to ‘improve’ physical appearance and body building rather than competitive sport.

Many users become dependent on these drugs. The side-effects of AAS abuse include acne, weight gain, mood changes (especially aggressive behaviour), decreased testes size and low sperm counts leading to infertility.

There is some evidence that longer term effects include prostate cancer and heart disease but good quality studies are lacking.

A recent American study1 from the journal Circulation assessed three different measures of cardiovascular disease (CVD) in weight-lifters aged 34 to 54 who had used AAS for at least two years compared to those who had not used AAS.

This cross-sectional study showed that users of AAS had significantly worse outcomes on the three CVD measures, although one measure was normal in those who had previously used AAS but were not using at the time of the study, suggesting some recovery after stopping the AAS.

However, the other two measures indicated long-term damage to heart function and atherosclerosis (build-up of plaques leading to clogging of the artery connected to the heart). Although this study had some limitations it adds to the evidence that there are serious health implications for men who do not have testosterone deficiency but are using steroids for other purposes.

The risks may be difficult to quantify as the drugs available from suppliers at the local gym or on the internet are not regulated.

They may contain unknown substances, have varying concentrations or may contain hormones mixed with other drugs or dietary supplements (mixing drugs can be dangerous as they may interact with each other).

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Are there natural ways to boost testosterone?

  February 12, 2018
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Are there natural ways to boost testosterone?

Yes. In some cases, men can raise their testosterone levels by changing some lifestyle habits.

Low testosterone can have a variety of causes. Sometimes, there are problems in parts of the body involved with testosterone production, such as the hypothalamus, the pituitary gland, or the testes. Men’s testosterone levels naturally decline as they get older, too.

Symptoms of low testosterone include diminished sex drive, loss of muscle mass, weakness, and moodiness. While testosterone replacement therapy may help, some men find that their symptoms improve by following healthy habits.

Improve sleep hygiene

A man’s body makes testosterone while he’s sleeping. As a result, the less he sleeps, the less testosterone his body will produce. In a 2011 study of younger men, researchers found that after one week of reduced sleep, testosterone levels decreased by 10% to 15%.

For better sleep, men might consider the following tips:

  • Make sleep a priority, with a goal of seven to nine hours of quality sleep each night.

  • Relax and “unplug” at bedtime. Avoid using electronics like televisions, smartphones, and tablets.

  • Cut down on caffeine and alcohol consumption.

  • Exercise regularly.

  • Go to bed and get up at the same time every day.

  • Manage stress, and ask for help if necessary.

  • See a doctor if sleep problems persist

Maintain a healthy weight

Obesity is also related to low testosterone. Normally, some of a man’s testosterone converts to another hormone called estrogen. This process typically happens in fat cells. So being overweight or obese can increase the amount of testosterone converted to estrogen and, in turn, decrease overall testosterone levels.

To keep weight under control, men are advised to:

  • Eat healthy foods like fruits, vegetables, and whole grains. Avoid sugars and processed foods.

  • Watch portion sizes.

  • Exercise regularly and stay active.

  • Discuss any concerns with a doctor, nutritionist, or fitness specialist.

Ask a doctor about your current medications

Testosterone production can be impaired by some medications (such as opiates for pain) and hormones. Changing drugs or doses may help, but this step should always be taken with a doctor’s guidance.

Avoid anabolic steroids and supplements

Anabolic steroids or other performance enhancing drugs can interfere with testosterone production and should be avoided.

Supplements that claim to boost testosterone levels should be avoided as well. While these products are easy to buy online or at a pharmacy, they are not always effective. They may also contain ingredients that can cause harmful interactions with drugs a man is already taking. Sometimes, these ingredients are not listed on the product packaging.

Men should always consult their doctor before taking any type of supplement.

For men with low testosterone symptoms, seeing a doctor is always a good idea. A thorough physical exam may reveal other possible reasons for low testosterone, such as inflammation or infection. A doctor can make recommendations and tailor treatment to the individual.

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Male Infertility

  December 20, 2017
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Male Infertility

Definition

Up to 15 percent of couples are infertile. This means they aren't able to conceive a child even though they've had frequent, unprotected sexual intercourse for a year or longer. In up to half of these couples, male infertility plays a role.

Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility.

Not being able to conceive a child can be stressful and frustrating, but a number of male infertility treatments are available.

Symptoms

The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes signs and symptoms.

Although most men with male infertility do not notice symptoms other than inability to conceive a child, signs and symptoms associated with male infertility include:

  • Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
  • Pain, swelling or a lump in the testicle area
  • Recurrent respiratory infections
  • Inability to smell
  • Abnormal breast growth (gynecomastia)
  • Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
  • Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)

 

When to see a doctor

See a doctor if you have been unable to conceive a child after a year of regular, unprotected intercourse or sooner if you have any of the following:

  • Have erection or ejaculation problems, low sex drive, or other problems with sexual function
  • Have pain, discomfort, a lump or swelling in the testicle area
  • Have a history of testicle, prostate or sexual problems
  • Have had groin, testicle, penis or scrotum surgery

Causes

Male fertility is a complex process. To get your partner pregnant, the following must occur:

  • You must produce healthy sperm.Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
  • Sperm have to be carried into the semen.Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
  • There needs to be enough sperm in the semen.If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner's egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.
  • Sperm must be functional and able to move.If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner's egg.

Medical causes

Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:

  • A varicocele is a swelling of the veins that drain the testicle. It's the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it may be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm.

Treating the varicocele can improve sperm numbers and function, and may potentially improve outcomes when using assisted reproductive techniques such as in vitro fertilization.

  • 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.
  • Ejaculation issues.Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.

Some men with spinal cord injuries or certain diseases can't ejaculate semen, even though they still produce sperm. Often in these cases sperm can still be retrieved for use in assisted reproductive techniques.

  • Antibodies that attack sperm.Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
  • 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.
  • 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.
  • Hormone imbalances.Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
  • Defects of tubules that transport sperm.Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.

Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.

  • Chromosome defects.Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann's syndrome and Kartagener's syndrome.
  • 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.
  • Celiac disease.A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
  • Certain medications.Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
  • Prior surgeries.Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles.

 

Environmental causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

  • Industrial chemicals.Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
  • Heavy metal exposure.Exposure to lead or other heavy metals also may cause infertility.
  • Radiation or X-rays.Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
  • Overheating the testicles.Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.

Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and may slightly reduce sperm production.

Health, lifestyle and other causes

Some other causes of male infertility include:

  • Illicit drug use.Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
  • Alcohol use.Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
  • Tobacco smoking.Men who smoke may have a lower sperm count than do those who don't smoke. Secondhand smoke also may affect male fertility.
  • Emotional stress.Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
  • Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.

Certain occupations including welding or those involving prolonged sitting, such as truck driving, may be associated with a risk of infertility. However, the research to support these links is mixed.

 

 

Risk factors

Risk factors linked to male infertility include:

  • Smoking tobacco
  • Using alcohol
  • Using certain illicit drugs
  • Being overweight
  • Having certain past or present infections
  • Being exposed to toxins
  • Overheating the testicles
  • Having experienced trauma to the testicles
  • Having a prior vasectomy or major abdominal or pelvic surgery
  • Having a history of undescended testicles
  • Being born with a fertility disorder or having a blood relative with a fertility disorder
  • Having certain medical conditions, including tumors and chronic illnesses, such as sickle cell disease
  • Taking certain medications or undergoing medical treatments, such as surgery or radiation used for treating cancer

Tests and diagnosis

Many infertile couples have more than one cause of infertility, so it's likely you will both need to see a doctor. It might take a number of tests to determine the cause of infertility. In some cases, a cause is never identified.

Infertility tests can be expensive and might not be covered by insurance — find out what your medical plan covers ahead of time.

Diagnosing male infertility problems usually involves:

  • General physical examination and medical history.This includes examining your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and about your sexual development during puberty.
  • Semen analysis.You can provide a semen sample by masturbating and ejaculating into a special container at the doctor's office or by using a special condom to collect semen during intercourse.

Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections.

Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.

Your doctor might recommend additional tests to help identify the cause of your infertility. These can include:

  • Scrotal ultrasound.This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor see if there is a varicocele or other problems in the testicles and supporting structures.
  • Hormone testing.Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems might also contribute to infertility. A blood test measures the level of testosterone and other hormones.
  • Post-ejaculation urinalysis.Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
  • Genetic tests.When sperm concentration is extremely low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might be ordered to diagnose various congenital or inherited syndromes.
  • Testicular biopsy.This test involves removing samples from the testicle with a needle. If the results of the testicular biopsy show that sperm production is normal your problem is likely caused by a blockage or another problem with sperm transport.

However, this test is not commonly used to diagnose the cause of infertility.

  • Specialized sperm function tests.A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg, and whether there's any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change recommendations for treatment.
  • Transrectal ultrasound.A small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate, and look for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).

Treatments and drugs

Often, an exact cause of infertility can't be identified. Even if an exact cause isn't clear, your doctor might be able to recommend treatments or procedures that will result in conception.

In cases of infertility, the female partner is also recommended to be checked. This can help to determine if she will require any specific treatments or if proceeding with assisted reproductive techniques is appropriate.

Treatments for male infertility include:

  • For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
  • Treating infections.Antibiotic treatment might cure an infection of the reproductive tract, but doesn't always restore fertility.
  • Treatments for sexual intercourse problems.Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
  • Hormone treatments and medications.Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
  • Assisted reproductive technology (ART).ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.

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Cancer and Male Fertility

  November 27, 2017
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Male cancer, cryopreservation, and fertility

What is the difference between semen and sperm?

This can be confusing since the terms are often used interchangeably in the media and casua conversation.

However, they are very different. Sperm are the male reproductive cells that contain genetic material.  A sperm is made up of three main parts: the head, the midpiece, and the tail. Semen is the liquid that is ejaculated and may or may not contain sperm. This liquid is produced by glands in the reproductive system and also contains enzymes and fructose in addition to sperm.

How can cancer treatment affect my ability to have a child?

Chemotherapy or radiation can affect your ability to make sperm or impact the ability of the sperm to fertilize an egg.
The type, location, and duration of the treatment can affect whether those changes are temporary or permanent.  For some types of cancer, the reproductive organs are removed or damaged during surgery that is performed to remove the cancer.

Are there options for preserving fertility in men who have been newly diagnosed with cancer?

Yes! Sperm can be collected and frozen for later use before cancer treatment is started. This way, you may be able to have children after your treatment. This process is called
cryopreservation or freezing. The kind of cancer you have and the treatments you will receive can determine what your options are.

What is involved in sperm collection?

For many men, collecting sperm to freeze is a simple, noninvasive procedure. You will be shown to a private room, asked to masturbate to orgasm, and collect your semen in a special container.
A usual semen sample will contain around 5-20 million sperm per milliliter and is able to be divided into several vials for storage. Often, since sperm production is affected by many factors, you may be asked to collect more than one sample. This helps to improve your chances of being able to have a child later.

What if I can’t give a sample?

Some men are unwilling or unable to collect a sample through masturbation. For these men, a special condom may be used to collect semen during intercourse.
Other men have a blockage in their reproductive tract; as  a result, no sperm are found in their semen. Sperm can be obtained through various procedures that remove them
directly from the testicle or reproductive tubes located beside the testicles.
Some men may have a condition that causes sperm and some or all of the semen to collect in the bladder instead of being released through the tip of the penis. For those men,
sperm can often be collected from the urine after intercourse.
If a man is unable to ejaculate (release semen durin orgasm), there are options. Sperm can be surgically removed from the testicles and injected directly into an egg in a process called intracytoplasmic sperm injection (ICSI).

If a man is not able to ejaculate due to spinal cord injury, vibratory stimulation or electroejaculation can be used. 

How is sperm cryopreserved?

Once collected, the semen sample is mixed with cryoprotectants. These are liquids that help protect the sperm against damage during freezing and thawing. The sample is then frozen by a slow-cooling method or a flash freezing method called vitrification.

How long can sperm be stored?

Sperm can be stored indefinitely. Sperm that have been frozen for over 20 years have been used to create pregnancies. Testicular tissue cryopreservation Because very few sperm are necessary to fertilize an egg in a dish, it is possible to obtain sperm directly from the testicle. In cases where very few sperm are produced, this may be the best option. Additionally, some patients have
not yet reached a point of puberty where they have sperm in their ejaculate. It is important to note that it will be necessary to have intracytoplasmic sperm injection (ICSI) when using testicular sperm.

When a boy has not begun to make mature sperm, options are limited. In some research centers across the world, samples of testicular tissue are removed and frozen. When
it’s time to attempt pregnancy, the tissue is examined for stem cells. Stem cells are cells that have the potential to develop into many different kinds of cells. The hope is to
isolate these few cells and mature them into functional sperm. So far, animal research is promising and human studies are ongoing. It is important to remember that this is
an experimental procedure and whether it will be successful is not known.

Conclusion

The most important thing to remember about fertility  preservation is that it should be done prior to any cancer treatment if possible. This will give you the best chance of having usable sperm.

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