Χάρης Χ. Χηνιάδης

Historically, infertility has largely been attributed to the female but infact male related factors account for about 40% -female related factors relate to another 40% while a combination of male & female factors account for 10%, and the remaining 10% is due to unexplained causes.

Considerable advances of recent years have led to great advances in treating male infertily.

Male infertility can be caused by a number of factors, including problems, with sperm production, blockage of the sperm delivery system, antibodies against sperm, injury to the testicle, problems relating to hormone production, and anatomical problems.

Passed illness, infections and medications can also cause infertility.

Some of the commonest causes

Lifestyle factors

Any factors which raise the temperature of the scrotum (such as the use of long baths, a job involving long hours sitting down) can harm sperm production.
Certain medicines and recreational drugs can decrease male fertility. These include alcohol, marijuana, cocaine, cigarettes, anabolic steroids, some drugs used for ulcers, anti-hypertensive drugs (specifically calcium channel blockers), aspirin, some drugs for epilepsy, and antidepressants.
These drugs should never be simply discontinued, but substitutions can be made after consulting with your primary care physician.

Hormonal imbalances

Hormone problems affecting sperm count include thyroid problems, low testosterone levels, elevated FSH, and excess prolactin.

Immune problems

Immune reactions to sperm in the man (autoimmune) can be a problem post-vasectomy, but may also have other causes. Anti-sperm antibodies can "attack" the sperm, thus preventing it from being able to fertilize the egg.

Infection

Mumps contracted after childhood, and, occasionally, venereal diseases such as gonorrhea and chlamydia can harm male fertility. Also, recurrent infections of the prostate can lower sperm count and motility.

Exposure to certain chemicals, such as lead and arsenic, and many types of paints or varnishes, can also adversely affect male fertility.

Impotence/ Sexual Dysfunction

There are a variety of medical causes that can contribute, including diabetes mellitus, medications such as antidepressants, etc. Up to 20% of men may have decreased sexual desire, inability to maintain an erection, and premature ejaculation. This could result from low testosterone or performance anxiety.

Obstruction/Blockage

Due to prior surgery or infection the vas deferens may be damaged.

Trauma to testicles

Severe injury to the testicles can result in decreased sperm production

Varicocele

An enlarged vein in the scrotum, which causes pooling of blood and an elevated temperature. Although controversial, some argue it is one of the most common and readily treatable causes of male infertility. Others say that varicocele is also common among fertile men, and question the connection with infertility and the need for treatment. In general, very large or painful varicoceles that go untreated can cause permanent damage to the testicles.
The options are either surgery to close it off, or balloon insertion to block the blood flow.

Previous Vasectomy

Vasectomies can often be reversed. However, the more time has passed, the more likely it is that the man will have an immune reaction to his own sperm and the lower the chance of being able to produce a pregnancy.

Retrograde ejaculation

Can be caused by certain medications, surgeries, and nerve damage (for example, from diabetes mellitus). Sperm goes in the wrong direction and is ejaculated into the bladder.
Sperm can be however collected in the urine, prepared and used in IVF.

Previous Cancer Treatment

Chemotherapy and radiation can cause abnormal sperm or sterility. Freezing of sperm before such therapy should be advised.

Genetic Abnormalities

Severe male factor problems can have genetic cause and a small percentage of infertile men have Klinefelter's Syndrome; they have two X chromosomes and one Y chromosome, rather than the normal one X and one Y.

How does Sperm Mature?

Sperm develop I specialized cells called sertoli cells which are found in the seminal tubules in the testes. The development process of the development process of the sperm begins with the division of very immature sperm cells called spermatogonia and proceed thru various stages to maturity. Mature cells are tadpole shaped and called spermatozoa. Spermatozoa leave the seminiferous tubules to pass into the epididimus where they acquire the ability to move.

The maturation time of spermatozoa is approximately 70 days.

Mature sperm remain in the vas deferens until the man ejaculates. As the man ejaculates, spermatozoa combine with fluid from the seminal vesicle and with a thick secretion from the prostate gland to creating sperm.
Semen is gel like but liquefies in approx 30 mins, enabling the sperm to move more effectively through the female reproductive tract to reach the oocyte.

The Egg and Sperm

Each month a single egg matures in side a follicle (cyst like structure) with the ovary. At mid-cycle the egg is released from the follicle (ovulation).
The egg travels down one of the fallopian tubes towards the uterus.
Fertilization usually takes place at the end of the fallopian tube near the uterus. It a highly random event, and at best the chance of conception is 25% in any month.

Normally millions of sperm are deposited in the vagina. However as they swim through the cervix and uterus, up the fallopian tube their numbers decline. Only a few hundred sperm will gat close to the egg.
Sperm must then penetrate the egg and fertilised the egg. Several will try but only one will succeed.

It is reported that sperm can survive for 2-3 days within the female repro tract and the length of time that a woman's egg can fertilise is from 12-24hrs.