According to statistics, every tenth married couple is infertile, i.e. not able to conceive without the help of medicine. It should be noted that women diseases cause infertility in only 40% of couples who cannot have a baby. In 45% of cases «guilty» is the man. The remaining 15% suffer from incompatibility — so-called immunological infertility — and other, rarer forms.
Male Infertility. A Bit of Theory
Before we start talking about male infertility, let’s remember some facts on male reproductive function.
A sperm is a cell, secreted by the male body. It is necessary for conception. Sperm consists of a head, neck, middle piece and tail. The sperm head is the most important part. It contains the genetic information that a father is ready to pass his child. The tail of the sperm helps it to move and to reach an egg, which can’t move.
A sperm is produced in convoluted tubules of the testes, which are covered with special spermatogenic epithelium. Convoluted tubules become straight. The sperm must pass through these tubules to mature and become ready for fertilization. The total length of all tubules in each testis is about 500 meters. Straight tubules of the testis gradually pass into the epididymis. There the sperms become able to get into a woman’s body and reach the egg. It’s there that ductus deferens begins, which passes through the inguinal canal into the abdominal cavity and into the seminal vesicles, which are located behind the bladder.
In seminal vesicles, sperms accumulate and mix with the secret of their walls. This secret mainly contains the nutrients that a sperm needs on its way to the egg. From the seminal vesicles sperm passes through the prostate gland, mingling with its secret. The resulting suspension of sperms, nutrients and chemical compounds is called semen. While ejaculation, the semen gets into the urethra and then it’s spewed with power out of the male body.
Forms of Male Infertility
There are two main forms of male infertility — secretory and obstructive. While the secretory form, normal formation of sperm in the convoluted tubules of the testes is impossible. While obstructive — there is an obstacle on its way to the urethra.
Let’s talk about each of these forms separately.
The secretory form of male infertility
In this form the testes do not produce sufficient amount of sperm, needed to reach and fertilize the egg, or sperms have impaired motility, or the majority of the sperm cells have some defect in the structure.
Some effect on the testes is always in the basis of secretory forms of infertility. The most common disease, leading to impaired production of sperm, is a varicose vein of the testicle, or varicocele. This leads to dilatation of testicular veins, so that they are not able to give a full outflow of blood from the testicles, which develops its stagnation, blood circulation tissue of the testis and oppression of its function. In most cases, varicocele is left, but in some time, blood circulation in the healthy right testis also goes wrong. The result of this disease can dramatically reduce the production of sperm by both testes, which leads to the secretory form of male infertility.
A similar phenomenon is possible if a man has hydrocele. This means that a significant amount of liquid accumulates in the scrotum and squeezes the testicles. If prolonged absence of treatment, this compression can lead to impaired blood supply to the testicular tissue, which ultimately can end in infertility. Inguinal hernia can have a similar result.
A more rare disease leading to infertility is cryptorchidism — testicles undescended in the scrotum. According to existing medical approaches to cryptorchidism, the treatment of this disease must be fully completed until the age of 7, when testicles must already be in the scrotum. If this does not happen, the function of the testicles can be significantly reduced.
Another disease, often leading to male infertility, is themumps. The virus that causes this disease tends to affect different glands of the body. Mumps almost always begins with inflammation of salivary glands. The patient’s face becomes sick and rounded. Sex glands, especially the testicles, are also inflamed. If inflammation of the testicles (orchitis) is strong enough, and the necessary treatment is not provided, it may result in disturbance of their function.
A variety of external factors can cause damage to the spermatogenic epithelium. Prolonged exposure to penetrating radiation can cause not only radiation sickness and a variety of disorders, but also serious damage to the spermatogenic epithelium of the testes, which will lead to a significant reduction of sperm. Exposure to electromagnetic oscillations, significant in intensity or duration, can lead to the same outcome. This is particularly true for those, who wear modern means of communication on the belt. Researches on the impact of mobile phones on male infertility has not yet given clear results, but it is possible that the results will not be encouraging.
It is also worth noting that high temperatures have dampening effect on testicular function. This is true not only for welders, firefighters and stokers, but also for those, who like to steam in the sauna or take a hot bath. It is better to end such procedures with a cool shower, or at least to let the body cool before putting on clothes, if you care about your fertility. Regular cycle training can also be no good for male fertility if your bike or your underwear is not well-chosen, as compression, high temperature and permanent impacts on the perineum can easily lead to the reduction or complete disruption of testicular function.
Such diseases as syphilis, tuberculosis, typhoid fever, hormonal disorders, prolonged administration of anticancer, anti-epileptic drugs, some antibiotics, steroid hormones and anti-androgens can also lead to the disturbance of spermatogenic function of the testicles. Such factors as prolonged stress, lack of proteins and vitamins in the diet, adverse environmental factors, chronic sleep deprivation, abuse of cigarettes, alcohol, and drugs can also cause reduction of sperm.
Evaluation of the fertility spermogram and testicular biopsy are the main methods of diagnosing secretory form of male infertility. Testicular biopsy allows not only to determine the state of the testicular tissue, but also to find the cause of the disease.
Obstructive Form of Male infertility.
In this form of male infertility, sperm motility becomes impossible.
The development of obliteration, that is obstruction of the VAS deferens, happens for a variety of reasons. It commonly occurs after epididymitis — inflammation of the epididymis. After the inflammation, the epididymis are glued or clogged, resulting in none of the sperm from the testicles can get into the seminal vesicles. Trauma of testicles or groin, especially those without examination and treatment by a doctor, can lead to the same result. The obstruction of the seminal tract often develops as a result of accidental damage during surgery on the pelvic organs — bladder, ureters, rectum etc.
There are cases of compression of the VAS duct by a cyst or tumor of the epididymis. Congenital absence of the epididymis or VAS duct can lead to the development of this form of infertility. Syphilis and tuberculosis are other diseases, which may cause male infertility.
Special methods to determine the presence, localization and extent of the area of obliteration are used for the diagnosis of obstruction of VAS deferens. The treatment of obstructive form of male infertility is restoration of patency of the seminal tract. The success of the operation depends, to the greatest extent, on the length of the area of obliteration. Depending on this, either excision of the place impenetrable to sperm, or the formation of a new path for sperm is done.