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Male-Induced Infertility (Male Infertility) | Cahit Cenksoy

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  • Release date: March

Male-Induced Infertility (Male Infertility)

Since infertility is not an individual's, but a couple's problem, focusing only on problems related to women means not seeing half of the picture.  In 35% of couples diagnosed with infertility the problem is caused by a woman, in 20% - caused both by a woman and a man, in 30% - caused by a man, and in 15% - the cause of infertility cannot be explained.


Causes of Male-Induced Infertility

In more than 90% of cases of male-induced infertility, low sperm count, poor sperm quality, or both are present.


The causes include anatomical problems, hormonal imbalances and genetic anomalies.  Oligozoospermia means that the sperm density is low.  In addition, it may be accompanied by sperm anomalies and low mobility. Azoospermia means that there is no sperm in the ejaculatory fluid.


Some men may also experience ejaculation problems. These can be listed as retrograde (opposite ejaculation), premature ejaculation (pre-ejaculation) or an-ejaculation (lack of ejaculation).


We can summarize the definitions and explanations of anomalies in sperm as follows:

Aspermia: The patient cannot produce fluid during ejaculation in any way.

Azoospermia: Sperm cannot be found in the patient's ejaculatory fluid (semen).

 Oligozoospermia or oligospermia: Sperm density is less than 15 million per ml.

Asthenozoospermia or asthenospermia: Less than 40% of sperm are motile and less than 32% are fast-forward motile.

Abnormal spermatozoa (teratozoospermia ): Less than 4% of sperm have a normal structure.

Necrospermia: All sperm are dead.


Conditions that may increase infertility in men: 

These conditions can be listed as diabetes, obesity, sickle cell anemia, chronic kidney disease, hemochromatosis, mumps, chickenpox, prostate inflammation, urethral inflammation, testicular infection, testicular torsion, testicular tumor, varicocele, sudden onset febrile diseases, anesthesia, surgery, heart attack, starvation, head trauma, stroke, heart failure, liver diseases, respiratory failure, burns, congenital anomalies and genetic disorders. 


The rate of testosterone in men, as well as sperm density, decreases with age. 


70% of the conditions that cause infertility in men can be revealed after a detailed interrogation, urological history details, physical examination, hormone levels and spermiogram test.


When questioning the causes of male infertility, situations such as alcohol use and frequency, diseases that were suffered in childhood, undescended testicle (cryptoorchidism), traumas, frequency of sexual intercourse, surgical history, early or late entry into puberty should definitely be questioned.


Some patients may be born with a congenital sex chromosome disorder, as in Klienfelter syndrome ( having an extra X chromosome: 47 XXY ). Such syndromes can cause infertility by affecting sexual development. 


The general state of health in men can directly affect infertility.  Chronic diseases such as diabetes can cause nervous impotence and retrograde (in the opposite direction) ejaculation. Obesity, on the other hand, increases the conversion of male hormones to female hormone (estradiol), therefore, LH (luteinizing hormone ) decreases. When LH decreases, testosterone decreases and sperm density decreases. 


When a sperm test (spermiogram) is performed, it should take 3 months to evaluate the change. The wrong result may be obtained by 10% in the first test.  The probability of the second test being misjudged is about 2%.


Hormonal evaluation should include LH, FSH, Prolactin, Testosterone and Estradiol levels. If FSH and LH are high, it means that there is a problem with production in the testicles (hypergonadotropic hypogonadism). In this case, it means that there is a problem in testosterone production and a testicular biopsy should be performed.


Treatment should be directed towards the cause. Lifestyle changes lead to an increase in sperm quality. Reducing smoking, wearing loose underwear, weight loss, and reducing medication use leads to an improvement in sperm results.


In obese men, aromatase inhibitors can improve sperm results by increasing FSH and LH.  Weight loss and reducing alcohol consumption can increase sperm density.


The Infertility Network UK reported that zinc increases sperm motility, vitamin C reduces sperm DNA damage and prevents sperm agglutination, arginine increases sperm production, vitamin B12 and vitamin E increase fertility (pregnancy rates), coenzyme Q-10 increases quality, quantity and motility of sperm.  


Sitting for a very long time, cycling for a long distance, the use of anabolic steroids (used in bodybuilding) and working for a long time at a high temperature ( such as a hammam - oven..) impairs sperm production and increases infertility.


Since direct testosterone supplementation from outside suppresses the hormones FSH and LH; it is not recommended for the treatment of infertility.


Surgical correction of varicocele does not always improve sperm results.   If the varicocele does not cause pain or discomfort, it should not be operated. Especially, varicocele operation is not recommended for patients whose sperm count is normal.