In this edition, I am going to deliberate on the various causes of male factor infertility.
In
our series, “Answers to frequently asked questions” we defined male
infertility as a situation where the quality of the sperm produced by the male
partner is either abnormal, inadequate or with no sperm cells at all. Such that
his normal female partner is unable to get pregnant.
The
reasons for such abnormalities or inadequacies would now be discussed in more
detail.
It
has been variously estimated that the source of problems in a couple with
fertility is approximately:
Ø Solely
30% in the female
Ø Solely
30% in the male
Ø Solely 20% in both male
and female combined and in about 20%, no recognizable cause (unexplained
infertility) is found.
The
experience in our Clinics is not significantly different from the above male
contribution to subfertility is therefore not less than 40% overall.
A
GENERAL FACTORS INFLUENCING MALE
INFERTILITY
1. AGE
In men, the probability
of conception (fecundability) is maximal at age 24-25 years and tend to fall
after the age of 40 years. Although sperm production usually continues to some
extent until old age. One of our recent pregnancies belong to a 76 year old
male partner.
2. General health and
Nutrition
Good General health is
associated with fertility but bad health is not an absolute barrier to
conception.
Excessive alcohol
consumption, prolonged cigarette smoking and drug addiction, all are harmful to
sperm production and to a less extent to sexual ability.
3. Psychological
Factors
Anxiety, stress, and
tension are common features in modern life and are adverse factors for
fertility in both male and female while they predispose to reduced erection
ability in male, they may cause irregularity in the menstrual cycle of the
female partner. Also anger, depression and even grief may be generated as a
result of delay in getting pregnant thus a vicious cycle is established.
Intercourse schedule by
prescription from doctors may remove desirable spontaneity in love-making.
Post-coital test used to
determine the viability of sperm deposited into the vaginal during intercourse.
Sometimes, the knowledge that a subsequent post-coital examination would be
preformed on a woman may result in loss of erection in the male partner.
4. Timing
and frequency of Intercourse.
Eggs are released
(ovulation) approximately 14 days before a woman’s menstruation irrespective of
the cycle length.
A woman is most fertile
around this time (the fertile period). Therefore intercourse outside if this
period may not result in pregnancy.
NB: - It should be noted that
only about 80% of women would menstruate following ovulation. On the other hand
about 20% of women would experience and abnormal period without a preceding
ovulation.
BASIC KNOWLEDGE OF MALE PHYSIOLOGY
Sperms
are produced inside some tiny tubes in the innermost part of the testis. They
move from there to be matured and stored in an area called the Epidydimis. The
whole process of sperm production to maturity takes about 3 months.
During
intercourse, the sperms are transported from the epidydimis through another
tube called the vas deferens, to the tube (urethra) of the male organ (penis).
During its passage, the raw sperms are mixed with fluid produced by other
glands as they pass to the outside resulting in the final ejaculate which is
deposited in the vagina during intercourse.
B. SPECIFIC
FACTORS CAUSING MALE INFERTILITY
1. (a) Previous
Infections:- Infections affecting any
part of the testis or its tube may lead to permanent damage to the sperm
producing cells. The commonest example is caused by mump virus. This infection
is common in childhood and result in damage to the testis. Also other parts of
the tube and glands may be so adversely affected.
Another common type of
infection is that caused by
Gonorrhoea and Chlamydia.
PLEASE NOTE THAT
STAPHYLOCOCCUS AUREUS DOES NOT CAUSE INFERTILITY contrary to widely
publicised information given by quack “doctors”and questionable laboratories
The staphylococcus
aureus bacteria at best could only be contaminants in any sperm specimen
submitted for examination. They are usually skin germs, not sperm germs.
A carefully taken
specimen of sperm, preferably by masturbation would never grow staphylococcus,
but other germs that are relevantly present in the sperm itself
(b) Surgery
Accidents can occur
during surgery for example during hernia repair, or other pelvic
operation/resulting in injury to the tubes that carry sperm from the testis.
(c) Excessive
Smoking/Drinking can
lead to reduction in sperm production, decrease in their ability to move and a
reduction in the number of normal forms.
(d) Certain drugs and
chemical agents
such as steroids can have a serious effect on sperm production.
Men who suffer chronic
alcoholism with a Liver disease called liver cirrhosis could experience
complete failure of the functions of their testis.
(e) Radiation and
radiotherapy can lead to irreversible damage to sperm production ability of
the testis.
(f) A common cause of low
sperm count is called VARICOCOELE. A Varicocoele is the presence
of engorged veins around the testis. This dilated veins cause unduly high
temperature around the testis, which in turn lowers the ability of the testes
to produce sperms in adequate number and of good movement.
2. Antisperm
Antibodies
Sometimes, some
substances inside the semen produced can attach to the sperm cell (spermatozoa)
and disturb their movements and ability to fertilise egg.
These substances are
sometimes found after some previous genital infections and operations.
3. Azospermia
& Oligospermia
Azospermia simply means
complete absence of spermatozoa in the semen produced. Oligospermia means
significantly reduced number of such sperms. These are terms that our readers
commonly come across daily.
The above two problems
can be caused by obstruction to the flow of sperm in the sperm tube as a result
of operation such as hernia operation. Sometimes such obstruction can be
in-born. It could also be due to infections by gonorrhoea, tuberculosis.
Such absence of spermatozoa
can also be due to the following:
Ø
Chromosome
problem as in some disorders which affect males called Klinefelter’s syndrome
Ø
Previous
infection by mump virus mentioned above
Ø
When
the testes does not descend into the testis at birth or for a long time.
Ø
Generally,
during ill-health such as that of long term illness of the kidneys requiring
blood cleaning (dialysis).
Ø
Some
rare abnormally where the hormones from the brain that normally enable sperm
production are absent.
4. Failure
to Deposit Spermatozoa in the Vagina
this problems
collectively would contribute to failure to get sperm into the vagina. Examples
are
Impotence:- This is lack of erection
Premature ejaculation:- This results when the
man releases sperm even before penetration into the vagina. The result is that
little or no sperm gets into the vagina.
Hypospadia and phimosos:- Hypospadia is a
condition in which the opening on the penis opens not at the tip but way
back-under the penis shaft.
Phimosis is an abnormal
curvature of the penile shaft. In all these cases, semen is usually unable to
be deposited into the vagina at ejaculation.
Retrograde ejaculation:- In this unusual
condition, semen is ejaculated backwards into the urine bladder instead of into
the penis hole (penile urethra). This could be the case in males who have had
prostate operation.
5. Problems
associated with the semen fluid
(1)
Examples
of these are: -
(a)
Low
fructose content of semen
(b)
Higher than normal level of prostaglandin
level in the semen and
(c)
Unusually thick (viscous) semen.
(2)
Usually
small or high volume of semen produced is associated with low fertility
potential.
Readers
are encouraged to generate questions on the issues discussed in this edition.
Answers to questions would be provided in the next edition.
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