CAUSES OF MALE INFERTILTY
SPERM DEFECTS OR DISORDER Sperms defects or disorders are the most common causes of male infertility. The vast majority of cases of male infertility are due to a low sperm count (around 70% of cases). Often poor motility and a high rate of abnormal sperms are associated with a low sperm count. There are many reasons for sperm defects including hormonal imbalances, testicular varicocele and infections often a definite cause cannot be found. When no sperm whatever are found in the semen, testicular failure or failure to ejaculate may be the cause. Testicular failure may be result of an injury, a late complication of mumps, or damage to the blood supply to the testicle. Alternatively, the problem may’ve a hormonal cause, with the pituitary gland failing to stimulate the testes to produce sperm.
The inability of the testes to produce sperm, despite hormonal simulation, can be caused by undescended testes, cellular defects within the testes and congenital chromosomal abnormalities such as Klinefelter’s syndrome.
TUBE DAMAGE
Tubal damage caused by infectionscan prevent the sperm from getting into the semen as can retrograde ejaculation where the sperm passes into the bladder instead of being released through the penis into the vagina.
IMMUNOLOGICAL DISORDERS
A very small percentage of men suffer from Immunological disorders that can cause them to produce antibodies against their own sperm. This is the result of an autoimmune response to surgical interference, trauma or infection that is thought to be responsible for 10% of unexplained male infertility. The cause of this phenomenon however remains partly unclea.
TREATMENT OF MALE INFERTILITY
In recent years there has been a great increase in scientific and medical interest in male infertility and the range of treatment options currently available includes drug therapy, surgery and ART. The main approches to the treatment to male infertility are summarized and described below.
- Drug therapy
- Surgical Therapy
- ART in male infertility
- Intracytoplasmic sperm injection (ICSI)
Drug Therapy
Fewer than 5% of infertile men have a hormonal disorder that can be treated with hormone therapy. Hormonal imbalances caused by a dysfuction inthe mechanism of interaction between the hypothalamus, the pituitary gland and the testes directly affect the development of sperm. In this type of fertility disorder, FSH therapy is highly successful. Gonadotropins are sometimes chosen to treat unexplained male infertility, as seen in the cases of oligozoospermia (when sperm count is abnormally low) or asthenospermia (when less than 40% of the sperm are motile). Other types of drug treatment include antibiotics to treat infertility resulting from infections and treatment with bromocriptine when impaired sperm production is due to hyperprolactinaemia (increased levels of prolactin hormone in the blood)
Surgical therapy
Surgical therapy in male infertility aims at overcoming anatomical barriers impeding sperm production and maturation (in the testes and the epididymis) or ejaculation. Several techniques have been developed, whereby spermatozoa are retrieved either from the epididymis (percutaneous epididymal sperm aspiration, PESA, or microsurgical epididymal sperm aspiration MESA) or from the testes (testicular sperm aspiration, TESA or testicular sperm extraction, TESE). These techniques are mainly used in conjuction with ICSI.
ART in male infertility
The term ART is used to describe all the methods of artificially assisted conception and refers to several different methods designed to overcome barriers to natural fertilization. The earlier forms of ART were those designed to assist in cases of male infertility, such as assisted transfer of sperms into the vagina or uterus. Intrauterine insemination (IUI) is still widely used today, however mainly for specific cases. Since the first successful birth after IVF in the UK in 1978, many techniques have been developed and success rates have increased dramatically.
Today, ART is called upon for cases of infertility due to anatomical problems (e.g. blocked fallopian tubes), severe male factors (sperm defects, low sperm counts, male and female antisperm antibodies), widespread endometriosis and unexplained infertility. One of these techniques, In Vitro fertilization (IVF) has now been widely practiced for more than 15 years and is the starting point for most ART treatments. Current ART techniques are summarized and described in detail below.
Intracytoplasmic sperm injection (ICSI)
Highly effective treatment for male factor infertility problems
