It is estimated that the male factor is responsible for almost 40-50% of infertility cases. This number accounts for about 5-10% of the male population. Since there could be conditions affecting both partners that impede spontaneous conception, infertility should not be attributed to either male or female only factors. A thorough investigation of both partners should always take place prior to initiation of a treatment plan.
Male infertility factors could be divided in 6 categories:
- Testicular factor (abnormal spermatogenesis)
Defective spermatogenesis may be due to primary functional inability of the testes, genetic syndromes (Down’s syndrome, Klinefelter’s syndrome), or defective testical growing (cryptorchism, atrophy, germ cell aplasia, Sertoli cell-only syndrome, anorchia).
Varicocele, environmental factors (air pollution, increased temperature), viral orchitis, radiation, drugs and chemicals affecting spermatogenesis, constant physical stress, emotional factors, nutrition e.t.c may also affect male fertility.
- Non-testicular factor (Sexual disorders, ejaculatory duct disorders)
Obstructive azoospermia (complete obstruction) and oligoazoospermia (partial obstruction) are included in this category. They are caused by anomalies or obstruction of the ejaculatory duct system, infections (epididymitis, prostatitis) or postoperative disorders (vasectomy).Retrograde ejaculation is a less common cause of male infertility. The phenomenon of retrograde ejaculation is a backward ejaculation of semen into the urinary bladder which comes out during urination.
Retrograde ejaculation may be caused by mellitus diabetes neuropathy or postoperatively, after operations for prostate disease. All the patients presenting with retrograde ejaculation visiting our center, fathered by using a method reported by Dr. Kapetanakis E, Rao R, Dmowski P, Scommegna A, fertilization achieved using frozen sperm after retrograde ejaculation Fertil. Steril. 1978. 29:360).
Sexual dysfunction refers to a large range of conditions that prevent effective sexual interaction (hypospadias, impotence, incomplete ejaculation, very short or very long abstinence).
- Central factors (abnormalities of hypothalamic and pituary function, endocrine disorders)
Pituitary disorders, Kallman’s Syndrome, prolactinomas, androgen insensitivity syndrome and inherited and defective androgen production (congenital adrenal hyperplasia) may cause infertility. - Reproductive system- urinary tract inflammatory diseases
There are indications that Ureaplasma urealyticum, Chlamydia trachomatis and other gram (-) organisms may cause male and female infertility, although this topic is controversial. - Immunologic factors and infertility
In recent years it has become increasingly apparent that immunologic factors in both men and women can play a role in the process of reproduction.
Some men present antibodies against their own sperm (autoantibodies). If the antibody title in the blood sera and in the seminal plasma (antisperm antibodies) is elevated, this may indicate infertility. - Genetic factors – DNA Fragmentation
A host of tests designed to measure sperm DNA damage have been developed over the last few years. Results are generally reported as the percentage of sperm having fragmented DNA, the so-called sperm DNA fragmentation index (DFI).
Poor quality sperm DNA (DFI >30) can reduce a couple’s chance of pregnancy by up to 10 fold and also increase the risk of spontaneous abortions and IVF failure.
Life style changes may improve sperm DNA fragmentation: A diet rich in antioxidants such as fruits, vegetables, green tea and stopping smoking has been shown to improve semen quality. Treatment of infection with antibiotics, antioxidant supplements (Vit C/E, Co-enzyme Q10, L – carnitine etc.) and surgical repair of varicocoele may improve sperm DNA integrity thus improving fertility and pregnancy outcome.
