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Male Infertility
Definition
Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female
Causes of Male Infertility
Pre-testicular causes
Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including:
- Hypogonadism due to various causes
- Drugs, alcohol, smoking
- Strenuous riding (bicycle riding horseback riding)
- Medications, including those that affect spermatogenesis such as chemotherapy, anabolic steroids, cimetidine, spironolactone; those that decrease FSH levels such as phenytoin; those that decrease sperm motility such as sulfasalazine and nitrofurantoin
- Genetic abnormalities such as a Robertsonian translocation
Testicular factors
Testicular factors refer to conditions where the testes produce semen of low quantity and/or poor quality despite adequate hormonal support and include:
- Age
- Genetic defects on the Y chromosome
- Abnormal set of chromosomes
- Klinefelter syndrome
- Neoplasm, e.g. seminoma
- Idiopathic failure
- Cryptorchidism
- Varicocele (14% in one study)
- Trauma
- Hydrocele
- Mumps
- Malaria
- Testicular cancer
- Idiopathic oligospermia - Post-testicular causes
Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation:
- Vas deferens obstruction
- Lack of Vas deferens, often related to genetic markers for Cystic Fibrosis
- Infection, e.g. prostatitis
- Retrograde ejaculation
- Ejaculatory duct obstruction
- Hypospadias
- Impotence
Diagnosis of Male Infertility
Is done with the help of
- Medical history
- Physical examination
- Semen analysis
- Blood analysis for determination of FSH and testosterone levels
Treatment of Male Infertility
Treatments vary according to the underlying disease and the degree of the impairment of the male fertility
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