Infertility

Infertility is unable to achieve a pregnancy after one year of unprotected intercourse.

PRE-TESTICULAR CAUSES OF INFERTILITY

• Hypothalamic disease
• Isolated gonadotropin deficiency (Kallmann’s syndrome)
• Isolated LH deficiency (“Fertile eunuch”)
• Isolated FSH deficiency
• Congenital hypogonadrotropic syndromes
• Pituitary disease
• Pituitary insufficiency (tumors, infiltrative processes, operation, radiation)
• Hyperprolactinemia
• Hemochromatosis
• Exogenous hormones (estrogen-androgen excess, glucocorticoid excess, hyper and hypothyroidism).

TESTICULAR CAUSES OF INFERTILITY

• Chromosomal abnormalities (Klinefelter’s syndrome, XX disorder (sex reversal syndrome), XYY syndrome)
• Noonan’s syndrome (male Turner’s syndrome)
• Myotonic dystrophy
• Bilateral anorchia (vanishing testes syndrome)
• Sertoli-cell-only syndrome (germinal cell aplasia)
• Gonadotoxins (drugs, radiation)
• Orchitis
• Trauma
• Systemic disease (renal failure, hepatic disease, sickle cell disease)
• Defective androgen synthesis or action
• Cryptorchidism
• Varicocele

POST-TESTICULAR CAUSES OF INFERTILITY

• Disorders of sperm transport
• Congenital disorders
• Acquired disorders
• Functional disorders
• Disorders of sperm motility or function
• Congenital defects of the sperm tail
• Maturation defects
• Immunologic disorders
• Infection
• Sexual dysfunction
• Drugs that reduce fertility :
  Many drugs, both prescribed and those used recreationally, can reduce fertility. Any fertility concerns related to prescribed drugs should be discussed with your GP – do not just stop taking them yourself.

  Table 1:

  • Recreational drugs that may affect fertility.
  • Alcohol Reduces sperm count and quality
  • Tobacco May reduce sperm motility
  • Marijuana May affect hormone production
  • Opiates (heroin, morphine) Affect hormone production
  • Anabolic steriods Affect hormone production

  Table 2:

  • Prescribed drugs that may affect fertility.
    • Amiodarone Inflammation of the testicles and epididymis (epididymo-orchitis) leading to problems with sperm production Abnormal heart rhythm
    • Cancer chemotherapies May severely reduce sperm count, quality and motility. Effects may be permanent Cancer
    • Cimetidine Affects hormone production and reduces sperm count Peptic ulcer and acid reflux disease, indigestion
    • Colchicine May severely reduce sperm count Gout
    • Digoxin Affects hormone production Heart failure; abnormal heart rhythm
    • Erythromycin May reduce sperm count Chest infections
    • Gentamicin Reduces sperm count Bacterial infections
    • Hormonal therapies May disrupt other hormone production Various
    • Ketoconazole Reduces sperm count Fungal infections
    • Methotrexate Reduces sperm count Some cancers; arthritis
    • Nitrofurantoin Reduces sperm count Urinary tract infection
    • Phenytoin Reduces sperm quality and motility Epilepsy
    • Spironolactone Affects hormone production Fluid retention
    • Sulphasalazine Reduces sperm count and quality Ulcerative colitis
    • Environmental toxins and radiation

Several media reports have highlighted research studies showing that sperm counts are falling and that male fertility is declining, possibly because of environmental pollution.

Factor Which effect man fertility

Risk factors

A number of risk factors are linked to male infertility. They include:

• Smoking tobacco
• Using alcohol
• Using certain illegal drugs
• Being overweight
• Having certain past or present infections
• Being exposed to toxins
• Overheating the testicles
• Having a prior vasectomy or vasectomy reversal
• Being born with a fertility disorder or having a blood relative with a fertility disorder
• Having certain medical conditions, including tumors and chronic illnesses
• Taking certain medications or undergoing medical treatments, such surgery or radiation used for treating cancer
• Performing certain prolonged activities such as bicycling or horseback riding, especially on a hard seat or poorly adjusted bicycle

Treatments and drugs

Your doctor will try to improve your fertility by either correcting an underlying problem (if one is found) or trying treatments that seem like they may be helpful. Often, an exact cause of infertility can’t be identified. Even if an exact cause isn’t clear, your doctor may be able to recommend treatments that work. In all cases of infertility, the female partner also will need to be checked and may need treatment. In some cases, treatment of the female partner may help compensate for male fertility problems.

Treatments for male infertility include:

• Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired.
• Treating infections. Antibiotic treatment may cure an infection of the reproductive tract, but doesn’t always restore fertility.
• Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
• Hormone treatments and medications. Your doctor may recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
• Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.

When treatment doesn’t work:

Sometimes male fertility problems can’t be treated, and it’s impossible for a man to father a child. Your doctor may suggest that you and your partner consider either using sperm from a donor or adopting a child.