Infertility is the inability of a couple (the man and his wife) to achieve conception (pregnancy) after one full year of regular, unprotected, penetrative, vaginal sexual intercourse. The man and the woman contribute equally to the cause of infertility, meaning that no one party (only the woman or man) is responsible for infertility in all cases of infertility: it can either be from the man or woman or the both of them.
The cause of infertility can be congenital (the problem occurred before birth) or acquired (the cause of infertility happened between any time after birth to the current age of the person).
For a man, infertility can occur due to problems in the brain (hypothalamus and pituitary gland) and the adrenal glands located on top of the kidneys, the testes, or the structures that transport sperm from the testes to the outside.
When the testes are the cause of infertility in a man, the following can be the problem:
- Some men with infertility have abnormalities in their sex chromosomes (in which they have two X chromosomes, instead of one, and one Y chromosome) which occurred during the formation of the mother’s egg or the father’s sperm cell from which they were formed at fertilisation. Men with such an abnormality in their sex chromosomes have poorly developed (small) testes and female-like breasts, and many of them produce semen containing no sperm cells in it despite the fact that a lot of them have normal libido, erection and orgasm.
- A condition known as varicocele, which is the enlargement of the veins within the scrotum, can cause infertility in men. This enlargement causes an increase in temperature in the testes which affects sperm production; it can also lead to a backflow of waste products being carried away in the blood from the testes and affect oxygen supply to the testes, all which can negatively impact sperm production in the testes.
- Mumps virus infection in men usually causes what is known as orchitis, a condition in which the testes are swollen from inflammation. Mumps is characterised by a massive swelling of one or both cheeks and this occurs some days before the swelling of the testes.
The mumps virus directly damages the structures within the testes where sperm production takes place and the swelling of the testes due to this viral infection severely impacts blood supply to some parts of the testes causing tissue death: all of this affects the ability to produce healthy sperm cells, leading to infertility in the affected man.
Sexually transmitted infections like gonorrhoea and chlamydia can damage tissues of the testes causing infertility if they are not properly treated.
- Men who had missing testes at birth due to non-descent of the testes have a higher risk of being infertile especially if these testes didn’t descend by one year of age. Even with surgical treatment to bring the testes down into the scrotum at this early stage, some of these male children develop infertility problems in adulthood because of the impairment in the processes of normal sperm production which occurred while the testes were undescended.
- Physical trauma to the testes such as a fall or a road traffic accident; complication from surgery on the testes; constant exposure of the testes to heat (in long distance drivers whose seats are directly over the hot engines of their vehicles); constant exposure to radiations (X-rays, and radiation treatment for cancer); chemotherapy for men undergoing cancer treatment; regular wearing of tight boxers: all these can negatively affect sperm production in the testes, leading to infertility.
- Long-term alcohol intake, cigarette smoking and consumption of marijuana have a negative effect on sperm production and can contribute to infertility in men.
There are many other causes of infertility in men and treatment will require a collaboration between medical doctors with expertise in different specialities such as gynaecology, urology, endocrinology (diabetes and other hormonal problems), neurology and neurosurgery (the brain and spinal cord) and so on depending on the identified cause of infertility. Hence, it is advisable men go to a very good specialist hospital or a teaching hospital when seeking treatment for infertility.
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