What are fertility problems?
Infertility can be defined as the failure to achieve pregnancy after regular unprotected sex (without the use of any contraception) for at least a year.
'Primary' infertility means failure to achieve a first pregnancy, 'secondary' infertility means failure to achieve a subsequent pregnancy.
Primary infertility is an extremely common problem, affecting more than one in seven (15 per cent) couples attempting their first pregnancy. Among those experiencing difficulty with conception, a male fertility problem is considered important in around 40 per cent of couples. In 15 per cent of couples it will be solely a male fertility problem and in around 25 per cent, there will be a problem in both partners.
Why do men get fertility problems?
There are several causes of fertility problems in men. They include : -
- obstructive problems (blockages in sperm-carrying tubes)
- testicular injury and disease
- sperm disorders
- genetic disorders
- (problems with erection) and ejaculation
- hormonal problems
- general medical disorders that reduce fertility
- drugs that reduce fertility
- environmental toxins and radiation.
A blockage in a sperm-carrying tubes has many potential causes.
The most common are outlined below : -
- Groin surgery (including hernia repair and fixation of undescended testicles).
- Trauma to the scrotum sack covering the testicles (even fairly minor sporting injuries).
- Infection (particularly chlamydia, gonorrhoea and tuberculosis).
- Previous vasectomy (a form of contraception that involves tying the sperm-carrying tubes).
Some men have congenital (present at birth) absence of the vas deferens on one or both sides. The vas deferens is the tube that conducts the testicular component of semen to the urethra, which then carries semen through the penis to the outside world.
About 10 per cent of men with an obstructive cause for their infertility will have this problem. The seminal vesicles (where other semen components are made) are often absent too.
Another rare obstructive cause is Berry-Perkins-Young syndrome, in which sufferers have a chronic chest disease (bronchiectasis), chronic sinusitis and obstructive infertility.
Testicular injury and disease
A blow to the testicles, which may occur in sport or during a fight, can cause swelling of the testicles, or bleeding in or around them. This probably causes the blood supply to the testicles to fail, resulting in permanent damage to the sperm production mechanism.
Torsion of the testicles (twisting of a testicle on its cord) can have a similar effect if it is not treated very quickly with surgery. Viral infections can cause inflammation of the testicles (orchitis, which usually appears as painful swelling of the testicles) and failure of sperm production.
Mumps is the best-known cause, but is not the only one. Mumps will only affect fertility if it causes orchitis and, even then, only rarely. Undescended testicles (cryptorchidism) are another common cause of failure of sperm production. Male infants and children are routinely examined to identify this problem, as future fertility can only be preserved if surgical treatment to fix the testicles in the scrotum is performed in early childhood. Even surgery in infancy does not guarantee future fertility.
A varicocele is a dilation of the testicular veins in the spermatic cord that leads from the testicles to the abdomen. The role of this condition in causing infertility is uncertain and highly controversial. Varicoceles occur in 15-20 per cent of fertile men and 30 to 40 per cent of men with fertility problems. They can occur on either or both sides, but are far more common on the left.
They are best identified when the man is standing up and are often described as feeling like 'a bag of worms'. Experts suggest that the varicocele either heats up the testicles or impairs their blood supply resulting in a build-up of body waste products, thus affecting fertility. The co-existence of other risk factors, such as smoking, with varicocele seems to have a greater effect on the risk of infertility.
Disorders of sperm numbers, movement and shape are common in men with infertility. Prolonged abstinence from ejaculation can affect sperm motility. Modern techniques can identify structural and biochemical abnormalities within the individual sperm.
Problems with chromosomes (packages of genetic material) occur in about 2 to 20 per cent of infertile men and can affect their fertility in two ways:
- chromosome disorders can affect the development of the testicles. These are usually disorders of the sex chromosomes, by far the most common being Klinefelter's syndrome. In this disorder, instead of having 46 chromosomes, including one X and one Y chromosome (46XY), the man has an additional X chromosome (47XXY).
- chromosome abnormalities can disrupt cell division and sperm production.
Problems with erection and ejaculation
Problems with sex are the principal cause of infertility in about 5% of couples.
This can be due to : -
- erectile dysfunction (inability to attain or maintain an erection adequate for intercourse)
- premature ejaculation
- failure to ejaculate
- inability to achieve vaginal penetration for other reasons.
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