Male infertility
Male infertility may be suspected whenever a couple fails to achieve pregnancy after about 1 year of regular, unprotected intercourse.
Causes and incidence
Some factors associated with male infertility include:
❑ varicocele, a mass of dilated and tortuous varicose veins in the spermatic cord
❑ semen disorders, such as volume or motility disturbances and inadequate sperm density
❑ proliferation of abnormal or immature sperm, with variations in the head’s size and shape
❑ systemic disease, such as diabetes mellitus, neoplasms, hepatic and renal diseases, and viral disturbances, especially mumps-related orchitis
❑ genital infections, such as gonorrhea, tuberculosis, and herpes
❑ disorders of the testes, such as cryptorchidism, Sertoli-cell-only syndrome, and ductal obstruction (caused by absence or ligation of vas deferens or infection)
❑ genetic defects, such as Klinefelter’s and Reifenstein’s syndromes
❑ immunologic disorders, such as autoimmune infertility and allergic orchitis
❑ endocrine imbalances that disrupt pituitary gonadotropins, inhibiting spermatogenesis, testosterone production, or both (as in Kallmann’s syndrome, panhypopituitarism, hypothyroidism, and congenital adrenal hyperplasia)
❑ chemicals and drugs that can inhibit gonadotropins or interfere with spermatogenesis, such as arsenic, methotrexate, medroxyprogesterone, nitrofurantoin, monoamine oxidase inhibitors, and some antihypertensives
❑ sexual problems, such as erectile dysfunction, ejaculatory incompetence, and low libido.
Age, occupation, and traumatic injury to the testes can also contribute to male infertility. Approximately 30% to 40% of infertility problems in the United States are attributed to the male.
Signs and symptoms
The obvious indication of male infertility is failure to impregnate a fertile woman. Clinical features may include atrophied testes; empty scrotum; scrotal edema; varicocele or anteversion of the epididymis; inflamed seminal vesicles; beading or abnormal nodes on the spermatic cord and vas; penile nodes, warts, plaques, or hypospadias; prostatitis, which may be acute or chronic; and prostatic enlargement, nodules, swelling, or tenderness. In addition, male infertility commonly induces troublesome negative emotions in a couple — anger, hurt, disgust, guilt, and loss of self-esteem.
Diagnosis
A detailed patient history may reveal abnormal sexual development, delayed puberty, infertility in previous relationships, and a medical history of prolonged fever, mumps, impaired nutritional status, previous surgery, or trauma to genitalia. After a thorough patient history and physical examination, the most conclusive test for male infertility is semen analysis. The specimen is collected after 2 to 3 days of complete abstinence to determine volume and viscosity as well as sperm count, motility, swimming speed, and shape.
Other laboratory tests include gonadotropin assay to determine the integrity of the pituitary gonadal axis, serum testosterone levels to determine end organ response to luteinizing hormone (LH), urine 17-ketosteroid levels to measure testicular function, and testicular biopsy to help clarify unexplained oligospermia and azoospermia. Vasography and seminal vesiculography may be necessary.
Treatment
When anatomic dysfunction or infection causes infertility, treatment consists of correcting the underlying problem. A varicocele requires surgical repair or removal. For patients with sexual dysfunction, treatment includes education, counseling or therapy (on sexual techniques, coital frequency, and reproductive physiology), and proper nutrition with vitamin supplements. Decreased follicle-stimulating hormone levels may respond to vitamin B therapy; decreased LH levels, to human chorionic gonadotropin (hCG) therapy. Normal or elevated LH level requires low dosages of testosterone. Decreased testosterone levels, decreased semen motility, and volume disturbances may respond to hCG.
A patient with oligospermia who has a normal history and physical examination, normal hormonal assays, and no signs of systemic disease requires emotional support and counseling, adequate nutrition, multivitamins, and selective therapeutic agents, such as clomiphene, hCG, and low dosages of testosterone. Obvious alternatives to such treatment are adoption and artificial insemination.
Special considerations
❑ Educate the couple, as necessary, about reproductive and sexual function and about factors that may interfere with fertility such as the use of lubricants and douches.
❑ Urge men with oligospermia to avoid habits that may interfere with normal spermatogenesis by elevating scrotal temperature, such as wearing tight underwear and athletic supporters, taking hot tub baths, or habitually riding a bicycle. Explain that cool scrotal temperature is essential for normal spermatogenesis.
❑ When possible, advise the infertile couple to join group programs to share their feelings and concerns with other couples who have the same problem.
❑ Help prevent male infertility by encouraging the patient to have regular physical examinations, to protect gonads during athletic activity, and to receive early treatment for sexually transmitted diseases and surgical correction for anatomic defects.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
Other Book Chapters Related to Infertility
Read excerpts from these other book chapters related to Infertility:
Medical Books Excerpts
- AMENORRHEA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- Amenorrhea
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "A Pocket Manual of Differential Diagnosis" (1999)
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- Amenorrhea
- "Professional Guide to Diseases (Eighth Edition)" (2005)
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- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Amenorrhea
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Infertility
» Next page: Amenorrhea (Professional Guide to Signs & Symptoms (Fifth Edition))
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