Hormonal Disorders
Infertility can result from disorders of the testicles themselves, or an abnormality affecting the pituitary and hypothalamus glands in the brain that produce hormones that control the testicles (the hypothalamus or pituitary glands.
Genetic & Familial Disorders
Genetic disorders of the testes such as Klinefelter's syndrome (male is born with two X and one Y chromosome instead of one X and one Y), microdeletion of chromosomes amongst many others cause abnormal development of the testicles.
Injury
Previous Surgery
Varicocele
Undescended Testes
Direct: Testicular or Pelvic Trauma
Indirect: Heat, Radiation, Radiotherapy.
Inguinal, Scrotal, Retroperitoneal, Bladder Neck, Vasectomy, Hydrocele.
In this, veins of the scrotum get enlarged and tortuous,.
Physiologically, it is important for testes to have a temperature .
Sexual Issues
Often treatable, problems with sexual intercourse or technique may affect fertility. Difficulties with erection of the penis (erectile dysfunction), premature ejaculation, painful intercourse (dyspareunia),.
Retrograde Ejaculation
This occurs when semen enters the bladder during ejaculation rather than emerging out through the penis. Various conditions can cause retrograde ejaculation, including diabetes, bladder.
Misplaced Urinary Opening (Hypospadias)
A birth defect can cause the urinary (urethral) opening to be abnormally located on the underside of the penis. If not surgically corrected, this condition can prevent sperm from reaching the woman's cervix.
Infections
Sexually transmitted diseases (STDs), such as chlamydia and gonorrhea, are most often associated with male infertility. These infections can cause scarring and block sperm passage.
Abnormal/low Sperm Count
Alcohol and drugs, Tobacco smoking, Emotional stress
Alcohol or drug dependency can cause reduced fertility. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Men who smoke may have a lower sperm count than do those who don't smoke. Passive smoking may affect male fertility. Stress may interfere with certain hormones needed to produce sperm.Environmental Issues (exposure to toxins, heavy metals, excessive heat, etc.)
Medical conditions
Various medical conditions that can cause infertility include Diabetes, Pituitary gland disease, Hypothalamus disorder, Multiple sclerosis, Cushing's syndrome, Hypogonadism.Idiopathic (cause not known).
Evaluation
Some infertile couples have more than one cause of their infertility. In some cases, the cause of infertility may be unclear, or it may take a number of tests to determine the cause.For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman's vagina.
Tests for male infertility attempt to determine whether any of these processes are impaired.
They include:
Medical History
This includes questions about illnesses, disabilities and surgeries that could affect fertility. Medications and sexual habits are also evaluated. Sexual development as a boy and whether one has had any signs of low testosterone such as decreased body or facial hair and development of breast etc. are also looked for.
Semen Analysis
This is the gold standard for diagnosis of male infertility. Physical characteristics of semen, the number of sperm present, any abnormalities in the shape and structure (morphology) and movement (motility) of the sperm are evaluated. The lab will also check your semen for signs of problems, such as infections or blood. Often sperm counts fluctuate from one specimen to the next, so your doctor may want to evaluate fertilizing potential with few different samples. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting further male infertility tests.Depending on initial findings, the doctor may recommend additional, more specialised tests that can help identify the cause of infertility.
Scrotal Ultrasound
Ultrasound, which uses high-frequency sound waves to produce images of structures within your body, can help your doctor look for evidence of a varicocele or obstruction of the epididymis.
Hormone Testing
Hormones produced by the hypothalamus and pituitary glands and the testicles play a key role in sexual development and sperm production. Your doctor may recommend a blood test to determine the level of testosterone and other male hormones that affect fertility.
Genetic Tests
These tests are used if your doctor suspects your fertility problems could be caused by an inherited sex chromosome abnormality. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome.
Testicular Biopsy
This test involves removing samples from the testicle with a needle. It may be used if semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal.
Anti-sperm Antibody Tests
These tests are used to check for immune cells (antibodies) that attack sperm and can affect their ability to function.Specialised sperm Function TestsA number of different tests can be used to evaluate how well sperm survive after ejaculation, how well they can penetrate the egg membrane, and whether there's any problem attaching to the egg.
