CAUSES OF INFERTILITY IN MEN

 

Cancer treatment: Chemotherapy and radiation can cause abnormal sperm or sterility.

DES (diethylstilbestrol) exposure: Synthetic estrogen used in the 50s and 60s used by women to prevent miscarriage. Can cause low sperm counts, decreased sperm motility, and abnormal sperm forms, small penises, undescended testicles (risk factor for testicular cancer), abnormal testicles.

Hormonal imbalances: Hormone problems affecting sperm count include thyroid problems, low testosterone levels, elevated FSH, and excess prolactin (see next entry).

Hyperprolactinemia (excess prolactin): can inhibit GnRH, resulting in lower LH and testosterone. Also low FSH.

Idiopathic oligospermia: A fancy way of saying, "You don't have much sperm, and we have no idea why."

Immune problems: Both men and women can have immune reactions to sperm. There is a lot of controversy about how prevalent this is. Immune reactions to sperm in the man (autoimmune) can be a problem post-vasectomy, but may also have other causes. Anti-sperm antibodies in the male are often indicated by hyperviscosity which may inhibit forward progression. In mild cases, anti-sperm antibodies in the male or female (alloimmune) may be overcome by IUIs, for which the man will be asked to ejaculate into a cup with a special preparation in it. If IUI does not work, or if the problem is considered too severe, IVF may be necessary, with ICSI likely for male anti-sperm antibodies. Predisone, a steroid, may be given to the party producing the antibodies.

Impotence: One of the less common causes. Note: impotence is a *medical* problem. There are a variety of medical causes that can contribute, including diabetes mellitus, certain required medications such as antidepressants, etc. Sexual advice from friends is generally *not* welcome. Some useful advice on impotence can be found at http://www.impotence.org. he drug Viagra, according to the manufacturer, does not appear to have any negative impact on sperm. See http://www.viagra.com/hcp/pro_pack_insert.htm.

Infection: Postpubertal mumps, and, occasionally, venereal diseases such as gonorrhea and chlamydia can harm male fertility. Also, recurrent infections such as prostatitis can lower sperm count and motility.

Klinefelter's Syndrome: Men with Klinefelter's syndrome have two X chromosomes and one Y chromosome, rather than the normal one X and one Y. They are generally tall and thin, with small testicles. More information can be found at http://www.globalwebsol.com/vv/ and http://www.genetic.org. Both sites include listserv and support group addresses.

Lifestyle factors: These include factors which raise the temperature of the scrotum (such as the use of hot tubs or long baths), or harm sperm production. A variety of medicines and recreational drugs can decrease male fertility. These include alcohol, marijuana, cocaine, cigarettes, anabolic steroids, sulfasalazine, cimetidine (Tagamet, used for ulcers), nitrofurantoin (used for UTIs), anti-hypertensive drugs (specifically calcium channel blockers), aspirin, Dilantin (for epilepsy), colchicine, and antidepressants (note that some of these drugs should *not* be simply discontinued, because they may be required for other serious medical problems). Exposure to certain chemicals, such as lead and arsenic, and many types of paints or varnishes, can also adversely affect male fertility.

Obstruction: Can occur at various points, blocking sperm from getting out. Treated surgically. Often may be easier to work around obstruction by doing MESA or TESA instead of trying to repair surgically.

Prior surgery: The vas may be damaged during surgery fo hernia repair, orchiopexy, and even during varicocelectomy.

Retrograde ejaculation: Can be caused by certain medications, surgeries, and nerve damage (for example, from diabetes mellitus). Sperm goes in the wrong direction and can be found in the urine.

Sexual Dysfunction: Reported in up to 20% of infertile men. May include decreased sexual desire, inability to maintain an erection, and premature ejaculation. This could result from low testosterone or performance anxiety.

Trauma to testicles: Injury to testicles, such as from being hit, followed by atrophy. May also be the result of having the mumps and develop bi-lateral orchitis.

Undescended testicle: If the testicles do not descend during puberty, their body temperature may be too high, reducing quality and quantity of sperm production. Rare.

Varicocele: An enlarged vein in the scrotum, which causes pooling of blood and an elevated temperature. This one is controversial. According to some, it is one of the most common and readily treatable causes of male infertility. Others say that varicocele is also common among fertile men, and question the connection with infertility and the need for treatment. Large varicoceles that go untreated can cause permanent damage to the testicles. This can lead to testicular failure or atrophy. Testicular failure is indicated by an elevated FSH and means that the testicles are starting to stop producing sperm. Testicular atrophy is indicated by small testicle size and often leads to lower testosterone levels. This affects sperm counts and can also lead to the need for testosterone replacement therapy as the man ages. Note: Testosterone replacement _should not_ be used while pursuing fertility treatments as it will make the brain think it doesn't need to make testosterone and sperm counts will diminish even further. Description of surgery with graphics is available at http://www.maleinfertility.org/new-varicocelectomy.html

Vasectomy reversal: Though vasectomies are meant as a permanent means of birth control, it turns out that they can often be reversed. However, it is easier to reverse them if not too much time has passed since the vasectomy. The more time has passed, the more likely it is that the man will have an immune reaction to his own sperm.