Male infertility
3042204
225239219
2008-07-12T17:07:57Z
Arcadian
104523
/* References */ -nonrefs
{{Infobox_Disease
| Name = {{PAGENAME}}
| Image =
| Caption =
| DiseasesDB = 7772
| ICD10 = {{ICD10|N|46||n|40}}
| ICD9 = {{ICD9|606}}
| ICDO =
| OMIM =
| MedlinePlus = 001191
| eMedicineSubj = med
| eMedicineTopic = 3535
| eMedicine_mult = {{eMedicine2|med|1167}}
| MeshID = D007248
}}
'''Male infertility''' is a term that refers to [[infertility]] in male humans.
Male infertility is involved in a sexually paired couple's inability to conceive in a significant number of cases, with estimates ranging from 40-50%. <ref name="titleMen's Health - Male Factor Infertility">{{cite web |url=http://healthcare.utah.edu/healthinfo/adult/men/infertil.htm |title=Men's Health - Male Factor Infertility |accessdate=2007-11-21 |format= |work=}}</ref><ref name="pmid15049583">{{cite journal |author=Brugh VM, Lipshultz LI |title=Male factor infertility: evaluation and management |journal=Med. Clin. North Am. |volume=88 |issue=2 |pages=367–85 |year=2004 |pmid=15049583 |doi=10.1016/S0025-7125(03)00150-0}}</ref><ref name="pmid14500443">{{cite journal |author=Hirsh A |title=Male subfertility |journal=BMJ |volume=327 |issue=7416 |pages=669–72 |year=2003 |pmid=14500443 |doi=10.1136/bmj.327.7416.669}}</ref>
==Causes==
Factors relating only to male infertility include<ref>Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA. ''WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male''. [[Cambridge University Press]], 2000. ISBN 0-521-77474-8.</ref>:
===Pretesticular causes===
*[[Hypogonadism]] due to various causes
*[[Drugs]], [[alcohol]], [[smoking]]
*Strenuous riding ([[Bicycle riding]],<ref name="pmid15716187">{{cite journal |author=Leibovitch I, Mor Y |title=The vicious cycling: bicycling related urogenital disorders |journal=Eur. Urol. |volume=47 |issue=3 |pages=277–86; discussion 286–7 |year=2005 |pmid=15716187 |doi=10.1016/j.eururo.2004.10.024}}</ref> [[Horseback riding]])
===Testicular factors===
Testicular factors of male infertility include:
*Bad [[semen quality]]
**Abnormal sperm morphology
**[[oligospermia]]
**[[Azoospermia]] (complete lack of sperm in semen, can be due to scar tissue in testicle)
Factors that, in turn, affect the semen quality include:
*Genetic defects on the [[Y chromosome]]
** [[Y chromosome microdeletion]]s
*Abnormal set of chromosomes
** [[Klinefelter syndrome]]
*[[Neoplasm]], e.g. [[seminoma]]
*[[Idiopathic]] failure
*[[Cryptorchidism]]
*[[Varicocele]] (14% in one study)<ref name="title">{{cite web |url=http://www.umm.edu/patiented/articles/what_causes_of_male_infertility_000067_4.htm |title=Infertility in men |accessdate=2007-11-21 |format= |work=}}</ref><ref name="pmid11744480">{{cite journal |author=Costabile RA, Spevak M |title=Characterization of patients presenting with male factor infertility in an equal access, no cost medical system |journal=Urology |volume=58 |issue=6 |pages=1021–4 |year=2001 |pmid=11744480 |doi=}}</ref>
*[[Physical trauma|Trauma]]
*[[Hydrocele]]
*[[Mumps]]<ref name="pmid17082302">{{cite journal |author=Masarani M, Wazait H, Dinneen M |title=Mumps orchitis |journal=Journal of the Royal Society of Medicine |volume=99 |issue=11 |pages=573–5 |year=2006 |pmid=17082302 |doi=10.1258/jrsm.99.11.573}}</ref>
*[[Malaria]]
*[[Testicular dysgenesis syndrome]]
*Defects in [[USP26]] in some cases<ref name="pmid17968467">{{cite journal |author=Zhang J, Qiu SD, Li SB, ''et al'' |title=Novel mutations in ubiquitin-specific protease 26 gene might cause spermatogenesis impairment and male infertility |journal=Asian J. Androl. |volume=9 |issue=6 |pages=809–14 |year=2007 |pmid=17968467 |doi=10.1111/j.1745-7262.2007.305.x |doi_brokendate=2008-06-23}}</ref>
===Posttesticular causes===
*[[Vas deferens]] obstruction
*Lack of [[Vas deferens]], often related to genetic markers for [[Cystic Fibrosis]]
*[[Infection]], e.g. [[prostatitis]]
*[[Retrograde ejaculation]]
*[[Hypospadias]]
*[[Impotence]]
*[[Acrosomal]] defect/egg penetration defect
==Diagnosis==
The diagnosis of infertility begins with a medical history and physical exam by a urologist, preferably one with experience or who specializes in male infertility. The provider may order blood tests to look for hormone imbalances or disease. A semen sample will be needed. Blood tests may indicate genetic causes.
====Efficiency====
In the majority of cases of male infertility and low sperm quality, no clear cause can be identified with current diagnostic methods.
====Medical history====
The cornerstone of the male partner evaluation is the history. It should note the duration of infertility, earlier pregnancies with present or past partners, and whether there was previous difficulty with conception.
The history should include prior testicular (penis) insults ([[Testicular_torsion|torsion]], [[cryptorchidism]], [[Physical trauma|trauma]]), [[infections]] ([[mumps]] [[orchitis]], [[epididymitis]]), environmental factors (excessive heat, [[radiation]], [[chemotherapy]]), [[medication]]s ([[anabolic steroids]], [[cimetidine]], and [[spironolactone]] may affect spermatogenesis; [[phenytoin]] may lower [[FSH]]; [[sulfasalazine]] and [[nitrofurantoin]] affect sperm motility), and drug use ([[alcohol]], [[smoking]]).
Sexual habits, frequency and timing of intercourse, use of [[lubricant]]s, and each partner's previous fertility experiences are important.
Loss of [[libido]] and [[headaches]] or [[visual disturbances]] may indicate a [[pituitary tumor]].
The past medical or surgical history may reveal thyroid or liver disease (abnormalities of spermatogenesis), [[diabetic neuropathy]] ([[retrograde ejaculation]]), radical pelvic or [[retroperitoneal]] surgery (absent seminal emission secondary to sympathetic nerve injury), or [[hernia repair]] (damage to the vas deferens or testicular blood supply).
====Physical examination====
A complete examination of the infertile male is important to identify general health issues associated with infertility. For example, the patient should be adequately virilized; signs of decreased body hair or gynecomastia may suggest androgen deficiency.
The scrotal contents should be carefully palpated with the patient standing. As it is often psychologically uncomfortable for men to be examined, one helpful hint is to make the examination as efficient and as matter of fact as possible.
The peritesticular area should also be examined. Irregularities of the epididymis, located posterior-lateral to the testis, include induration, tenderness, or cysts.
====Sperm sample====
{{Main|Semen analysis}}
{{See|Semen quality}}
The volume of the semen is measured, as well as the number of sperm in the sample. How well the sperm move is also assessed. This is the most common type of fertility testing<ref>[http://www.fertilitytesting.co.uk/ Fertility Testing]</ref>.
====Blood sample====
A blood sample can reveal genetic causes of infertility, e.g. a [[Y chromosome microdeletion]], cystic fibrosis.
==Prevention==
Some strategies suggested or proposed for avoiding male infertility include the following:
* Avoiding [[smoking]]<ref name="pmid17304390">{{cite journal |author=Gaur DS, Talekar M, Pathak VP |title=Effect of cigarette smoking on semen quality of infertile men |journal=Singapore medical journal |volume=48 |issue=2 |pages=119–23 |year=2007 |pmid=17304390 |doi=}}</ref> as it damages sperm DNA
* Avoiding [[drugs]] and medications known to cause fertility problems, like [[steroids]] and some [[antifungal]] medications.
* Avoiding excessive [[exercise]].
* Avoiding exposure to environmental hazards such as [[pesticide]]s and [[heavy metal]]s such as [[lead]], [[mercury (element)|mercury]] and [[cadmium]].
* Avoiding frequent hot baths or use of [[hot tub]]s.
* Avoiding tight [[underwear]] or pants.
* Eating a diet with adequate [[folic acid]], [[vitamin C]], [[Zinc]], [[calcium]], [[magnesium]], [[selenium]], [[iron]] loaded food.
* Getting early treatment for [[sexually transmitted disease]]s.
* Having regular [[physical examinations]] to detect early signs of infections or abnormalities.
* Keeping diseases, such as [[diabetes]] and [[hypothyroidism]], under control.
* Practicing [[safer sex]] to avoid [[sexually transmitted diseases]].
* Taking a [[lycopene]] supplement.<ref name="pmid16978292">{{cite journal |author=Goyal A, Delves GH, Chopra M, Lwaleed BA, Cooper AJ |title=Prostate cells exposed to lycopene in vitro liberate lycopene-enriched exosomes |journal=BJU Int. |volume=98 |issue=4 |pages=907–11 |year=2006 |pmid=16978292 |doi=10.1111/j.1464-410X.2006.06434.x}}</ref>
* Wearing protection over the [[scrotum]] during athletic activities.
==Treatment==
In cases of posttesticular causes, infertility may often be treated surgically. However, for sperm quality causes, e.g. oligospermia, there is no effective medication<ref name=malpani>[http://www.drmalpani.com/oligospermia.htm drmalpani.com]</ref>. Still, [[in vitro fertilization|IVF]] or even [[intracytoplasmic sperm injection|ICSI]] may be an alternative.<ref name=malpani/>
==See also==
*[[Fertility preservation]]
== Literature ==
* M. Crausaz, J. Vargas, R. Parapanov, Y. Chollet, M. Wissard, E. Stettler, A. Senn, M. Germond: ''First Evaluation of Human Sperm Quality in Various Geographic Regions in Switzerland''. Chimia 62 (2008), 395–400. {{doi|10.2533/chimia.2008.395}}
==References==
{{reflist|2}}
{{Diseases of the pelvis, genitals and breasts}}
[[Category:Andrology]]
[[Category:Fertility medicine]]