According to the Center for Male Reproductive Medicine & Microsurgery at Weill Cornell Medicine, 10 percent of men in the U.S. who are trying to conceive suffer from various degrees of infertility. The World Health Organization defines infertility as an inability to achieve pregnancy after one year of having unprotected, regular sexual intercourse. This clinical definition applies to both men and women. In cases of male infertility, doctors generally find two primary causes: producing enough sperm to initiate conception and getting spermatozoa to reach a woman’s uterus and fallopian tubes.
Varicocele: the Most Common Cause of Male Infertility
Men diagnosed with varicocele have bulging, larger than normal veins in their scrotum (typically the left testicle) that interfere with regulating testicular temperature. Enzymes necessary for testosterone and sperm production require a certain temperature for maintaining viability. A slightly elevated testicular temperature can adversely affect the production of testosterone and sperm.
A popular treatment for varicocele is a microsurgical procedure called a varicocelectomy. After making a small incision in the male abdomen near the area where testicles descended, the surgeon identifies veins causing varicocele and cuts them to stop the flow of blood to the varicocele. Varicocelectomies should reduce testicular temperature and improve the viability of sperm.
Nonsurgical treatment of varicocele is also available. Percutaneous embolization involves insertion of a small catheter into a large vein in a man’s neck or groin. From there, the catheter is advanced to a particularly large vein in the scrotum, where the vein is blocked off using a coil, balloon or special medication.
Blockages of the Reproductive Tract
The second most diagnosed cause of male infertility is obstruction of the reproductive tract. Men with azoospermia, or little to no sperm count, usually have some kind of blockage interfering with the transportation of sperm out of the testes. Alternately, non-obstructive azoospermia indicates men who are not producing sperm normally. Doctors determine what kind of blockage infertile men have with testicular biopsies.
After placing a man under local anesthesia, doctors perform a testicular biopsy by removing a small portion of tissue and examining it under a microscope to evaluate sperm-producing cells and hormone-releasing cells called Leydig cells. If the stained slide indicates normal sperm production, then doctors assume a blockage outside the testes is responsible for infertility. Since testicular biopsies do not reveal exactly where obstructions exist, further tests will be needed.
Sexually transmitted diseases or urinary tract infections may also cause blockages in the male reproductive system. Gonorrhea or chlamydia bacteria may infect the epididymis, a tiny duct allowing sperm to “swim” prior to fertilizing an egg. An epididymis infection causes blockage by accumulation scar tissue, which can thicken the duct and inhibit sperm from escaping the duct.
Congenital Lack of the Vas Deferens
One percent of male infertility is due to men born without the vas deferens, the tube responsible for ejaculating sperm out of the penis. Treatment for a missing vas deferens involves retrieval of sperm from epididymis ducts, freezing the sperm and using sperm later during an in-vitro fertilization procedure. Currently, artificial tubes cannot replace a missing vas deferens because they are not strong enough to support transportation of sperm from the testes to the penis.
Retrograde Ejaculation and Male Infertility
Backward (retrograde) ejaculation is diagnosed if semen goes into the bladder instead of being ejaculated normally through the penis. The primary cause of retrograde ejaculation involves the abnormal closure of the bladder neck. Instead of closing automatically at the moment a man ejaculates, it remains open and allows semen to enter the bladder.
Possible causes of retrograde ejaculation include having previous surgeries that interfere with nerve and/or muscle control of the bladder, taking hypertension medications or diabetic bladder neuropathy. Treatment for retrograde ejaculation involves the collection of sperm at ejaculation and through collecting urine immediately after ejaculation. This sperm sample is then used during an intrauterine insemination procedure or other assisted reproductive technologies like IVF.
Four out of 100 men with infertility problems may be diagnosed with idiopathic infertility. This means abnormally low sperm counts exist for no clinical reason.
If you and your partner have been unsuccessful in conceiving a child after one year of unprotected, regular intercourse, call Viera Fertility Center for a consultation. We wish to help you discover the reason for your infertility.
For more information about male infertility and treatments available, please call Viera Fertility Center today at 321-751-HOPE.