Causes of Male Infertility

The male reproductive system does the sperm production, stores it and transport it when required, which is all controlled by the hormonal system. The sperms are produced in the testicle and are stored in the epididymis. At the time of ejaculation, the sperm are transported via the vas deferens through the ejaculatory duct mixed with seminal fluid from the seminal vesicles and prostate glands and leaves the penis through the urethra.

Male infertility can result from low sperm production, abnormal sperm function, ejaculatory duct dysfunction & erectile dysfunction. Lifestyle factors, environmental factors, chronic health problems may also contribute to male infertility.

Causes of Male Infertility:

• Hormonal Imbalance: Imbalance in the hypothalamus, pituitary, adrenal, and thyroid glands may lead to male infertility.
• Physical Causes: like blockage in the ejaculatory pathway which can be due to injury, surgery of bladder or urethra, spinal injuries, medication, diabetes, or retrograde ejaculation where the semen enters the urinary bladder after the orgasm.
• Infections: Inflammation in the epididymis or testicles can cause, blockage in the passage of sperm production. Inflammation can be caused by sexually transmitted disease like Gonorrhea or HIV etc, which may lead to permanent testicular damage.
• Sexual problems: Early ejaculation or inability to ejaculate, erectile dysfunction, painful intercourse etc
• Varicocele: Varicocele is a reversible condition in which the veins get swelled up leading to drained testicle and poor sperm quality and quantity.
• Anti Sperm Antibodies: these are the antibodies that identify sperm as invaders and attack them to eliminate them.
• Genetic Factors: Chromosomal abnormalities or single gene mutations. Klinefelter’s syndrome, cystic fibrosis, Kalman’s syndrome are some of the genetic problems associated with male related infertility.
• Medication or Surgeries: Certain drugs like, Cancer medications, arthritis medications, long term anabolic drugs, or ulcer drugs may cause male infertility by impairing sperm production.
• Environmental Factors: Males exposed to hazardous substances in their workplace – chemicals, insecticides, adhesives, silicones and radiation, occupations requiring prolonged sitting (such as driving) or being exposed to high temperatures (such as bakeries) affects the sperm production.
• Lifestyle Factors: Alcohol consumption, smoking, obesity, repeated use of drugs such as cocaine and cannabinoids damages the sperm DNA and affects the sperm quality.

Azoospermia:

This is a medical condition of a man whose semen contains no sperm. In humans, Azoospermia affects about 1% of the male population and may be seen in upto 20 % of male infertility situations. A lack of sperm in the ejaculate can be due to the blockage of the male genital system (obstructive Azoospermia) with completely normal sperm production or the result of poor sperm production ( non-obstructive azoospermia), which interferes with the production of sperm.

Azoospermia is usually detected in the course of an infertility evaluation. It is done on the basis of two semen analysis evaluations done at separate occasions (when the seminal specimen after centrifugation shows no sperm under the microscopic examination). Hormonal test like, FSH, LH, Total Testosterone, Prolactin, Semen test for Fructose levels ,Ultrasound scrotum and Karyotype are also important to diagnose the case.

There are two main types of azoospermia:

1. Obstructive Azoospermia: In this type, there is a physical obstruction that prevents sperm from being ejaculated despite normal sperm production in the testes. Common causes of obstructive azoospermia include:
   • Congenital absence or blockage of the vas deferens: The vas deferens is the tube that carries sperm from the testicles to the urethra. When this tube is missing or blocked, it can result in obstructive azoospermia.
   • Previous vasectomy: A vasectomy is a surgical procedure that involves cutting and sealing the vas deferens to prevent sperm from reaching the ejaculate. In some cases, vasectomy can be reversed to restore sperm flow.
   • Epididymal blockage: The epididymis is a structure attached to the testicles where sperm mature and are stored. Blockage or absence of the epididymis can lead to obstructive azoospermia.
   • Other acquired obstructions: Infections, scarring from previous surgeries or trauma, and certain genetic conditions can cause obstructions in the reproductive tract, leading to azoospermia.
2. Non-Obstructive Azoospermia: Non-obstructive azoospermia occurs when there is a problem with sperm production in the testes. Despite normal sperm transport pathways, sperm production is severely impaired or absent. Causes of non-obstructive azoospermia include:
   • Testicular failure: Conditions such as testicular atrophy, genetic disorders (e.g., Klinefelter syndrome), hormonal imbalances, certain medications, and radiation or chemotherapy treatments can result in reduced or absent sperm production.
   • Sertoli cell-only syndrome: This is a condition in which only Sertoli cells (cells that support sperm development) are present in the testes, but no sperm are produced.
   • Genetic abnormalities: Certain genetic conditions, such as Y chromosome microdeletions or chromosomal abnormalities, can lead to impaired sperm production.
   • Hypogonadotropic hypogonadism: This is a condition where low FSH and LH hormones are secreted by the pituitary gland and can lead to oligospermia or azoospermia.