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Male Infertility of Testicular Origin

Male Infertility of Testicular Origin

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According to the best sexologist in Delhi, there are numerous factors that can cause male infertility as a result of their effect on the generation and maturation of sperm in the testicles themselves, generating oligozoospermia (low concentration of sperm in semen), asthenozoospermia (low mobility of sperm), teratozoospermia (abnormal in sperm morphology) or secretory azoospermia (no sperm are produced in the testes).

The most common causes of male infertility of testicular origin include the following:

  • High testicular temperature: the normal temperature of the testicles should be between 35.5º and 36º. Any elevation above these figures has a negative impact on the sperm maturation process that begins in the seminiferous tubules.
  • Toxic agents: there are numerous environmental factors to whose exposure the testicles can see altered the activity of Sertoli cells, which play an essential role in the transformation of spermatidine into mature sperm: tobacco, environmental pollution, pesticides, consumption of meat from animals hormonalized with estrogens, use of certain drugs, radiotherapy, professional exposure to toxic substances, etc.
  • Klinefelter syndrome or XXY males: this is a chromosomal abnormality in which males have an extra X chromosome, causing a drop in testosterone that prevents sperm production (azoospermia). In addition, it causes anatomical alterations in the sexual organs, such as hypoganadism or micropenis.
  • Other genetic factors: in recent times, genetic alterations have been detected in areas of the Y chromosome that negatively affect the spermatogenesis process, causing oligospermia or azoospermia. This is the reason that in assisted reproduction clinics men with a sperm concentration of less than five million.
  • Trauma: strong blows to the testicles can affect the mechanisms of sperm production and maturation.
  • Testicular pathologies: there are different diseases that affect the testicle and that condition the correct production of sperm:

–  Varicocele: is responsible for 20% of cases of male infertility that are detected in assisted reproduction clinics. It is characterized by venous valve insufficiency of the spermatic veins and, depending on its severity, can cause teratozoospermia and oligozoospermia.
–  Cryptorchidism: It is a problem that occurs essentially in boys as one or both testicles do not descend into the scrotum, so, among other things, they are subjected to temperatures above 36º, which affects the quality of the sperm. It can also occur after puberty as a result of mumps.
–  Hydrocele: it is the accumulation of fluid around the testicle, which causes a significant increase in the overall volume of the scrotal bag that contains it. In principle, it may not compromise fertility, but there is a risk of complications that can cause infertility.
–  Genitourinary infections: they can cause testicular atrophy, obstruction of the seminal tract, generation of antisperm antibodies or compromise the accessory glands. They account for 5% of cases of male infertility, although some studies indicate that in 15% of men the semen analysis offers positive results.

male infertility

Infertility in Men

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Male infertility is the reason for 30% of cases of infertility among couples. The main reasons are:

  • Decrease in the number of sperm, as the man gets older;
  • Little sperm mobility;
  • Abnormal sperm;
  • Absence of sperm production;
  • Vasectomy;
  • Difficulty in sexual intercourse;
  • Sexually transmitted diseases.

A spermogram is performed to detect the reason for male infertility, an examination in which semen is evaluated. In macroscopic analysis, characteristics such as color, odor, viscosity, volume and pH are observed. In microscopy, sperm concentration, motility and morphology are identified.

One of the most common problems for the production of healthy sperm is the excessive increase in temperature inside the testicles. This can occur due to diseases such as cryptorchidism (irregular positioning of the testicles) and varicocele (varicose veins in the scrotum region), in addition to cases in which the permanence of man in high ambient temperatures alters the quality of the semen produced.

Problems with spermatogenesis can also be caused by changes such as orchitis (testicular inflammation) or by various endocrine diseases that alter the production of pituitary hormones that stimulate the production of sperm in the testicles.

On the other hand, there are several types of infectious processes, tumors and congenital malformations, which can alter the anatomy and obstruct the channels that transport sperm from the testicles to the outside. The total or bilateral obstruction of these channels, namely the epididymides and vas deferens, can cause infertility in man. In some cases, correction surgery solves the problem of infertility.

Some sexually transmitted infections that affect the ejaculation channel, such as infections caused by bacteria (chlamydia, ureaplasma), trichomoniasis or gonorrhea can alter sperm rates.

Finally, anatomical or functional problems that prevent the proper deposit of semen inside the vagina through intercourse, as with hypospadias, erection disorders and premature ejaculation, can also favor male infertility.

According to the cause of male infertility, the sexologist doctor in Delhi will indicate the appropriate treatment and the ideal procedure to be adopted.

infertility treatment in Delhi

Diseases that affect Fertility in men

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Due to the unhealthy lifestyle, the number of men who have too few sperm, or the quality of these spermatozoa is too low for fertilization without treatment by sexologist in Delhi.

Male fertility is mainly harmed by a sedentary lifestyle, testicular overheating, excess alcohol, drugs (especially cocaine, marijuana, morphine), toxic working conditions (e.g. working at high temperatures). Sometimes a lifestyle change is enough to bring fertility back.

Studies on the causes of male infertility are much simpler and cheaper than for women. So do not hesitate to suspect such a problem.

Causes of infertility: sperm is of poor quality

The basic test, in addition to assessing the correctness of genitalia, is semen analysis. They are collected as a result of masturbation, after a minimum of 3 days of sexual abstinence. A healthy, normal ejaculate should have a volume of about 5 ml (teaspoon content), but a range of 2 to 5 ml is allowed. There are 20 to 300 million sperm for each, of which at least 30 percent it should be properly built, and at least 40 percent adequate mobility (average speed not less than 25m / sec).

A single examination does not prejudge infertility. As a rule, the test is repeated after 2-3 months and, if the result is confirmed, further diagnostics and treatment are implemented.

The most common cause of male infertility are disorders related to sperm quality (here, lifestyle, the use of certain medications, e.g. neuroleptics, antidepressants) or testicular damage (testicular torsion, abnormal position, and incorrect penile structure) and age – above 40 years.

Diseases that can affect male fertility

Piggy

This viral disease, one of the typical for childhood, with painful swelling of the salivary glands, neck and jaw, is very dangerous, and not only because the paramixovirus causing it is extremely contagious (easily spreads through the droplet, but even through breathing or using the same dishes). Mainly because about 1/3 of boys may experience inflammatory testicular swelling after puberty. This is a complication that can cause infertility. Until an effective vaccine was introduced in the 1970s, mumps was a very common disease in children. Today it occurs sporadically. However, it is estimated that around 5 percent vaccine people do not develop the desired immunity. In such cases, complications may also occur, the symptoms of which are high fever (over 39.5 degrees C), vomiting, inflammatory changes or swelling of the testicles, severe headache. The appearance of complications requires prompt medical intervention.

Varicose veins of the spermatic cord

The disease consists of widening, spraining, and lengthening the venous vessels that collect blood from the testis and form so-called scrotum within the scrotum. flagellate weave. This plexus is part of the spermatic cord, in its scrotum, above the testicle. Varicose veins of the spermatic cord are most often found in young men. Appear in about 15 percent. men, mainly on the left (90%). Approx. 30-40 percent of men seeking advice for infertility are patients with varicocele. The causes of the disease are seen in the failure or congenital absence of valves in the nuclear veins. This impairs the outflow of venous blood, which “lies” in the veins, exerting excessive pressure on the flagellate plexus and causing it to widen, lengthen and twist.

Varicose veins cause degenerative changes in the testicles – the testicles become chronically hypoxic, overheated. And so for proper sperm development, the temperature in the scrotum should be 2-3 degrees Celsius lower than in the abdomen. In a patient with varicocele, this temperature difference is only 0.1 deg. C. And although varicose veins of the cord occur basically on one side, degenerative changes often affect both testicles (the temperature increases throughout the scrotum). Changes in the testicles reduce the total sperm count and increase the percentage of abnormal sperm.

Kallmann syndrome

This is a genetic disorder characterized mainly by the lack or impairment of smell, but also by delayed puberty or even its absence. Men with Kallmann syndrome have very small testicles, a small penis, very low testosterone levels, and absent olfactory bulbs. The cause of the disease is a deficiency in the secretion of gonadoliberin – gonadotropin-releasing hormone (GnRH). If Kallmann’s syndrome is diagnosed over 16 years of age, eunuchoid proportions of body structure often occur. The shoulder span may exceed 6 cm in height, and the ratio of upper to lower body may be reduced.

Kallmann syndrome gives a fairly good therapeutic prognosis when it comes to the preservation of secondary sexual characteristics, fertility is slightly worse. Patients with testicular sizes over 2.5 cm have a better prognosis.

Pituitary gland failure

Pituitary gland diseases (e.g. pituitary adenoma ) are often associated with gonadotropin deficiency. sterility.

Sexually transmitted infections

As a result of sexually transmitted infections, mainly caused by Chlamydia trachomatis or Mycoplasma hominis, complications can develop that can lead to permanent infertility. Infections with other bacteria can also lead to the maturation of abnormal sperm. Inflammation of the testicles and epididymis, caused by the penetration of e.g. E.coli, Enterococcus faecalis, Ureaplasmaeuraelyticum, can lead to fibrosis in the testicles, which will reduce them and even disappear.

Inflammation of the prostate gland and seminal vesicles

This disease can prevent sexual intercourse and also lead to adverse changes in semen, significantly reducing the ability of sperm to fertilize.

Important

Diabetes, nephritis, tuberculosis, pancreas, thyroid, and liver diseases – these general diseases are also, although to a lesser extent, a risk factor for male infertility. Chemo and radiation therapy also leads to changes in fertility. Therefore, before possible irradiation or treatment with chemistry, it is worth freezing the semen.
Male Infertility

Male Infertility

One of the fields in which the best sexologist in Delhi has accumulated the most experience is the study and treatment of the male with infertility.

The philosophy of Dr. P K Gupta is to always carry out a study of the male in all those couples that consult for infertility and in those that are:

  • Altered seminogram
  • Erection or ejaculation problem as a cause of infertility
  • Genetic or family disease

In most couples, a male assessment should be made prior to any technique of assisted reproduction. The reasons that make us think so are the following:

  • Many of the causes of male infertility can be treated so that it is possible to solve the problem of the couple permanently. We believe that it is a better solution to solve the cause that conditions infertility (and expect to have a pregnancy in a natural way) than to achieve a pregnancy without having solved the problem presented by the man.
  • In many cases, the success rates achieved when treating males are even higher than those offered by “In vitro” Fertilization ( IVF ).
  • If the patient presents a severe alteration in the seminal quality, it is convenient to rule out genetic causes for said deterioration. The genetic alterations that the father carries are going to be transmitted to his offspring in the same degree or to a higher degree. These circumstances should be previously known to adopt the most advisable attitude based on the findings and their consequences.
  • Sometimes infertility is only the first manifestation of much more serious problems affecting the male: testicular tumor, genitourinary tuberculosis, renal agenesis, etc.

In our experience, better results are obtained than with assisted reproduction techniques in the following situations:

  • Reconstruction of vasectomies or vaso-vasostomies
  • Treatment of seminal infections
  • Treatment of erection or ejaculation problems
  • Treatment of hormonal defects
  • Varicocele correction in selected cases

When should the male be studied?

The evaluation of males with infertility problems is essential in all cases, even in those in which assisted reproduction techniques are going to be used. The sexologist doctor in Delhi must assess the males with infertility, trying to diagnose the problems that can be solved, which would allow the male to recover his fertility. When assisted reproduction techniques are going to be required, the andrological evaluation will also be necessary to rule out certain (mainly genetic) problems that may exist.

What are the main causes of male infertility?

Until a few years ago the causes that caused male infertility had not been studied in depth. However, advances in the field of sexology have made it possible to find an explanation for three-quarters of male infertility situations, which makes it possible in many cases to act on these causes in order to recover or improve their reproductive capacity.

A large part of cases of male infertility has a specific cause that can be identified. The presence of varicocele (a set of dilated veins around the testicles), infections in the seminal tract (ducts that carry semen from the testicles) and the existence of obstructions in the genital organs explain, together with genetic and congenital factors that they condition the production of sperm, approximately 70 percent of the cases, while the remaining 30 percent of the situations still do not have a known cause.

Some investigations point to different environmental factors such as exposure to radiation, pesticides or toxic substances used in the industry along with smoking as responsible for numerous cases of male infertility in recent decades. However, the exact influence of these factors on the deterioration of semen quality is not known with precision. Except in specific situations in which there has been a continuous exposure over time to high doses of these substances, we can not consider these factors as determinants of infertility.

Thus, in order of frequency, the main causes of male infertility are the following:

  • Varicocele (36%)
  • Obstructive azoospermia (17%)
  • Secretory azoospermia (15%)
  • Problems of erection or ejaculation (9%): The problems of erection or ejaculation (absence of ejaculation, the ejaculation of the semen towards the bladder instead of towards the outside, etc.) are the cause of up to 10% of cases of infertility of masculine origin.
  • Secretory Oligozoospermia (6.5%):
  • Infection of the seminal pathway (6.2%): The seminal pathway is the tube through which the sperm exit from the testicle to the outside. If there is an infectious process at some point along this route, the sperm will have to cross that infected area and this may mean that many will die or be destroyed
  • Obstructive oligozoospermia (6.2%):
  • Hormonal problems (3.1%): Sometimes male infertility is due to the existence of problems (due to excess or defect) in the sex hormones.
  • Unknown causes (16.6%): Despite having followed an adequate diagnostic process, between 15 and 20% of them will not be able to reach a diagnosis of the problem that causes the poor quality of the semen.