Did you know that the man is responsible for infertility or shared infertility with the woman in approximately 50% of couples? Infertility or sterility is the absence of gestation after 1 year of sexual activity without using any contraceptive system.
But what are the causes of male infertility? Generally speaking, men can be infertile due to the following causes:
- Problems depositing semen in the female genital tract. These include erectile dysfunction (absence of erection), severe premature ejaculation (ejaculation before penetration can take place), absence of ejaculation (usually due to psychological problems), retrograde ejaculation (semen goes into the bladder instead of the urethra, which can happen for example in diabetic men), severe anomalies of the urinary meatus that abnormally flows into any part of the penis or the perineal area and other penile disorders such as severe curvatures or other congenital anomalies (from birth).
- Alterations in the number of spermatozoa at the semen level. There may be no sperm at all, which is called azoospermia, either because they are not produced at the level of the testicles or because there is some malformation or obstruction at any level of the seminal tract. These disorders can be present from birth or as a consequence of trauma or infections. It can also happen that there is a reduced number of spermatozoa (below 15 million/ml which is the lower limit of normality). This situation is called oligozoospermia and may be due to any of the causes mentioned above.
- Alterations in the quality of the spermatozoa. Either of the progressive mobility that must be at least 32% (if it is lower it is called asthenozoospermia) or of the shape (more than 4% must have a normal shape; otherwise it is called teratozoospermia). Its causes can be of various types (seminal tract infection, immunological disorders, varicocele, etc.), although they are often unknown, as is the case in a large number of male infertilities.
Is it possible to prevent infertility?
There are problems that can be detected in infancy such as the lack of descent of one or both testicles into the scrotal sac at birth, which is called cryptorchidism. In these cases medical or surgical treatments should be applied before the age of one year to try to descend the testicles into the scrotum and avoid alterations in sperm production.
All problems involving testicular enlargement at any age (trauma, inflammation, torsion, etc.) should be treated. An important varicocele (dilatation of the veins) can affect the number and/or quality of spermatozoa, so it may be advisable to perform a small surgery consisting in ligating the veins (varicocelectomy).
In those patients who are going to undergo certain treatments such as chemotherapy or radiotherapy, it is advisable to freeze spermatozoa beforehand in order to be able to use them in the future, if necessary, by means of assisted reproduction techniques.
To detect male infertility it is essential to perform a physical examination, mainly of the genital area.
First of all, an exhaustive clinical history and physical examination should be carried out and then 1 or 2 semen analyses should be requested, where the number of spermatozoa is evaluated, as well as their mobility, shape and vitality.
According to the results of these tests, other studies such as hormonal, genetic or bacteriological studies in blood or semen may be indicated.
In cases of azoospermia, a testicular biopsy may be indicated. It consists of obtaining one or several fragments of tissue from one or both testicles in order to differentiate between problems in the production of spermatozoa and obstructions of the seminal duct. If sperm are found, they can be cryopreserved for future use in assisted reproductive techniques.
Imaging studies such as ultrasound and Doppler may also be necessary to detect certain abnormalities of the testicle, its blood vessels or seminal duct.
What treatments can be applied?
Whenever possible, treatment of the pathologies that may be responsible for infertility, whether pharmacological or surgical, should be applied. For cases in which the number of spermatozoa is low or of poor quality, it is preferable to apply treatments such as antioxidant drugs with dubious and inconsistent results.
When there is obstruction of the seminal duct, certain techniques such as microsurgery of the epididymis or vas deferens may be indicated in order to restore the patency of these ducts. The most frequent cause of obstruction of the vas deferens is vasectomy.
When the obstruction is in the ejaculatory ducts (final tract of the seminal duct that passes through the prostate before emptying into the urethra), endoscopic surgery (through the urethra) can be used to unblock the ducts.
When no other treatment is possible or when other treatments have failed, assisted reproduction techniques such as intrauterine insemination (sperm are deposited inside the uterine cavity) should be recommended, classic in vitro fertilization (IVF) (eggs and sperm are brought together while waiting for the latter to penetrate the former) and intracytoplasmic sperm injection (ICSI), where one sperm is injected into each of the woman’s eggs after hormonal stimulation to obtain a good number of eggs.
In those cases in which sperm are produced in the testicle but cannot reach the urethra, it is possible to obtain them directly from the testicle using the ICSI technique. ICSI is the current technique of choice in severe cases of male infertility, in which sperm obtained from the semen, testicle or any level of the seminal tract, either fresh or cryopreserved, can be used.
When sperm or eggs cannot be obtained, are of poor quality, or when previous techniques have failed, consideration should be given to the use of donor germ cells for use in assisted reproductive techniques.