Causes of male subfertility

  

MALE  SUBFERTILITY  .

 

Question 1 :Prevalence:-  Males are wholly responsible for 1/3 rd of all subfertility problem, and is partly responsible for another  20% cases. There   in total about 50% of all cases of subfertility males are involved.

Question 2: What  is the Normal  fertile Semen  Parameters?:-  WHO Lab Manual (2010)- in App. A1.1 declares that 5% of all fertile men(whose partners were  able to conceive by 12 months of trying):- in 5% of such fertile men the criteria were Density = 15 million/ ml; 32% for good forward progression ( motility  within 60 minutes of of ejaculation,   and normal  morphology of 4%  . This WILL SUFFICE AND SUCH MEN SHOULD NOT BE CALLED AS SUBSTANDARD SEMEN SAMPLE.

. Question  3:  What are the common causes of male subfertility?

  In about 50% of cases of male subfertility no obvious cause is detected. There is no watertight separation between different causes of which contribute to male subfertility. Basically there are  three   types of diseases which can be clinically diagnosed as A) complete absence of sperms in the ejaculated semen B) Sperms are present but there quality or quantity is far less to yield fertilization and to develop embryonic competency and successful pregnancy. C) The third group is that male sexual disorders here the male partner is unable to deposit semen at the right time of fertile period.

According to Poongothai J et all: Singapore M ed J: 2009; 50(4), 336-347  the causes are as follows :-

A)                Varicocele=37%; B) Idiopathic (no obvious cause-)-25%; C) testicular failure 9%, D) Seminal disoddreds-7%, E) Obstructive azoospermia-6%; F) Cryptorchidism-6%.

 

Question  4:  Type 1 Male Infertility:: -Absence of sperms (Azoospermia):- 1) Primary Testicular Failure-this occurs during development process(FSH  will be high). This is the most common cause of azoospermia. . There is a syndrome called TDS=Testicular Dysgenesis Syndrome- which lead to low or absent sperms, Cryptorchidism, Hypospadius-.Therefore pregnant mothers  should maintain optimal health so that the foetus inside womb grow properly. 2) Genetic diseases so that sperm production is interfered with most common cause of azoospermia) 3) Idiopathic (cause not known inspite of several investigations), 4) Hypothalamic-Pituitary Diseases (Primary hypogonadism). Additionally, following diseases can lead to absence production of sperms in the testis e.g. Testicular Dysfunction Syndrome, Maldescent of testis, Torsion, Viral and bacterial infections, Chemotherapy and radiation. Testicular Dysfunction Syndrome is the result of variety of factors defective Thee is point mutations but environment has a an added role in the expression of the disease e.g. maternal toxins, maternal life style, dietary habits, lack of exercise,

In cases of TDS there is both abnormal functions of Leydig cells which secrete intratesticular androgen. Sertoli cells secrete some products which helps semimeferous tubules to produce spermatogenesis.

Question 6 What is meant by  Type  2 Male Infertility? :  Sperms are present but are of poor quality:-1) MAGI- Male Accessory Gland Infections of varying nature, 2)Acquired Testicular damage---part damage-therefore subnormal functioning of testis –sperm production is interfered with- Life style factors, Obesity, Environmental  toxins, Varicocele,  systemic disease., Ageing, Immunological causes, one sided obstruction of ejaculatory duct (either vas or epididymis).

Question 7 : Type  3 Male Subfertility.  Male sexual Disorders:- Disorders of Erection, Or ejaculation. Mostly psychological drugs, Psychotherapy, Sildenafil types of drugs may work