Male Infertility

Physiology of sperm (or “about sperm” or “sperm”)

 

Male reproductive cells – spermatozoa – are produced in the testicles, through a process that is controlled by hormones and takes about 70 days.

 

Spermatozoa are composed by the head (where the cell nucleus is located which contains 23 chromosomes), the intermediate portion (where the energy is produced) and the tail that allows its movements.

 

The spermatozoa leave the testicle by channels that constitute the seminal route and that begin in the epididymis. They continue through the ductus deferens, following the ejaculatory channels that cross the prostate and terminate in the urethra.

During ejaculation, the spermatozoa will join secretions from the seminal vesicles and from the prostate, which are useful for their survival and progression, constituting sperm.

 

The reproductive capacity of the man depends on the:

– Sexual function (erection and ejaculation) and

– Spermatogenic function (formation of spermatozoids)

 

Male fertility can be altered either by a decrease in the quantity and/or quality of the spermatozoa, or by the mechanical impossibility of depositing the sperm at the bottom of the vagina during sexual intercourse (erectile dysfunction, absence of ejaculation).

 

[statistical data] COLOCARB AQUI??

Half of the couples who consult for an infertility problem have a male infertility factor, and in about 30% of the cases, infertility is exclusively male (in Handbook of Sterility and Human Reproduction, 3rd Edition).

 

  1. b) Factors

 

Obesity, smoking, and abusive alcohol and drug use are lifestyle factors that may contribute to male infertility. Obesity and alcoholism are associated with a relative increase in estrogens (female hormones) that may impair sexual function and spermatogenesis.

Increasingly, scientific data link environmental factors such as exposure to toxicants (lead, mercury, bromopropane and dibromopropane – present in some pesticides), radiation and sources of heat (including the use of personal computers on the thighs), as harmful for male fertility. Some professions, such as welders and long-distance drivers, have even been associated with male infertility.

Certain drugs, such as those used in the treatment of cancer, can also cause male sterility, and this effect should be safeguarded by cryopreservation of sperm prior to initiation of treatment. Other drugs that may interfere with spermatogenesis and/or sexual function are: anabolic steroids, finasteride (used to treat alopecia in young men), some anti-hypertensives, psychotropic drugs and antibiotics.

 

  1. c) Diseases

 

Faced with a male infertility problem, one must always look for a systemic disease, although in many cases it is not possible to identify a cause. In any case, it is very important to have a careful medical examination of the masculine element of the couple, because in some rare cases, male infertility may be the form of presentation of testicular or pituitary tumors (prolactinomas).

 

Thus, the major pathologies that may be at the root of male infertility include:

– Varicocele (venous dilatation of the spermatic venous system) occurs in about 30-40% of infertile men and is one of the few male pathologies amenable to treatment;

– Endocrine disorders (Kallmann syndrome, pituitary tumors, Cushing’s syndrome, thyroid pathology)

– infection of the seminal ductus (infectious agents may be viruses, such as parotiditis, which is usually contracted in childhood and can reach any element of the seminal or excretory ductus)

– Hypertension and Diabetes (can mainly affect sexual function, due to changes in the microvasculature and also, in the case of hypertension, due to the drugs used in its treatment).

– Genetic diseases or mutations (Klinefelter syndrome, Y chromosome microdeletions, etc.)

 

How to prevent?

 

The best way to prevent infertility is to adopt a healthy lifestyle: not to smoke or use drugs, consume alcohol moderately and choose to practice physical exercise and eating healthy, avoiding obesity and associated diseases such as hypertension and Diabetes. Chronic exposure to heat sources should, when possible, be avoided.

 

How to treat?

As stated previously, after performing the medical assessment of the infertile man, the underlying cause of infertility must be treated, whenever identified. Treatment of varicocele, for example, is one example where a significant improvement in seminal quality can be achieved.

In cases where no cause is identified and changes in the spermogram are slight, treatment with anti-oxidants may produce some improvement in spermatozoa number and mobility.

When it is not possible to treat male infertility, the use of medically assisted procreation techniques such as intracytoplasmic sperm microinjection (ICSI) is the best option.

(Links to medical and surgical treatment)

 

Alternative solutions

In the case of secretory azoospermia (total absence of spermatozoa, even in testicular biopsy) or other severe seminal alterations with failure of previous treatments, the most effective form of treatment consists in the use of donor spermatozoa.