- Affected by the raised local (scrotal) temperature,
- Presence of varicocele,
- Use of tight under-garments,
- An occupational hazard where men are subjected to excessive heat
- Incomplete development of testis.
- Late descent or non-descent of the testis
- Obstructions can be due to
- Absence of the tract (vas) from birth.
- How masculine the man is by assessing body and facial hair;
- The presence of any breast swelling;
- Any evidence of previous surgical scars in the groin or scrotal areas;
- Assessment of the development of the penis should follow, together with assessing whether the testes are present in the scrotum;
- Careful examination of the testes must take place, including a measurement of their size and texture.
- The epididymis is carefully examined to determine whether it is enlarged, whether there is evidence of lumpy growths ('cysts') and whether the vas deferens can be felt;
- The blood vessels entering the testis at the top of the scrotum should be examined both with the man lying down and standing up, which is one of the best ways to determine whether or not a varicocele is present;
- If there is any suggestion of inflammation of the prostate gland, a rectal examination of the prostate should be undertaken.
The sperm count is the total number of sperm found in semen. A normal sperm sample has at least 40 million sperm cells. If the sperm count is lower than 40 million, this does not necessarily imply that the man is infertile, however it may take longer to achieve conception.
The concentration is the number of sperm cells per milliliter of semen. A concentration of at least 20 million sperm per milliliter is considered "normal".
Sperm motility refers to the ability of the sperm to move or "swim". The ability of the sperm to travel through the cervical mucus and to the fallopian tubes is essential. Enough sperm should be able to move quickly enough and in a straight direction to be capable of fertilization. “Normal" sperm motility is about 50%.
Speed is sometimes referred to as "rapid linear progression". It refers to the number of sperm that are the fastest swimmers and are likely to fertilize the egg.
Morphology is the size and shape of the sperm. Normal sperm have an oval "head" and a long tail. Defects in sperm morphology may impair the swimming strength or the ability of the sperm to penetrate and fertilize an egg. In a semen analysis, 15% or more of the sample should be normal sperm.
Varicocele is varicose (enlarged and twisted) veins located in the testicles. Varicocele can impair sperm production and therefore reduce sperm counts.
Hypogonadism is a condition that results in markedly decreased levels of the hormone testosterone. This deficiency negatively impacts sperm production and therefore sperm count. Typically hypogonadism is a congenital (present at birth) problem, however it can develop later in life from various brain tumors, radiation treatments, or rarely, unknown causes.
Both men and women can have anti-sperm antibodies, which are proteins in the body that "attack" sperm cells and disable them, preventing them from reaching and fertilizing a viable egg. Anti-sperm antibodies can attach to either the head or the tail of sperm, causing the sperm to stick together or preventing them from penetrating the egg. Thus, the antibodies mainly affect sperm motility and morphology.
There is no question about it - alcohol consumption has been definitively linked to impaired fertility in both men and women. In men, alcohol consumption may damage the sperm or reduce sperm counts. Both sexes should reduce alcohol intake as much as possible when trying to conceive.
Drugs - recreational, anabolic steroids
Research has indicated that use of drugs such as heroin; amphetamines, cocaine, and PCP have been associated with decreased libido, erectile failure, and ejaculatory problems. Furthermore, drugs such as heroin are known to interfere with normal hormonal production, leading to decreased LH and testosterone levels. Anabolic steroids, frequently used by athletes to increase muscle mass, significantly impact sperm production, and reduce sperm counts.
Smoking has a negative impact on both male and female fertility. Second hand smoke (passive smoking) can be just as harmful as smoking itself. In men, smoking reduces sperm counts and impairs sperm motility. In women, smoking has been linked to impaired fertility and increased risk of miscarriage.
It is generally recommended that the male partner avoid frequent saunas and hot baths. High temperatures are believed to interfere with sperm production, and may therefore lower the sperm count. Avoiding heat does not mean that the man should not take a hot shower!
Clothing - boxers vs. briefs
Are boxers or briefs most suitable when trying to conceive? It is recommended that the man wear loose fitting clothing, which means boxer shorts and loose trousers. The reason for this is that tight clothing can increase the temperature in the scrotum and as a result, decrease the sperm production.
Timing of Sexual Intercourse
Exposure to heavy metals, particularly lead, pesticides, and anesthetic gases has been associated with potential impairments to sperm quality. Radiation treatment (perhaps for cancer) may affect sperm production, and therefore impact fertility. If you work with environmental chemicals or are exposed to radiation on a Timing sexual intercourse around the time of ovulation is one of the easiest and most effective strategies that you can take to enhance your chances of conception. The man is constantly making sperm, however the woman's fertile period only happens once a month! Therefore, it is important to time intercourse during that fertile period.
Chemicals & radiation routine basis, and are experiencing difficulty in achieving pregnancy, you should speak to your doctor. Occupational hazards are considered a risk factor for infertility.
A healthy stress free and enjoyable sex life is very important.
Viral and bacterial infections can have varying affects on current and future male fertility. This is why it is so important to provide a detailed medical history to your doctor. Mycoplasma infections can affect fertility by interfering with sperm motility, and mumps after puberty can cause testicular damage.
Calcium Channel Blockers
Medications known as calcium channel blockers can cause male infertility. These medications are typically used to control blood pressure in individuals with hypertension. If you are taking a medication for high blood pressure and are not sure if it is a calcium channel blocker, ask the doctor. He may be able to switch you to an alternative antihypertensive medication that does not interfere with your fertility.
Cimetidine, also known as Tagamet®, is a medication used to treat stomach ulcers or reflux disease in both men and women. It may contribute to male infertility by causing increased levels of prolactin which results in decreased LH and testosterone levels, which in turn leads to lower sperm counts as well as decreased sexual performance.
Numerous antibiotics have been associated with causing male infertility. The chart below summarizes the names of the antibiotics and their effect on sperm.
|Antibiotic Drug or Class:||How it affects male fertility:||Comments:|
|Minocycline||Toxic to developed sperm||Toxic to bovine (cow) sperm; believed to be toxic to human sperm as well|
|Nitrofurantoins (nitrofurantoin, furadantin)||Interfere with sperm production resulting in decreased sperm count||Unknown if lower doses affect sperm to a smaller degree – recommendation is to choose an alternative antibiotic|
|Macrolides (erythromycin, troleandomycin)||May cause reduced sperm motility or sperm death (spermicidal)||Present information based on animal data, but believed to apply to humans as well|
|Aminoglycosides (neomycin, gentamicin)||Negative affects on the production of sperm; neomycin can reduce count and motility||Other aminoglycosides have not demonstrated any negative effects on sperm in laboratory studies|
|Sulfasalazine||Can cause a decrease in sperm count, motility, and morphology||Reversible after discontinuation of drug. Case reports are in patients being treated for inflammatory bowel disease (IBD)|
Retrograde ejaculation is a condition where sperm are forced backwards into the bladder instead of forward through the urethra. This occurs because the muscles of the urethra are not functioning properly during ejaculation (orgasm). Retrograde ejaculation is frequently associated with diabetes, multiple sclerosis, and spinal cord injury, and can significantly affect sperm count.
Chemotherapy can affect fertility in the man by reducing sperm count and/or motility. It may also cause damage to existing sperm. The impact on fertility can be temporary or permanent depending on numerous factors.
Conditions such as undescended testes or congenital malformations of any part of the male reproductive system can lead to mild to severe reduction in sperm counts, depending on the specific problem and degree of malformation.
|Minimal Standards of Adequacy|
|Sperm||20 million per milliliter|
|Motility||over 60 percent|
|Speed||Grade 2 or higher|
|Morphology||Greater than 60 percent are normal shape|
The key test that will be performed is a semen analysis. The sample will be examined for the
- Amount of semen
- Consistency of semen
- Number of sperm
- Movement of sperm
- Shape of sperm
- "Clumping" of sperm
- Presence of substances other than sperm in the semen
Investigations indicated to diagnose a case of Infertility:-
- Testicular biopsy
- Radio-immunoassays like FSH, LH, Prolactin
- Agglutination tests
- Scrotal Sonography or Colour-doppler
Hormone replacement therapy or other medication, depending upon the cause.
Surgery may be indicated in case of varicocele or other obstructions.
- Infertility cannot always be prevented. But the following steps may help:
- Avoid use of tobacco, marijuana, opiates, and anabolic steroids.
- Avoid exposure to harmful chemicals and heavy metals.
- Avoid excessive use of alcohol.
- Protect yourself from sexually transmitted disease by using condoms and minimizing the number of sexual partners.