The Male Infertility Causes and Treatment

Causes of Male Infertility

• Varicocele

• Infections :                                                                                                      
• a. acute : smallpox, mumps, other viral infections                                       
• b. chronic : TB, leprosy, prostatitis

• Sexually transmitted diseases
• Idiopathic - cause unknown

• Injury                                                                                                              a. direct : testicular or pelvic trauma, heat, irradiation                                b. indirect : radiotherapy, chemotherapy, environmental toxins, drugs, marijuana, tobacco, alcohol

• Undescended testes (cryptorchidism)
• Previous surgery : inguinal, scrotal, retroperitoneal, bladder neck, vasectomy
• Obstructions : congenital (aplasia), vasectomy, post-infective
• Systemic illnesses esp. hepatic, renal
• Immunologic : infection, obstruction
• Ejaculatory disturbances
• Spinal cord lesions
• Genetic, endocrine & familial disorders : Klinefelter's syndrome, Young's syndrome, cystic fibrosis, adrenal hyperplasia
• Sexual dysfunctions

Sometimes, in spite of the most meticulous search, no obvious cause can be found for the infertility. This group, known as the idiopathic infertility group, constitutes a large percentage.


TREATMENT

Treatment of male infertility is difficult and sometimes frustrating. Immediate results are hard to produce and persistence with therapy is required.

The following modalities of treatment are generally employed.

1. Medical treatment
This consists of the administration of certain drugs to improve seminal quality. Clomiphene citrate, mesterolone, tamoxifen, gonadotropin injections, antibiotics, steroids etc. are commonly used.

2. Surgical treatment
Microsurgery in progressObstructions in the sperm conduction pathway, varicoceles, undescended testes etc. can be treated by operation.

Modern microsurgical techniques are of great help. Even patients who have undergone a vasectomy in the past can have their vasectomy reversed and the tubes recanalised successfully using microsurgery.

3. Assisted reproduction
In many cases, neither medicines nor operations are of help. In such cases, an attempt is made in the reproductive laboratory to improve semen quality and facilitate the penetration of the sperm into the ovum. This includes sperm washing/capacitation, intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), in vitro fertilisation (IVF), and micro-manipulation (ICSI).

Microsurgery and assisted reproduction require considerable training, skill and infrastructure.

Despite the availability of so many treatment modalities, some patients remain incurable and no treatment, cheap or expensive, can improve their fertility prospects. One then has no alternative but to recommend an AID (donor insemination) or adoption.