Male Infertility Symptoms And Causes

Reproduction (or making a baby) is a simple and natural experience for most couples. However, for some couples it is very difficult to conceive. Male infertility is diagnosed when, after testing of both partners, reproductive problems have been found in the male partner.
How common is male infertility?

Infertility is a widespread problem. For about one in five infertile couples the problem lies solely in the male partner (male infertility).
Are there any signs or symptoms of male infertility?

In most cases, there are no obvious signs of an infertility problem. Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye.
How does the male reproductive system work?

The male reproductive tract is made up of the testes, a system of ducts (tubes) and other glands opening into the ducts.

The testes (testis: singular) are a pair of egg shaped glands that sit in the scrotum next to the base of the penis on the outside of the body.

Each normal testis is 15 to 35ml in volume in adult men. The testes are needed for the male reproductive system to function normally. The testes have two related but separate roles:

    production of sperm
    production of the male sex hormone, testosterone.

What causes male infertility?

Male infertility can be caused by problems that affect sperm production or the sperm transport process. With the results of medical tests, the doctor may be able to find a cause of the problem.

Known causes of male infertility can be:

Sperm production problems: The most common cause of male infertility is due to a problem in the sperm production process in the testes. Low numbers of sperm are made and/or the sperm that are made do not work properly. About two thirds of infertile men have sperm production problems.

Blockage of sperm transport: Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen.

This is the second most common cause of male infertility and affects about one in every five infertile men, including men who have had a vasectomy but now wish to have more children.

Sperm antibodies: In some men, substances in the semen and/or blood called sperm antibodies can develop which can reduce sperm movement and block egg binding (where the sperm attaches to the egg) as is needed for fertilisation.

About one in every 16 infertile men has sperm antibodies.

Sexual problems: Difficulties with sexual intercourse, such as erection or ejaculation problems, can also stop couples from becoming pregnant. Sexual problems are not a common cause of infertility.

Hormonal problems: Sometimes the pituitary gland does not send the right hormonal messages to the testes. This can cause both low testosterone levels and a failure of the testes to produce sperm.

Hormonal causes are uncommon, and affect less than one in 100 infertile men. Unfortunately, medical scientists do not yet understand all the details of sperm production and the fertilisation process. As a result, for many men with a sperm production problem, the cause cannot be identified.

Gynaecomastia causes and problems.

Gynaecomastia (often referred to as ‘man boobs’) is the enlargement of male breast tissue. Gynaecomastia appears as a rubbery or firm mass that starts from underneath the nipple and then spreads outwards over the breast area. The tissue is enlargement of glandular tissue, not fat tissue. In about half of cases, enlargement is found in both breasts; in the other cases it only affects one breast.

Gynaecomastia can happen in males of any age or weight. Obese men can appear to have man boobs as they have fat tissue all over the body including the breasts; this is not true gynaecomastia.

The growth of breast tissue can be painful or tender. This should always be checked by a doctor. Gynaecomastia can appear as a small lump that becomes tender as the mass becomes larger.
How common is gynaecomastia?

Gynaecomastia is very common in boys going through puberty, happening in more than half of all normal adolescent males, and usually goes away over time. In older men, enlargement of the breast tissue happens in about one-third of men.
What causes gynaecomastia?

Gynaecomastia commonly appears during infancy, puberty and older age. All males have the male sex hormone testosterone as well as low levels of the female hormone oestrogen, which controls breast tissue growth. When the testosterone to oestrogen ratio changes (that is, there is an imbalance in the levels of these two hormones with relatively higher amounts of oestrogen), breast tissue can grow.

Some men with gynaecomastia have higher than normal oestrogen levels.

Many newborn male babies have enlarged breast tissue because of transfer of oestrogen from the mother during pregnancy. The oestrogen goes down after birth so this type of gynaecomastia is temporary.

During mid to late puberty more oestrogen than testosterone is made by the maturing testis until the time when the testes start to make testosterone at adult levels. Gynaecomastia starting during puberty often goes away, but in less than one in 20 adolescent boys it continues into adulthood.

As men get older there is often a gradual decrease in testosterone levels (and therefore the ratio of oestrogen relative to testosterone goes up) and this can lead to gynaecomastia.

Gynaecomastia can also be caused by genetic problems, chronic diseases (especially kidney and liver disease) or some medicines. Men who take anabolic steroids for sporting performance or body building often develop gynaecomastia. In rare cases, gynaecomastia can be caused by a tumour in the testis or adrenal glands that makes large amounts of oestrogen.
What genetic problems cause gynaecomastia?

Klinefelter’s syndrome (KS), a chromosomal problem that affects one in every 650 males, is the main genetic cause of gynaecomastia. Men with KS have an extra X chromosome and do not make enough testosterone for the body to function normally. Male physical and reproductive development is affected and men with KS have small testes, are almost always infertile and often develop gynaecomastia.

Men with KS have an imbalance in their oestrogen to testosterone ratio because they have low testosterone levels. Testosterone therapy brings the ratio back to normal and helps prevent (when started at puberty) or improve the gynaecomastia, but it may not completely fix it and plastic surgery may be needed.
How can medicines or drugs cause gynaecomastia?

Medicines that can cause breast growth in men include certain antidepressants, medicines used for high blood pressure and tuberculosis, and some chemotherapy agents. Antibiotics, anti-ulcer and cardiovascular medicines have sometimes been found to change the balance of hormones in the body.

Drug abuse, especially the use of anabolic steroids, but also marijuana, opioids and excessive alcohol intake (that has caused chronic liver disease) can cause gynaecomastia.

Medicines that block the effects of testosterone are used in the treatment of prostate cancer and can lead to gynaecomastia.

In rare cases, the partners of women using topical oestrogen cream or gel for hormone replacement therapy may absorb enough oestrogen through regular, prolonged contact to cause gynaecomastia.

12 Common Causes of Low Libido

Has your desire disappeared? Once you get down to the root of your wrecked sex drive, you can take action to get it back again.

From a lack of sleep to having too much to drink, low libido is caused by a number of physiological, emotional, and lifestyle factors. Here are 12 common issues that can ruin the mood.

1. Stress. The body reacts to stress by releasing adrenaline and cortisol. Chronic stress, in particular, can interfere with your body’s hormone levels, and result in a low libido. The arteries can also narrow and restrict blood flow in response to stress, which can also lead to erectile dysfunction. Stress can also reduce your libido by distracting you and taking your mind off sexual desire.

2. Depression. Libido and depression share a complicated link. “Depression can change the body's biochemistry and therefore reduce libido,” says Mark L. Held, PhD, a clinical psychologist in the Denver area. “It's also harder to feel sexual when you're depressed.” Some medications commonly used to treat depression may also lower libido as a side effect.

3. Low Self-Esteem. It's hard to feel sexy when your self-confidence is down or when you have an unhealthy body image. “Someone who feels unattractive is less likely to want to engage in sex,” says Held. “Fears of rejection may also come in to play.”

4. Alcohol or Drug Use. While a little alcohol can help lower inhibitions, too much can impair your nervous system and lead to fatigue — making it difficult to become aroused. Other drugs can decrease your sex drive as well. For example, marijuana suppresses the pituitary gland, which regulates the production of testosterone.

5. Lack of Sleep. A good night's rest might be hard to come by, but you need sleep to keep a sharp mind, a healthy body, and an active libido. “When you’re exhausted, you’d rather catch up on sleep,” says Alan W. Shindel, MD, clinical instructor and fellow of andrology at the University of California at San Francisco. Physically, a lack of sleep can elevate cortisol levels, which also leads to low libido. Even more surprising in the sleep-ED connection? One recent study found that men with restless leg syndrome (a neurological disorder characterized by jumpy, creepy-crawly sensations as you’re falling asleep) are at higher risk for erectile dysfunction, probably due to low dopamine levels.

6. Medication. Some medications used to treat depression, high blood pressure, and other common illnesses can affect libido or cause sexual dysfunction.

7. Erectile Dysfunction. Low libido is a common emotional side effect of ED. “Once a man experiences ED, he may get anxious,” says Shindel. “His confidence is shaken, and he might be afraid it will happen again. His libido shuts down to preserve his ego.”

8. Hormone Imbalance. Libido is directly influenced by testosterone levels. Therefore, low libido is often caused by low testosterone levels — a hormone imbalance. “Low testosterone can be caused by injury, inflammation, or tumors in the testicles,” says Ira Sharlip, MD, clinical professor of urology at University of California at San Francisco and a spokesperson for the American Urological Association. Other causes of a hormone imbalance include cirrhosis of the liver or pituitary diseases. “The liver is responsible for breaking down estrogen; when it fails, estrogen level goes up, and this causes low libido. And pituitary diseases reduce the amount of testosterone in the body,” says Sharlip.

9. Menopause. Women may experience low libido during menopause for a number of reasons. Estrogen levels drop suddenly during these years, causing vaginal tissue to become dry. That, in turn, can lead to discomfort and pain during intercourse and discourage a woman’s sexual desire. Menopause can also lower testosterone, the hormone that boosts libido in women as well as men.

10. Health Conditions. Serious systemic illnesses, such as cancer or kidney disease, can suppress testosterone levels and reduce sperm production. “The body essentially goes into survival mode and doesn’t pay much attention to non-survival functions like producing testosterone and sperm,” says Shindel. Low testosterone is also a side effect of other illnesses, such as renal disease, HIV, and diabetes.

11. Relationship Trouble. When a couple is fighting or feeling distant from each other, they're less likely to want to be intimate. Communication problems, anger, conflicts, resentment — all these negative emotions can carry over into the bedroom.

12. Lack of Time. Have you ever been too busy for sex? The hectic schedules of daily life can put your sex life on the backburner. “Some people assume there will be time for sex at the end of the day when there is nothing else going on,” says Irwin Goldstein, MD, clinical professor of surgery at University of California at San Diego, director of sexual medicine at Alvarado Hospital, and director of San Diego Sexual Medicine. “They don’t schedule sex.” But unless you make time for each other and for intimacy, it may not happen. Eventually lack of sex can lead to low libido.

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.