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.

Anabolic Steroids and Infertility

Anabolic Steroids are synthetic substances similar to the male sex hormone testosterone. If used consistently from a young age they can be detrimental to the users health because they upset the body's hormonal balance.

Anabolic Steroids are known to have a variety of harmful side effects, are out of bounds for athletes and users are required to only take them under prescription of a medical doctor. Yet many people take them for the short term benefits they provide - for athletes to improve performance or to enhance physical appearance.

These drugs are often sold on the black market and because their short term benefits are so attractive users tend to ignore the dangerous and possible long term side effects. Users do not consider the effects these substances may have on their fertility health.
   

 Medical Benefits

Steroids aren't only used for bulking up but can be prescribed for legitimate medical reasons. Your medical practioner is well aware of the side effects and will prescribe a dosage with this in mind to cater for your particular situation.


 Some of the medical uses are:

    Men with too little testosterone - Whether it's due to an accident or a disease; such as testicular cancer, some men have to have their testicles removed.Their bodies will no longer be able to produce testosterone. They will be given prescribed oral anabolic steroids to replace the testosterone.

    People with chronic illnesses, such as cancer or even AIDS can use anabolic steroids to stimulate their appetite and help build muscle.
    Pituitary problems -  Steroids can help adolescent males with pituitary problems. When the pituitary gland malfunctions, the brain signals to the testes may not function correctly and the testes therefore does not produce testosterone. Boys suffering from this condition can be prescribed steroids at the appropriate age, as per his doctor. This treatment will allow them to develop secondary sexual characteristics, such as a deepening of the voice, growth spurts and pubic and facial hair.

Anabolic Steroids and fertility

There are a number of side effects users will experience when taking these substances. Some are short term and others may have long term side effects. Unfortunately any side effects will in most cases also effect the male fertility health. Some of these side effects can include:

Short term effects

    Puffiness and swelling in the face and neck due to increased water retention.
    Development of breast tissue in males.
    Increased risk of injury to muscles and joints.
    Increase in muscle mass.
    Heightened aggression, sleeping disorders, anxiety and irritability.
    Stunted growth if taken during adolescent growth spurts due to skeletal maturation and accelerated puberty changes.
    

Long term effects

    Growth of breasts due to the high level of testosterone some of which the body converts to oestrogen.
    Increased erectile dysfunction and shrinking testicles.
    Heart and liver disease - some steroids are toxic to the liver.
    Kidney disease due to the increase in toxins to be broken down.
    Aggressive behaviour and depression.
    Jaundice from high levels of steroids - affects liver function.
    Increased blood pressure.
    Prostate enlargement.


Anabolic Steroids and male infertility are often linked due to the effects on the body as mentioned here.  Any increased toxins in the body have the potential to affect the sperm being produced.

A semen analysis will give a good indication of the health of the sperm if a male has used steroids previously and is now having difficulty with infertility. A low sperm count will also be detected by going for a semen analysis.

Fortunately medical technology and advancement in procedures such as sperm washing as well as ICSI - Intra-Cytoplasmic Sperm Injection could assist men whose fertility may have been affected by the usage of Steroids.

Your doctor will be able to advise you on using an Assisted Reproductive Technology (ART) procedure in the event of being diagnosed with infertility due to this usage.

Anabolic Steroids and Fertility

There are a number of side effects users will experience when taking Anabolic Steroids. Some are short term and others may have long term side effects. Unfortunately any side effects will in most cases also effect the male fertility health. Some of these side effects can include:

Short term effects

    Puffiness and swelling in the face and neck due to increased water retention.
    Development of breast tissue in males.
    Increased risk of injury to muscles and joints.
    Increase in muscle mass.
    Heightened aggression, sleeping disorders, anxiety and irritability.
    Stunted growth if taken during adolescent growth spurts due to skeletal maturation and accelerated puberty changes.
    

Long term effects

    Growth of breasts due to the high level of testosterone some of which the body converts to oestrogen.
    Increased erectile dysfunction and shrinking testicles.
    Heart and liver disease - some steroids are toxic to the liver.
     Kidney disease due to the increase in toxins to be broken down.
    Aggressive behaviour and depression.
    Jaundice from high levels of steroids - affects liver function.
    Increased blood pressure.
    Prostate enlargement.


Anabolic Steroids and male infertility are often linked due to the effects on the body as mentioned here.  Any increased toxins in the body have the potential to affect the sperm being produced.

A semen analysis will give a good indication of the health of the sperm if a male has used steroids previously and is now having difficulty with infertility. A low sperm count will also be detected by going for a semen analysis.

Fortunately medical technology and advancement in procedures such as sperm washing as well as ICSI - Intra-Cytoplasmic Sperm Injection could assist men whose fertility may have been affected by the usage of Steroids.

Your doctor will be able to advise you on using an Assisted Reproductive Technology (ART) procedure in the event of being diagnosed with infertility due to this usage.

Natural remedies for infertility

In order to get rid of the toxins and increase your health status and hormonal balance, changing your infertility diet and considering the alkaline diet may assist in correcting your sperm problems.

Many of the side effects mentioned can be corrected by immediately stopping the usage of these substances, as well as considering lifestyle changes and partaking in moderate exercise such as walking and swimming or yoga.

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.

The Male Infertility

To be infertile means to be unable to beget children. From the medical standpoint, a couple is considered to be infertile if there has been no pregnancy after one to one-and-half years of unprotected sexual intercourse.

For the fertility process to proceed smoothly, both the man and the woman should be healthy and normal. Unfortunately, this aspect of conception is not known to most people. Traditionally (and very wrongly), it is the woman who is always blamed when a couple can't have a child. The investigation for infertility begins and ends with evaluation of the wife alone. Thus, a woman is often subjected to a D & C, laparoscopy etc. only to be told at the end of it all that everything is normal. It is not uncommon, in fact, for a man to divorce, not one but several wives under the mistaken (and chauvinistic) belief that she alone is responsible for the `barrenness'. Needless to say such men do not beget children even after several marriages !!

Approximately 15-20 percent of all cohabiting couples are infertile. Of these, in up to 50 percent of cases it is the male factor or the husband who is responsible for the infertility.

This means that nearly 7.5 to 10 percent of all men in the reproductive age group are infertile i.e. incapable of fathering children. This, by any yardstick, is a stupendous figure but one that very few know about.

Clamidiosis Signs and Symptoms

Incubation period is 5 – 30 days, and in most cases clamidiosis courses without symptoms. Sometimes appears pain during urination and little matter released from urethra. Often patients see the doctor when they already have complications which makes difficult clamidiosis treatment. There are two forms of clamidiosis: acute and chronic. Acute form of clamidiosis is characterized with mild course, without damaging lower parts of urogenital tract. Chronic form is characterized with spread of infection to upper parts of urogenital tract which frequently causes complications.

Regular examinations help to detect infection at early stages. Any diagnosis bases on the results of several methods of examinations. Goal seeking of pathogen usually starts after examination by the specialist (urologist, gynecologist, venereologist, andrologist). For example, in case of female infertility , unprompted misbirths, cervical erosion, inflammatory diseases in genital tracts, severe course of past pregnancies, is prescribed complex of diagnostic maneuvers to find sexually transmitted infections including clamidiosis. In males major symptom which would make the doctor suspect clamidiosis is prostatitis and urethritis, condylomata urethra opening. Examination may be performed in patients who had casual sex.

Primary examination makes specialist. In case he finds damages in reproductive system, he may suspect clamidiosis and suggest patient to undergo advanced examination to detect and confirm provisional diagnosis.

Matter for the investigation in females is scrape from surface of uterine cervix, urinary tract, vaginal discharges. In males for the investigation is taken sperm. Commonly are taken blood and urine. Modern methods (for example, Polymerase Chain Reaction) help to affirm with high precision if chlamydia was found or not in the obtained matter, and based on that specialist says the diagnosis. Using all the data obtained, including primary examinations data, the specialist prescribes treatment.

Clamidiosis

Clamidiosis is a most common sexually transmitted infection. Chlamydial infection occurs 2- 3 times more often than gonorrhea. According to statistics, around 5 – 10% sexually active people are carriers of this dangerous infection. Clamidiosis pathogen is Chlamydia trachomatis, which is a transitional form between bacteria and viruses. Chlamydia lives in a living cell like virus does, but has structure similar to bacteria. Such duplicity of nature makes this pathogen stand against immunity of infected person and resist the treatment.

Stages of Chlamydia life:
1. infectious stage, when it lives out of cell
2. reticular stage, when it lives in cell being a cell parasite

Chlamydia life cycle equals two days. When chlamydias multiply in cells, they fill whole cytoplasm and destroy the cell. Then they emerge in intercellular space and enter other cells. Thus cycle repeats over and over again.

Ways of infection transmission:

• sex
• baby infection during pregnancy
• baby infection through genitals during childbirth

There were rare cases of Chlamydia infection transmission via bed and body clothes.

What are the dangers of clamidiosis?
The danger of clamidiosis is that it courses without symptoms. Longtime unrecognized chlomydia in the body may lead to serious complications. In males clamidiosis results in prostate gland damage (prostatitis), seminal vesicles inflammation (vesiculitis), epididymis inflammation (epididymitis) , and even male infertility. Spreading through urinary tract, chlamydia causes cystitis. In females chlamydia causes cervical ectropion, vaginitis. Often chlamydias enter salpinges where they cause inflammation development which then leads to cicatrical changes and results in female infertility.

Clamidiosis damages not only urogenital system in a man. Remaining in human body without treatment, chlamydias gradually spread through the whole body and damage internals and joints, and even eyes. Infected mother may become sourse of infection for her baby. Chlamydia may cause misbirth, non-developing pregnancy, etc. Intrauterine infection of fetus may cause multiple damage of internals. Often after birth in baby are revealed various pathologies caused by chlamydia.

Unfortunately, clamidiosis may cause Reiter's syndrome. This rare disease is characterized with simultaneous development of arthritis, conjunctivitis and urethritis (urinary tract inflammation). In some cases occurs skin inflammation. Those conditions appear after past chlamydia infection. Nature of the disease is not known yet. It is known that under influence of chlamydia may occur changes in immune system which leads to production of “false” antibodies directed against proper cells.

Assisted Reproductive Technologies

1) Intracytoplasmic sperm injection is an artificial path shortening of sperm to egg. Sperm is injected directly into uterine cavity which increases chances of successful fertilization. Indications for intracytoplasmic sperm injection:
- ejaculatory dysfunction (breakdown of ejaculation process)
- immunological infertility
- oligozoospermia (low sperm count)

2) In vitro fertilization
In this procedure ovums are taken from female egg after preliminary hormonal stimulation which then are fertilized with male sperm (sperm of husband or donor). Embryos are grown in incubator during 48 – 72 hours, then they are inserted into female alvus. The success of this type of fertilization depends on state of female endocrine system. Frequency of pregnancy is higher in cases where more than 5 eggs were fertilized with sperm.

3) Intra Cytoplasmic Sperm Injection (ICSI)
Chances of azoospermia correction are low. However, today was implemented technique of sperm injection directly in cytoplasm of ovum (ICSI). Here are used singular sperm cells of epididymal (taken from male epididymis) or testicular origin. Indications for ICSI:

• concentration of sperm cells is less than 10 mil. (2 mil. for ICSI)
• sperm motility less than 10% (5% for ICSI)
• more than 70% pathological forms of sperm cells (over 96% for ICSI)
• opportunity to get sperm cells only surgically
• failure of other methods of infertility treatment

The effectiveness of artificial insemination techniques is 30% after just one attempt. Using of assisted reproductive technologies do greatly increases facilities of correction of most severe forms of male infertility including azoospermia. Effective treatment of infertility is possible only when urologists, ginecologists and in vitro fertilisation specialists do interact. Patient must be informed enough about modern techniques of infertlity treatment.

Immunological Infertility in Men

First stage in treatment of immunological infertility in men is elimination of all possible causative factors of autoimmune process development in reproductive system such as urogenital infections, varicocele, seminiferous path blocking, etc.

However, blood circulation normalization, absence of sexually transmitted diseases, repair of seminiferous paths (when is possible), elimination of production harms do not provide elimination of antisperm antibodies when they already started to reproduce themselves.

Therefore, second stage requires usage of one or complex of additional treatments:

• medication therapy (systemic enzyme therapy, hormonal therapy)
• special washings with further intrauterine or intratubal insertion of spermal cells
• extracorporal fertilization including fertilization with single spermal cell using method of microinjection in plasma

Remember that any stimulating therapy is contraindicated to patients with aspartate transaminase. When patient or/and his partner have antispermal antibodies and no other pathologies, then the diagnosis of isolated immune infertility is made.

In isolated immune infertility the nonsurgical empiric treatment is ineffective. The only real alternative here is assisted reproductive treatment.

Treatment of Male Infertility

Obstructive infertility
Obstructive azoospermia is characterized with normal testes size, normal rate of hormones, deficiency of spermatogenesis in ejaculate, genitalia inflammatory diseases, surgery on organs of scrotum and small pelvis, pathology of adnexas and seminiferous paths during palpation.

Optimal treatment for obstructive azoospermia is microsurgical regeneration of seminiferous paths with single-step obtainment of sperm cells from area before barrier. Obtained sperm cells may be used in ISCI (Intra Cytoplasmic Sperm Injection). Here a number of sperm cells undergo cryopreservation (deep freezing) and they are used in extracorporal fertilization in case of unsuccessful surgery.

Secretory infertility
Most complicated problem when using extracorporal fertilization is treatment of patients with secretory (non-obstructive) form of infertility. This form is characterized with signs of hypogonadism, singular sperm cells or spermatogenesis cells in ejaculate, hormonal shifts, genetic and chromosomal changes.

In secretory azoospermia may be preserved partial spermatogenesis. Thus optimal method of getting sperm cells in non-obstructive azoospermia during ISCI is bilateral multifocal testicular biopsy with usage of microsurgical methods. This is an instrumental control of research of spermatogenesis areas which were kept with the help of test centesis of different testicular areas.

Bilateral multifocal testicular biopsy helps to obtain up to 65% of sperm cells. In non-obstructive azoospermia on the back of hypogonadism (low testosterone rate resulted from hypothalamus pathology) it is necessary to undergo stimulation therapy with gonadotropic hormones.

In frank pathospermia on the back of genetic abnormalities, hypogonadism, obstructive semiology, varicocele is used empiric treatment. Combination of non-obstructive azoospermia with antispermal antibodies is contraindicated for performing stimulation therapy.

Antisperm Antibody Testing

Investigation of immunological factor of infertility is based on making tests on presence of antisperm antibodies in semen and in blood plasma in patient and his partner. Standard tests are performed:

• MAR is standard test for detecting percentage of spermatozoids with antisperm antibodies (positive result is 50% of spermatozoids with antibodies);
• IFA (immunofluorescent assay) detects level of antisperm antibodies in blood plasma in patient and his sexual partner.

Positive results of test prove the immune factor of infertility. When another pathologies are not found, the diagnosis of isolated immune infertility, which is found in 10% of marriages, is made. At this stage may be diagnosed varicocele, obstructive azoospermia, and may be detected group of patients with reduced fertility without specification of ethiology at this stage or immunologic factor of infertility. Results obtained at this stage help to narrow diagnostic algorithm of second stage.

On second stage next tests are performed:

• identification of hormonal level is required in patients with azoospermia. It detects the rate of testosterone, follicle-stimulating hormones interstitial cell-stimulating hormone and also sex-hormone that binds globulin which shows not only the amount of testosterone but also its biological activity.
• ultrasound investigation of scrotum organs helps to find structural changes and pathologic growths in testes, adnexas, prostate gland. This test shows changes in seminal vesicles in case of seminiferous paths distal sections blocking or no changes in innate agnesia of spermoduct. Chromatic doppler investigation helps to detect venous hyperemia in the system of spermatic veins and also detects subclinical varicocele.
• identification of urogenital infections agents is made to see if infertility is caused by infection. Indications for this test are: undetermined character of fertility reduction, recurrent pregnancy loss, and also preparation for additional reproductive techniques. Diagnostics of sexually transmitted infections must be made using immunofluorescent assay together with PCR (polymerase chain reaction).
• genetic investigations are made in azoospermia. Karyotyping detects abnormalities in chromosome set. Today becomes popular test which investigates AZF-segment of Y-chromosome. Around 10% of non-obstructive azoospermia cases are connected with dropping of one or several locuses in Y-chromosome on AZT-segment. Genetic investigations provide not only data about genes, but also about the chances that the disease may be transmitted to masculine descents.
• investigations of centrifuged semen and post-orgasmic urine helps to define causes of azoospermia. Investigation of post-orgasmic urine is made in case of retrograde ejaculation.
• seeding of semen is made in pyospermia, and also in case of bad results of spermogram.

Types of Male Infertility

Male infertility is male inability to conceive a child during 12 months of regular tries without using contraception. Contrary to common belief, male infertility occurs as frequently as female infertility and is 35% of total number of infertility cases.

Types of male infertility
1) Obstruction
In this form the normal maturation of spermatozoids in testicles is not broken but there is a barrier on the way of spermatozoids movement from testicles in urethra. This may be caused by inherent absence or narrowing of a portion of seminiferous tubules, commissures left after inflammation, scar left after surgery, cyst, growth in genitalia or in near-by organs. Anatomical defects of penis (phimosis, penile curvature) may also cause obstructive infertility in males.

2) Secretory problem
In this form of infertility testicles cannot produce healthy spermatozoids in counts enough to fertilize ovule. Causes of this problem:

• genetic factors
• hormonal dysregulations
• severe chronic diseases (diabetes)
• past inflammatory diseases of genitalia (orchitis, parotitis, etc) including sexually transmitted diseases

Factors provoking disease:

• protein deprivation
• avitaminosis
• testicles trauma
• occupational hazards (ionizing radiation, high temperatures, contact with various toxins, etc)

3) Immunological problem
This form of infertility develops after testicles trauma. Normally, testicles tissues are separated from blood stream with a special barrier. When testicles traumas occur, this barrier may get damaged which may put into contact testicles tissues with blood immune cells. Body starts to accept testicles as foreign formation and as a result develops immune reaction with formation of antibodies against testicles tissues. Antibodies may be developed also against apermatozoids. Antisperm antibodies may block spermatogenesis, break sperm motility, prevent spermatozoids from entering cervical canal of uterus, aggravate fertilization, interrupt fission and even contribute to termination of early pregnancy.

Diagnosis
First stage of examination includes accurate history taking (past fertilizations and urological diseases). Must be performed spermogram analysis, detection of immunologic infertility factor.

Infertility – Common Problem in Partners

Infertility is most pressing problem in modern couples. According to WHO data, around 16% couples in the world have diagnosis “infertility”. Infertility sounds like a definitive verdict for couples who dream of having a baby.

However, often the diagnosis is made too early when not all tests have been made. The talk is about detailed tests before making exact diagnosis. According to statistics, after narrow examination the diagnosis “infertility” is recalled in 50% cases because most couples have problems with fertilization and carrying of a pregnancy but this has nothing to do with infertility.

Conception and pregnancy are very delicate biological processes and even most insufficient derivations in body of one of partners may make both partners put much more efforts than put others.

Infertility is common problem for both partners which must be solved together. If you and your partner strictly decided to make everything to conceive a baby then you should be ready to change your lifestyle. Sometimes a couple needs several months of painstaking preparations to achieve wishful result. During all this period it is important to support each other all the time and to follow all doctor's recommendations.

Medical Problems Of Penis Enlargement

Despite common saying that “the most important is quality of sex and not penis size”, most men anyway want to increase their penis length at least at several centimeters not depending on the initial penis length. This desire is quite reasonable and it may hardly be called cranky one, first of all because it is subconsciously put by the nature and expressed the more strongly, the more a man feels like a male or a leader in the community.

Insufficient penis length may cause male enchainment with women, loss of interest, diffidence and a number of complexes. So penis size becomes one of the major factors in realization of male as an individual as well as an important indicator that directly affects the quality of life.

Besides its social significance, penis size also reflects general men's health, particularly the condition of endocrine and reproductive system. The point is that penis length depends on the level of sex hormones (testosterone) at puberty, when occurs most intensive growth of external genitalia. Low testosterone level leads not just to slow growth of penile tissues, it also leads to further emergence of mental problems that may result in infertility because of lowering and finally full stopping of sperm cells production. The more earlier you detect the disease the more quickly you start its treatment.

Today are known about 20 congenital diseases characterized by breaking production of sex hormones and resulting in small penis length. In some cases it may even result in male infertility. Congenital diseases prevalence is high enough and it is about 1 in 500 newborn boys. It is necessary to make examinations of the child. Those examinations should be made by andrologist or endocrinologist that specializes at men's health.

Examinations should be made when the boy is achieved 14 years old, because at early age treatment of this pathology will be very effective. One of the most frequent causes of poor development of penis is Kallmann syndrome. Early stage of body development in this syndrome is characterized by dyspoiesis of brain hypophysis cells responsible for synthesis of hormone producing testosterone. As a result, diseased children of 3-4 years have no testes in the scrotum. After making corrective operation on testes omission, parents usually calm down thinking that problem is solved.

However, when boy achieves 18-25 years old and he compares himself with other boys he understands that he has evident problems with the development of penis and testicles. This may lead to development of inferiority complex, as a result boy reduces his social circle, he refuses from sports and swimming pool. Fear of being made fun of makes him refuse from communication with girls. As a result these boys become isolated and they chose professions that are not connected with frequent communication with people. In this case there is no talk about brilliant career of journalist, businessman, politician and lawyer.