Infertility is understood as the absence of conception in a couple living a regular sexual life without using contraception for more than one year. Infertility is faced by about 15% of couples who plan to conception each year.
The cause of infertility may be a reproductive failure in one of the partners (male or female) or in both partners. The latter is most often observed, because the impaired fertility (ability to have children) of one of the partners can be compensated by the preserved fertility of the other partner.
About the male factor, or male infertility, speak in the presence of changes in sperm parameters or mechanism of its delivery, preventing conception. This situation is observed in half of the men surveyed for marital infertility. The causes of male infertility are quite diverse and include medical factors:
Varicocele is a varicose vein of the scrotum that disrupts the blood supply to the testicle. The most common reversible cause of male infertility. The exact cause of varicocele causes infertility is unknown, probably due to an increase in the temperature of the scrotum, leading to spermatogenesis disruption and reduced sperm quality. Treatment of varicocele can improve the sperm parameters, increase the chances of natural conception and conception as a result of assisted reproductive methods (IVF/ICSI).
Infections of the reproductive system, which are accompanied by the entry into the sperm of various inflammatory products that disturb the sperm function, resulting in a deterioration of sperm parameters. These include: inflammation of the epididymitis appendage (epididymitis) or the testicle itself (orchitis), the prostate (prostatitis) and some sexually transmitted infections, including chlamydia, gonorrhea, trichomoniasis.
Ejaculation disorders. Retrograde ejaculation most often leads to infertility – a condition where semen during an orgasm does not go out through the urinary tract, but moves in the opposite direction and enters the bladder. Retrograde ejaculation can lead to diabetes mellitus, spinal cord injuries, taking certain medications, as well as surgery on the prostate or bladder. Delay in ejaculation is much rarer when a man during intercourse cannot reach orgasm or reaches orgasm, but not in all sexual acts, and it takes a significant amount of time (sometimes more than an hour).
Immune factors. Sperm cells, unlike other cells in the body, contain half a set of chromosomes, so the immune system perceives them as foreign cells. When in contact with spermatozoa, the immune system produces special proteins – antibodies, which are fixed to the spermatozoa and disturb their functioning. Normally, this does not happen, because the testicles are arranged in a special way, and spermatozoa in the process of maturation are protected from the interaction with the immune system cells by a special structure – hematotesticular barrier. But any violation of testicular structure (injury, varicocele, violation of ejaculation pathways) can lead to damage to the hematotesticular barrier and the formation of antispermic antibodies.
Testicles are not allowed to pass (cryptorchidism). In some men, one or both testicles are not lowered into the scrotum at birth but are in the groin or abdomen. Outside the scrotum, the testicles cannot function fully because spermatogenesis requires temperatures below body temperature. This leads to an irreversible spermatogenesis disorder that persists even after the testicles are surgically lowered into the scrotum. The likelihood of infertility is much higher in men with bilateral cryptorchidism than with unilateral cryptorchidism.
Hormonal disorders. Thyroid diseases (hyper- and hypothyroidism), adrenal gland diseases, low testosterone levels (male hypogonadism) have a negative impact on spermatogenesis. The most severe spermatogenesis disorders are observed in the deficit of the main hormone stimulating spermatogenesis – FSH (follicle stimulating hormone), but such conditions are rarely observed.
Tumors. Benign and malignant tumors of the testis itself and the structures regulating spermatogenesis, such as pituitary gland or hypothalamus, are often accompanied by severe sperm production disorders. The methods used to treat tumors also have a negative impact on sperm quality: chemotherapy, radiation therapy, surgery.