Description

Male infertility refers to a man’s inability to cause pregnancy in a fertile female partner after 12 months of regular, unprotected intercourse. It accounts for about 40–50% of infertility cases. 1. Common Causes Male infertility often results from issues that affect sperm production, sperm function, or sperm delivery. Major categories include: A. Sperm Production Problems Low sperm count (oligospermia) No sperm in semen (azoospermia) Poor sperm motility (asthenospermia) Abnormal sperm shape (teratospermia) Causes: genetic disorders, varicocele, infections (mumps orchitis), undescended testes, toxins, radiation, smoking. B. Hormonal Causes Low testosterone Disorders of the pituitary or hypothalamus Examples: hyperprolactinemia, Kallmann syndrome. C. Obstruction of Sperm Pathways Blocked epididymis, vas deferens, or ejaculatory ducts due to: Infection (STIs, tuberculosis) Prior surgeries (hernia repair, vasectomy) Congenital absence of vas deferens (linked with CFTR mutations) D. Sexual/Ejaculatory Dysfunction Erectile dysfunction Retrograde ejaculation (semen goes into bladder) Premature ejaculation E. Lifestyle & Environmental Factors Smoking, heavy alcohol, drugs (anabolic steroids, marijuana) Heat exposure (saunas, laptops on lap) Obesity, stress Environmental toxins (pesticides, heavy metals) F. Immunologic Infertility Antisperm antibodies affecting motility or penetration. 2. Symptoms Male infertility usually has no obvious symptoms, except: Problems with sexual function Testicular pain or swelling Gynecomastia Loss of body hair Reduced libido Small or firm testes 3. Diagnosis A typical work-up includes: A. Semen Analysis (Main Test) Evaluates: Sperm count, motility, morphology Semen volume pH and vitality (Repeated at least 2 times, 2–3 weeks apart) B. Physical Exam Looking for varicocele, testicular size, hormonal signs. C. Hormone Tests FSH, LH, testosterone, prolactin, TSH. D. Imaging Scrotal ultrasound (varicocele) Transrectal ultrasound (duct obstruction)