Fertility issues in men can stem from a variety of medical conditions. This section covers several conditions that affect male fertility, including:
· anejaculation,
· genital tract infections,
· hypogonadotropic hypogonadism,
· genetic conditions, and
· retrograde ejaculation.
Anejaculation (Dry Ejaculate)
Anejaculation is when no semen fluid is released during a man’s climax. Although uncommon, it can be caused by factors such as spinal cord injury, prior surgery, diabetes, multiple sclerosis, birth abnormalities, and various mental, emotional, or unknown issues. To treat this condition, medications are often tried first. If these are ineffective, other options include penile vibratory stimulation (PVS), which uses vibration to induce ejaculation, or rectal probe electroejaculation (RPE), also known as electroejaculation (EEJ). In cases where these methods are unsuccessful, sperm may be retrieved directly from the testicles with a needle through a procedure called testicular sperm aspiration. Assisted reproductive techniques like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are valuable for men with anejaculation, as they address the underlying problem of impaired sperm and semen transport.
Genital Tract Infection
While genital tract infections rarely cause infertility, they can sometimes be identified through semen tests that reveal white blood cells. These white blood cells produce reactive oxygen species that can damage sperm, lowering the chances of successful fertilization. Severe infections of the epididymis and testes can lead to blockages in the epididymal duct. Treatment for full-blown infections often involves antibiotics, while non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, may be used for lesser inflammations. Chronic prostatitis, although rare, can also cause blockages in the ejaculatory ducts and affect fertility.
Hypogonadotropic Hypogonadism
Hypogonadotropic hypogonadism occurs when the testicles do not produce sperm due to insufficient stimulation by pituitary hormones. This condition can be congenital (present from birth) or acquired later in life. Congenital hypogonadotropic hypogonadism, also known as Kallmann syndrome, is caused by low levels of gonadotropin-releasing hormone (GnRH). Acquired hypogonadotropic hypogonadism can be brought on by health issues such as pituitary tumors, head trauma, or anabolic steroid use. Diagnosis often involves magnetic resonance imaging to check the pituitary gland and blood tests to measure prolactin levels. If hypogonadotropic hypogonadism is confirmed, gonadotropin replacement therapy is the next step, which generally results in normal sperm production and a high chance of achieving pregnancy.
Genetic Conditions
Some men are born with genetic conditions that affect fertility, which may be new (not present in other family members) or hereditary (passed from mother and/or father). These conditions often result in azoospermia (no sperm in the ejaculate). Examples include Klinefelter syndrome, where an extra chromosome is present, and Y chromosome microdeletion, where a small part of genetic material is missing. Genetic conditions can hinder the development of the male reproductive tract and the transport of sperm, ultimately affecting fertility.
Retrograde Ejaculation
Retrograde ejaculation occurs when semen flows back into the bladder instead of exiting through the penis. This condition can be caused by prostate or bladder surgeries, diabetes, spinal cord injury, certain medications (such as antidepressants and anti-hypertensives), and drugs used to treat prostate enlargement. Diagnosis involves a urine test to check for sperm under a microscope after ejaculation. Treatment often starts with over-the-counter medications. If these do not work, healthcare providers may collect sperm from the bladder after ejaculation for use in assisted reproductive techniques (ARTs).
Understanding and managing these various conditions can significantly improve the chances of overcoming male infertility.
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