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CAUSES OF MALE INFERTILITY

More than 90% of male infertility cases are due to low s***m counts, poor s***m quality, or both. The remaining cases of male infertility can be caused by a range of conditions including anatomical problems, hormonal imbalances, and genetic defects.

S***m Abnormalities

S***m abnormalities are a critical factor in male infertility. These abnormalities include:

Low s***m count
Poor s***m motility (movement)
Abnormal s***m shape
Risk Factors

Risk factors for male infertility include:

Varicocele, an enlarged varicose vein in the s***matic cord that connects to the testicle
Aging, which can reduce s***m counts and motility and decrease the genetic quality of s***m
Sexually transmitted diseases, which can cause scarring in the male reproductive system or impair s***m function
Lifestyle factors such as smoking and substance abuse
Long-term or intensive exposure to certain types of chemicals, toxins, or medications
Diagnosis

In addition to a medical history and physical exam, specific tests for male infertility include:

Semen analysis to evaluate the quantity and quality of s***m
Blood tests to evaluate hormone levels
Imaging tests to look for structural problems
Genetic testing to identify s***m DNA fragmentation, chromosomal defects, or genetic diseases
Treatment

Treatment for male infertility should first address any underlying medical conditions that may be contributing to fertility problems. Drug therapy may be used to treat hormonal disorders. Surgery may be used to repair varicoceles and correct any obstructions in the reproductive tract.

If fertility issues remain unresolved, intracytoplasmic s***m injection (ICSI) is commonly used in combination with in vitro fertilization (IVF) to achieve pregnancy when male infertility is a factor. ICSI involves injecting a single s***m into an egg obtained through IVF. The fertilized egg is then implanted back into the woman. Pregnancy success rates depend on many different factors.

Introduction

Infertility is the failure of a couple to become pregnant after one year of regular, unprotected in*******se. About a third of infertility problems are due to female infertility, and another third are due to male infertility. In the remaining cases, infertility affects both partners or the cause is unclear. [For information about female infertility, Infertility in women.]

The Male Reproductive System
Male fertility depends on the proper function of a complex system of organs and hormones:

The process begins in the area of the brain called the hypothalamus-pituitary axis, a system of glands, hormones, and chemical messengers called neurotransmitters, all of which are critical for reproduction.
The first step in fertility is the production of gonadotropin-releasing hormone (GnRH) in the hypothalamus, which prompts the pituitary gland to manufacture follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
FSH maintains s***m production, and LH stimulates the production of the male hormone testosterone.
Both s***m and testosterone production occurs in the two testicles, or te**es, which are contained in the scrotal sac (the sc***um). (This sac develops on the outside of the body because internal body temperature is too high to allow s***m production.)
Male reproductive anatomy
The male reproductive structures include the p***s, the sc***um, the seminal vesicles, and the prostate.

S***m

S***m are made in hundreds of microscopic tubes, known as seminiferous tubules, which make up most of the testicles.
Surrounding these tubules are clumps of tissue containing Leydig cells, which produce testosterone when stimulated by luteinizing hormone (LH).

S***m Development. The life cycle of s***m takes about 74 days:

S***m begin partially embedded in nurturing Sertoli cells, which are located in the lower parts of the seminiferous tubules.
As they mature and move along, they are stored in the upper part of the tubules. Young s***m cells are known as s***matids.
When the s***m has completed the development of its head and tail, it is released from the cell into the epididymis. This C-shaped tube is 1/300 of an inch in diameter and about 20 feet long. It loops back and forth on itself within a space that is only about one and a half inches long. The s***m's journey through the epididymis takes about 3 weeks.
The fluid in which the s***m is transported contains sugar in the form of fructose, which provides energy as the s***m matures. In the early stages of its passage, the s***m cannot swim in a forward direction and can only vibrate its tail weakly. By the time the s***m reaches the end of the epididymis, however, it is mature and looks like a microscopic squirming tadpole.
At maturity, each healthy s***m consists of a head that contains the man's genetic material (his DNA) and a tail that lashes back and forth at great speed to propel the head forward at about four times its own length every second. The ability of a s***m to move forward rapidly and straight is probably the most significant determinant of male fertility.
Ej*******on. When a man experiences sexual excitement, nerves stimulate the muscles in the epididymis to contract, which forces the s***m out through the p***s:

After being produced in the testicle, the s***m first pass through the epididymis and then into one of two rigid and wire-like muscular channels, called the vasa deferentia. (A single member of this pair of channels is called a vas deferens.)
Muscle contractions in the vas deferens from sexual activity propel the s***m along past the seminal vesicles. These are clusters of tissue that contribute fluid, called seminal fluid, to the s***m. The vas deferens also collects fluid from the nearby prostate gland. This mixture of various fluids and s***m is the semen.
Each vas deferens then joins together to form the ejaculatory duct. This duct, which now contains the s***m-containing semen, passes down through the urethra. (The urethra is the same channel in the p***s through which a man urinates, but during or**sm, muscles close off the bladder so that urine cannot enter the urethra.)
The semen is forced through the urethra during ej*******on, the final stage of or**sm when the s***m is literally shot out of the p***s.

Pathway of s***m

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Recognising the need to check whether trial results were “too good to be true”, the researchers also completed a systematic review of past trials, including 36 trials with 47,500 patients testing single and dual quarter-dose therapy. This previous evidence also indicated little or no side effects with very low doses, and important benefits with three or four drug combinations. Professor Clara Chow, of The George Institute, said the results were exciting but larger trials were still needed to see if these high rates could be maintained and repeated.

“Most people receive one medicine at a normal dose but that only controls blood pressure about half the time. In this small trial, blood pressure control was achieved for everyone. Trials will now test whether this can be repeated and maintained long-term,” Chow said.

“Minimising side effects is important for long-term treatments — we didn’t see any issues in this trial, as you would hope with very low dose therapy, but this is the area where more long-term research is most needed.

“We know that high blood pressure is a precursor to stroke, diabetes and heart attack. The need for even lower blood pressure levels has been widely accepted in the last few years. So, this could be an incredibly important step in helping to reduce the burden of disease globally,” said Chow. Hypertension or high blood pressure affects around 1.1 billion people worldwide.

Over four weeks 18 patients in Sydney were either given a quadpill — a single capsule containing four of the most commonly used blood pressure-lowering drugs each at a quarter dose — or a placebo.

This was then repeated for a further four weeks with the patients swapping their course of treatment.

Blood pressure levels were measured hourly over a 24 hour period at the end of each treatment, allowing researchers to significantly reduce the amount of patients normally required in a clinical trial.

As many as 100 per cent of patients on trial saw their blood levels drop below 140 over 90. Just 33 per cent of patients on the placebo achieved this rate.

None of the patients experienced side effects commonly associated with hypertension lowering drugs, which can vary from swollen ankles to kidney abnormalities depending on the type of class of the drug.

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