GYN CHRONICLES
Male Infertility
Dr. Maureen Owiti
A
s promised and reminded by our
able editor we’ll discuss Male
Infertility on this column in this
publication. I prefer using sub-fertility as
it implies there is hope. I love Argentinians
as they know it takes two to tango. The
same goes with fertility issues.
For a married couple it would be prudent
to remember that you need the support
of your spouse. I know we have solutions
for severe forms of either male or female
infertility in the form of donors but I am
as yet to meet a couple who would not
prefer to use their own gametes in their
endeavor to have children.
5% of couples are infertile and male
infertility accounts for about 40-50% of
all cases. What are the main causes of male
infertility? Like many conditions causes
for infertility can either be congenital i.e.
you are born with it or acquired.
Causes Of Infertility
Varicoceles: These are swollen veins in
the scrotum and are found in 16% of men
i.e. if we have 100 men 16 of them will
have this condition.
Anti-sperm antibodies/immunologic -
infertility: Some men produce antibodies
that attack their own sperm. This can occur
because of injury, surgery or infection.
Retrograde ejaculation: This is when
there is abnormal flow of semen from
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the ejaculatory tract back to the bladder
instead of out through the penis. This is
due to a nerve problem inhibiting muscles
in the bladder wall from closing. A
diagnosis can be made when high semen
volume is found in urine.
Obstructive azoospermia: This is when
there is a block in the vas deferens (tube
where sperm travel from the testicle to
penis). Again this can be due to surgery
(vasectomy), infection or an injury from
an accident affecting the pelvis. Some
people have congenital absence of vas
deferens.
Genetic and Chromosomal disorders:
Some people have abnormal number or
structure of chromosomes resulting in
problems with infertility. Examples of this
include: Mutations of the Cystic fibrosis
gene that causes Congenital absence of
vas deferens; Y chromosome deletions,
Kleinfelter syndrome, Down Syndrome
and so on.
Infections: Some infections can cause
damage to the testicular tissue and hamper
sperm production. These infection include
measles, mumps, chicken pox and so on
and it is worse if this occurs after puberty.
Medication: Some medication can
hamper sperm production, function and
delivery. These are medication used to
treat some common conditions such
as hypertension, arthritis, depression,
(gynaecomastia), Decreased facial or body
hair, Inability to smell, and Recurrent
chest infections.
In order to get the female partner to
conceive the male partner must be able
to produce enough healthy sperm and
the sperm should be adequate in terms of
number (quantity) and function (quality).
We measure this through a semen count.
For a good sperm sample we actually
need at least 39 million sperm in the
ejaculate. A crazy figure considering that
physiologically only one sperm should
fertilize the egg to produce a normal fetus.
Oligospermia refers to low sperm counts
in the semen sample.
In terms of quality there must be sperm
that move and they should move forward
at high speed. Usain Bolt manenos.
Where the sperm have limited progressive
movement we call this asthenozoospermia.
Some samples have a high number of
dead sperm – necrozoospermia. I find it
interesting when semen samples come up
with 88% normal sperm, however unless
we are using the wrong criteria even very
good samples will have only about 12%
normal sperm.
The cut off for abnormal sperm is 4%
meaning if less than 4% of sperm are
normal the sample is classified as having
teratozoospermia – many abnormal sperm.
A patient can have all of the above i.e.
oligoasthenoteratozoopsermia
(OATS)