Male Infertility Overview
Infertility is the inability to conceive after at least one
year of unprotected intercourse. Since most people are able to
conceive within this time, physicians recommend that couples
unable to do so be assessed for fertility problems. In men,
hormone disorders, illness, reproductive anatomy trauma and
obstruction, and sexual dysfunction can temporarily or
permanently affect sperm and prevent conception. Some disorders
become more difficult to treat the longer they persist without
treatment.
Sperm Development
Spermatogenesis takes place in the ducts
(seminiferous tubules) of the testes. Cell division produces
mature sperm cells (spermatozoa) that contain one-half of a
man's genetic code. Each spermatogenesis cycle consists of six
stages and takes about 16 days to complete. Approximately five
cycles, or 2 ? months, are needed to produce one mature sperm.
Energy-generating organelles (mitochondria) inside each sperm
power its tail (flagellum) so that it can swim to the female egg
once inside the vagina. Sperm development is ultimately
controlled by the endocrine (hormonal) system that comprises the
hypothalamic-pituitary-gonadal axis. Because sperm
development takes over 2 months, illness that was present during
the first cycle may affect mature sperm, regardless of a man's
health at the time of examination.
Incidence and Prevalence
According to the National Institutes of Health, male infertility
is involved in approximately 40% of the 2.6 million infertile
married couples in the United States. One-half of these men
experience irreversible infertility and cannot father children,
and a small number of these cases are caused by a treatable
medical condition.
Causes and Risk Factors
The primary causes of male infertility are
impaired sperm production, impaired sperm delivery, and
testosterone deficiency (hypogonadism). Infertility can
result from a condition that is present at birth (congenital) or
that develops later (acquired). Causes of infertility include
the following:
-
Chemotherapy
- Defect or obstruction in the reproductive system such as
failure of testes to descend into the scrotum (cryptorchidism)
or absence of one or both testicles (anorchism)
- Disease (e.g., cystic fibrosis, sickle cell anemia,
sexually transmitted diseases [STDs])
- Hormone dysfunction (testosterone deficiency; caused by
a disorder in the hypothalamic-pituitary-gonadal axis)
- Infection (e.g., prostatitis, epididymitis, orchitis;
can cause irreversible infertility if they occur before
puberty)
- Injury (e.g., testicular trauma)
- Medications to treat high blood pressure (hypertension)
and digestive disease
- Metabolic disorders such as hemochromatosis (affects how
the body uses and stores iron)
- Systemic disease (high fever, infection, kidney disease)
- Testicular cancer
- Varicocele
Procedural Overview
These procedures are performed to harvest sperm for
invitro fertilization procedures to attain pregnancy. The MESA
is a microscopic epididymal sperm aspiration, the TSA
is a testicular sperm aspiration and the testis biopsy obtains
testicular tissue to find individual sperm. The MESA and TSA or
TESE use fine needles that are inserted into the various
structures that sperm travel and aspirated. Very little seminal
fluid is required since only one live sperm per cycle is
required for intracytoplasmic sperm insertion (ICSI). These
procedures are completed using a scrotal incision and can be
completed in the office setting or in the hospital operating
room.
Learn more about Male Infertility procedures at Winter Park Urology...
- Male Infertility Pre-Surgical Information [LINK]
- Male Infertility Post Surgical Information [LINK]