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Male Infertility |
Male fertility requires normal erection and ejaculation and adequate semen quality. According to the World Health Organization (WHO), when a fertile man ejaculates during intercourse, he deposits at least 12 million motile and normal sperm at the base of the vagina. The disorders that can lead to infertility include:
An erection that is not able to penetrate the vagina can lead to infertility. The cause should be investigated and treated if possible. The use of sildenafil (Viagra) or prostaglandin E1 (Caverject) can be a great help in solving most types of erectile dysfunction. A man with erectile dysfunction who wants to have children and ejaculates normal semen can provide his own semen for artificial insemination.
Infertility can be due to the failure to ejaculate, as the man who does not ejaculate cannot deposit semen in the vagina. The most frequent causes of anejaculation are diabetes and spinal cord injuries that lead to paraplegia, although hormonal and psychological factors may also play a part. Men suffering from anejaculation produce sperm but cannot expel them.
TREATMENT: Anejaculation can be treated when the cause is hormonal, psychological or, in some cases, neurological. The usual treatment is to perform assisted reproduction, which involves extracting sperm. Methods include: a) electroejaculation, which involves checking into hospital and administering a general anesthetic, b) vibratory stimulation, which can cause hypertension, c) the extraction of sperm from the testicle by performing a biopsy and d) prostate massage. The latter is the simplest method and the one performed at the CEFER Reproduction Institute.
TREATMENT: Treatment can include artificial insemination, in vitro fertilization or ICSI. The technique to be used will depend on the quality of the sperm obtained.
Azoospermia means the absence of sperm in the semen. There are two types:
SECRETORY AZOOSPERMIA. This occurs when no sperm is produced in the testicles. The most frequent causes are: chromosomal or genetic conditions; cryptorchidism (when the testicles do not descend into the scrotum); orchitis (inflammation of the testes, often caused by mumps); hormone deficits; radiotherapy or chemotherapy.
TREATMENT: The condition can only be treated when it is caused by the lack of follicle-stimulating hormone (FSH) or luteinizing hormone (LH). It is possible for an azoospermic man to have sperm in some parts of the testes. In this case, the sperm can be extracted and used for in vitro fertilization with ICSI.
OBSTRUCTIVE AZOOSPERMIA. This occurs when sperm is produced in the testicles but the ducts that join the testicles to the penis are obstructed. The most frequent causes are: the congenital absence of vasa deferentia (e.g., in men with cystic fibrosis); seminal-duct infections that form a scar on the ducts which obstructs them; when the vasa deferentia are severed, e.g., during a vasectomy or as a result of complications during an inguinal hernia operation.
TREATMENT: Reconstructive surgery or in vitro fertilization with ICSI. The latter is more effective.
OLIGOASTHENOZOOSPERMIA This refers to a decrease in the number and motility of sperm. There are many possible causes, including chromosomal, genetic or hormonal disorders; infections; partial obstruction of the seminal ducts; varicocele (dilated veins in the testicles), etc.
TREATMENT: The methods for treating this condition depend on the cause. For cases that cannot be treated, either artificial insemination, in vitro fertilization or ICSI is recommended, depending on how severe the condition is
ASTHENOZOOSPERMIA: This refers to a decrease in sperm motility. If sperm are not motile, they cannot travel from the vagina (where they are deposited during intercourse) to the fallopian tubes, where they make contact with the egg. The most frequent causes are: infections, antisperm antibodies, varicocele and damage to the sperm tails. The condition can be diagnosed through the use of an electron microscope.
TREATMENT: Methods for treating the condition depend on the cause. Either artificial insemination, in vitro fertilization or ICSI is recommended for cases that cannot be treated.
