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Treatment Of Infertility In Men
The
medical infertility workup is usually able to diagnose the cause
of a fertility problem in a man. Identifying the problem is
the first step in recommending treatment. The most common causes
for male infertility are problems with testicles, problems with
sperm transport, hormonal problems, and ejaculatory problems.
Each is described in detail below.
Testicular
Problem
The testicles are the manufacturing plants for sperm production
(spermatogenesis). Normal sperm production requires hormonal
orchestration as well as a sound and safe physical environment.
Problems or injuries that affect the testicles can disrupt spermatogenesis.
The following table reviews testicular problems.
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Testicular
Problems
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Diagnosis
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Treatment
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| Varicocele |
Explanation |
Varicoceles (a mass of varicose veins in the scrotum) are a
leading cause of male infertility. A valve defect within
the veins causes the blood to back up and pool, resulting
in swollen veins. Varicoceles impair semen production. This
problem usually only affects one testicle, often the left
testicle. |
| Symptoms |
Large varicoceles produce a mass that visible through the scrotum.
A physician can feel moderately sized varicoceles. Small
ones are harder to detect. The testicle involved is often
smaller than the unaffected testicle. |
| Treatment |
Surgery is performed under general anesthesia, and in most
cases is successful in restoring fertility. |
| Mumps
Contracted As An Adult |
Explanation |
When
mumps are contracted as an adult, the virus can invade
one or both testicles, destroying the cells that are responsible
for sperm production.
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| Symptoms |
Small testicles are usually noted, high levels of FSH, and
low or no sperm production. |
| Treatment |
A mumps
vaccine can prevent the disease and should be considered
for men who did not contract mumps as a child. Low sperm
production may respond to hormone therapy with fertility
drugs or ART
(Assisted Reproductive Technology) procedures. If
no sperm are being produced, there is no treatment which
can restore this ability.
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| Infections
Affecting the Testicles |
Explanation |
Sexually
transmitted diseases (STD's) are the most common type
of infection that can lead damage of the reproductive
tract and cause infertility.
Any
illness that causes a high fever can temporarily reduce
sperm counts. Dental abscesses have been implicated in
low sperm counts.
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| Symptoms |
STD's
may cause thick discharge, pain on urination, or difficulty
urinating or ejaculating because of scar tissue. Some
STD's have no obvious symptoms.
Pain
and swelling may accompany any infection that has reached
the testicles.
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| Treatment |
In the
case of STD's, prevention is the best treatment. Condoms
can help reduce the risk of infections. Many STD's are
treatable with antibiotics.
In the
cases where STD's are not the culprit, good oral hygiene
can prevent oral bacteria from traveling through the bloodstream
and invading the testicles. In terms of other illnesses
and viruses, once treated, sperm production usually returns
to normal.
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| Trauma |
Explanation |
Injuries to the testicles can damage the sperm making machinery.
Sports injuries and torsion (when the testicle twists and
cuts off it's own blood supply) are traumas that can lead
to infertility. |
| Symptoms |
Sports injuries and torsion cause obvious pain. Swelling may
be noted. |
| Treatment |
Some injuries will require surgical treatment. Torsion is corrected
with the help of a urologist who unwinds the testicle which
restores normal blood flow. |
| Congenital
Defects |
Explanation |
Some
defects are congenital, or present at birth. Klinefelter's
Syndrome is a chromosome abnormality where there is an
extra X chromosome. (XXY). This syndrome prevents sperm
production.
Sertoli's
Cell Only Syndrome results in an inability to produce
sperm because the cells responsible for sperm production
don't develop during fetal development.
Undescended
Testicles is another cause for sperm production failure.
Testicles develop in the abdomen of the fetus and then
descend into the scrotum after birth. If the testicles
fail to descend, and go unnoticed, then the warmth of
the body destroys the sperm manufacturing capabilities.
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| Symptoms |
Klinefelter's
Syndrome often goes unnoticed until infertility is apparent.
If symptoms are present they include; small testicles,
and slightly enlarged breast tissue.
Sertoli's
Cell Only Syndrome is only detectable with infertility
tests. Semen has all of the normal components except sperm.
Undescended
Testicles can be detected by physical exam of the scrotal
sac.
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| Treatment |
Klinefelter's
Syndrome and Sertoli's Cell Only Syndrome cause untreatable
sterility. However, some men who have Klinefelter's have
a partial defect where some cells carry the extra chromosome
XXY, while other cells are normal XY. As long as some
cells are normal, there may be some sperm production.
ART procedures can be employed to increase the chances
of conception.
For undescended
testicles, HCG hormone can be given to male infants to stimulate
the descent of the testicles. If that is not successful, microsurgery
can be performed to move the testicles into the scrotum.
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| Other Factors |
Explanation |
High stress levels, excessive heat to the testicles, high altitudes,
poor diet, exposure to toxic substances, use of certain
drugs (including anabolic steroids) and alcohol can all
decrease sperm production. |
| Symptoms |
Lab tests will show decreased sperm production or abnormal
sperm cells. |
| Treatment |
Avoid the offending factor. Eat a balanced, healthy diet. Limit
alcohol intake. Avoid street drugs and check with your
doctor regarding the safety of any prescription drugs
that you are taking. Reduce
stress. Avoid exposure
to toxic substances. Avoid extremely high altitudes
because the lower oxygen content of the air can depress
sperm production. Relocating from a lower altitude to
a higher altitude temporarily reduces sperm counts. Once
the body has adjusted by increasing it's red blood cells,
the sperm production will return to normal. Heat kills
sperm. Avoid hot tubs, saunas and even tight briefs that
hold the testicles too close to the body.
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Back to the Top
Sperm
Transport Problems
Sperm may be produced normally in the testicles, but the next
feat involves moving the sperm from the testicles through the
epididymis, vas deferens and out through the penis. Any obstruction
in this pathway can prevent the sperm from reaching their target,
the egg.
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Sperm
Transport Problems
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Diagnosis
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Treatment
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Blocked
Ducts:
The Epididymis,
Vas Deferens or Ejaculatory Ducts |
Explanation |
Infections and sexually transmitted diseases (STD's) can cause
scarring that block the ducts. Tuberculosis (TB) can have
a similar damaging affect. Surgeries done to correct other
problems in the vicinity of the ducts could have bruised
or severed the vas deferens. Trauma and birth defects can
also render the transport system ineffective. |
| Symptoms |
Low or no sperm count. |
| Treatment |
Microsurgical repair is sometimes possible. Some untreated
infections or STD's can cause permanent sterility.
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| Vasectomy |
Explanation |
A vasectomy
is a form of permanent sterilization. The vas deferens
are cut or tied off to prevent sperm from exiting the
testicles. If a man later decides he wants to father a
child, the vasectomy becomes a barrier to fertilization.
Some
men who have had vasectomies will form antibodies to the
sperm that remain in the testicles. Once a man produces
antibodies to his own sperm, the antibodies continue to
attack the sperm even if the vasectomy is reversed.
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| Symptoms |
Sterility after the vasectomy. |
| Treatment |
Microsurgery
to reverse the vasectomy requires reconnecting the minute
tubes. Success rates vary, but reversal often restores
fertility.
Antibody
problems are addressed by ejaculating into a buffer solution.
The sperm can then be washed and used in ART procedures.
Cortisone is a drug that suppresses the immune system
and is used to treat the problem of sperm antibody formation.
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Back to the Top
Hormonal Problems
FSH and LH are hormones, messengers from the brain, that are
responsible for directing sperm production. Low hormone levels
can indicate a problem with the brain's control of sperm production.
High hormone levels usually mean the message to produce sperm
has been sent, but the testicles are unable to manufacture the
sperm. High levels of FSH and LH may indicate a problem that
does not currently have good treatment options. Low levels of
FSH and LH can often be corrected with hormone replacement therapy.
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Hormonal
Problems
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Diagnosis
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Treatment
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| Kallman's
Syndrome |
Explanation |
This
congenital problem (present at birth) effects the hypothalamus,
which is the region of the brain that starts the hormone
relay that directs sperm production. Men with Kallman's
Syndrome have no sperm in their ejaculate.
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| Symptoms |
Besides infertility, men with this syndrome tend to be tall
and thin, and have soft, small testicles. The men may be
color blind or deaf, and have no sense of smell. Testosterone
is not produced, and all other hormone levels are low. |
| Treatment |
Fertility
drugs are used to treat this disorder. Providing hMG
(a combination of FSH and LH) can stimulate the testicles
to produce testosterone so that male sexual characteristics
develop. HCG and LH-RH are other hormones that can stimulate
the testicles into normal sperm production.
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| Damage
To The Hypothalamus Or Pituitary |
Explanation |
The
hypothalamus and the pituitary gland are instrumental in
initiating the hormonal flow that directs sperm production.
Any injury to the brain or directly to the hypothalamus
or pituitary can shut down the hormonal control center and
lead to infertility. Brain tumors, infections, encephalitis
(brain infection) and certain drugs can be the cause of
the problem. |
| Symptoms |
No
or low sperm count. Low hormone levels of FSH, LH and testosterone.
High levels of prolactin hormone. Possibly small, soft testicles,
enlarged breast tissue and impotence. Blurred vision may
accompany large pituitary tumors. |
| Treatment |
Hormonal
replacement of FSH and LH may direct the testicles to
produce sperm. CAT scans can detect pituitary tumors and
then the tumor can be removed surgically. Some
forms of damage are irreparable. Your physician will be
able to direct you towards any treatment possibilities.
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| Faulty Adrenal Gland |
Explanation |
The adrenal glands, located on the kidneys, produce some testosterone.
(Most testosterone is produced by the testicles). Although
rare, if the adrenal gland produces too much testosterone,
the message to the brain is to stop sending FSH and LH.
This interferes with normal sperm production. |
| Symptoms |
If adrenal problems occur in young boys, they will experience
accelerated sexual maturation. If the problem occurs after
puberty, the result is low sperm count. Hormone tests will
detect low levels of FSH and LH and high levels of testosterone. |
| Treatment |
Cortisol treatment (a steroid) will correct the problem and
slow down the testosterone production. |
| Faulty
Thyroid Gland |
Explanation |
The thyroid gland directs cell metabolism. (Metabolism is the
rate at which cellular functions occur). Sperm production
can be may be affected by changes in metabolism. |
| Symptoms |
Hyperthyroidism (too much thyroid hormone) has symptoms that
include agitation, restlessness, insomnia, muscle fatigue,
shakiness, jumpy reflexes and irritability.
Hypothyroidism (too little thyroid hormone) has symptoms
that include sleepiness, poor reflexes, hair loss, slurred
speech, and constipation. |
| Treatment |
Hyperthyroidism is treated with drugs that reduce thyroid hormone
production, or the thyroid gland may be radiated. Hypothyroidism
is treated by thyroid replacement therapy. |
Back to the Top
Ejaculatory Problems
The process of
ejaculation propels the sperm out of the man's body, making the
sperm available for fertilizing the egg. Problems related to ejaculation
can interfere with the process of conception.
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Ejaculatory Problems
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Diagnosis
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Treatment
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| Impotence |
Explanation |
Impotence may have physical or psychological causes. Illicit
drugs, alcohol and some prescription drugs can cause impotence.
Stress and emotional upset may be the cause. Certain disease
states can cause impotence; for example poorly controlled
diabetes can lead to high blood sugar levels which damage
blood vessels and nerves. Spinal cord injuries may also
cause impotence. |
| Symptoms |
Inability to achieve or maintain an erection. |
| Treatment |
A medical workup must be done to distinguish between medical
or psychological causes. Counseling and resolution of
emotional conflict may correct the impotence. Abstain
from alcohol and drugs that result in impotence. Blood
sugar control in men with diabetes is crucial in preventing
all diabetes related complications, including impotence.
Men with spinal cord injuries can use a medical electrical
device designed to induce ejaculation. The collected sperm
can be used with ART
to fertilize an egg.
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| Retrograde Ejaculation |
Explanation |
The valve that
separates the urethra from the bladder is supposed to close during
an orgasm to force the semen out of the penis. A faulty valve won't
close. Instead of the ejaculate leaving the body through the penis,
it travels backwards into the bladder and is expelled later with
urination. Causes include uncontrolled diabetes, certain drugs (including
some high blood pressure medications), or injury to the area.
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| Symptoms |
An orgasm that doesn't produce any semen. Urine that is milky
white after an orgasm. |
| Treatment |
Injury may require surgical repair. Blood sugar control in
men with diabetes is crucial in preventing all diabetes
related complications, including retrograde ejaculation.
Lastly, medical technology allows collection of the sperm
from the voided urine. The collected sperm may then be
used with ART
to fertilize an egg.
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