Understanding Male Infertility: Key Tests and Causes
Male infertility is defined as the inability of a couple to conceive after two years of unprotected intercourse, with the female partner undergoing normal examinations while the male does not. This condition is a significant source of concern for many men. Statistics indicate that approximately 15% of married couples face infertility issues, with male factors contributing to around 50% of these cases. Therefore, it is essential for both partners in an infertile couple to undergo necessary tests to promptly identify the underlying causes and pursue targeted treatments.
Common Causes: Mumps and Orchitis
Conditions such as mumps and orchitis are known to contribute to male infertility. During physical examinations, if the testicles appear uneven in texture or irregular in shape, it may suggest the presence of scarring. Approximately half of the individuals with bilateral orchitis experience slight testicular atrophy. While atrophy in one testicle may not significantly impact fertility or sexual activity post-marriage, bilateral involvement can lead to more severe infertility issues, with reports indicating only about 5% of affected individuals retain their fertilization capability.
The mumps virus not only affects glandular tissues but also has a significant affinity for nerve tissues and the pancreas, particularly impacting the testicles. About one-fourth to one-fifth of mumps patients develop orchitis, with two-thirds of these cases being unilateral and the remaining third bilateral. The condition typically lasts from 3 to 5 days, but in severe cases, it can extend up to two weeks. Post-puberty orchitis may lead to irreversible damage to the testicular seminiferous tubules, resulting in atrophy and potential infertility. Additionally, adults experiencing bilateral mumps orchitis may face hypogonadism, azoospermia, or greatly reduced sperm counts, sometimes falling below 4 million/ml.
What Causes Male Infertility?
Generally, about 80% to 85% of couples conceive within the first year of marriage, with an additional 10% to 15% in the second year. If a couple remains infertile for over three years, it requires further investigation. Many patients with infertility issues consult healthcare providers without experiencing any other symptoms, only to discover abnormalities through standard tests. According to the World Health Organization (WHO), infertility for males is defined by at least 12 months of unprotected intercourse without conception. Primary male infertility refers to men who have never impregnated a woman, whereas secondary male infertility describes those who have previously fathered a child.
The chances of restoring fertility are generally higher for men with secondary infertility compared to primary infertility. Male infertility has become a common condition, with sperm counts considered normal when they exceed 60 million per milliliter, while counts below 20 million are viewed as concerning. The causes of male infertility are complex and classified into 16 categories by the WHO. Some of the primary causes include:
1. Reproductive Tract Infections
Infections in the male reproductive system can affect the normal function of the testes, leading to hormonal imbalances and decreased sperm production. Most patients may experience symptoms such as acute orchitis, epididymitis, prostatitis, or urethritis. In severe cases, scarring in the genital tract may hinder the transit of sperm, preventing successful conception.
2. Varicocele
Varicocele is characterized by the enlargement of veins within the scrotum, which can impede the blood flow from the testicles, raising their temperature and disrupting normal testicular metabolism. This environment can lead to impaired spermatogenesis, resulting in low sperm counts and reduced sperm motility.
3. Immune Function Abnormalities
Occasionally, men may develop autoimmune responses against their own sperm due to conditions like urethritis or prostatitis. If the blood-testis barrier is compromised, the immune system may generate anti-sperm antibodies, leading to sperm immobilization, low sperm counts, or complete lack of sperm, ultimately hindering fertilization.
Addressing male infertility requires a comprehensive understanding of its root causes. Early diagnosis and targeted treatment can greatly enhance the likelihood of conception, making it crucial for men to seek medical advice when facing infertility issues.