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8.1 Causes Of Infertility In Men


This article is from the Infertility FAQ, by Rebecca Smith Waddell bec@fertilityplus.org with numerous contributions by others.

8.1 Causes Of Infertility In Men

Cancer treatment: Chemotherapy and radiation can cause abnormal sperm
or sterility.

DES (diethylstilbestrol) exposure: Synthetic estrogen used in the 50s
and 60s used by women to prevent miscarriage. Can cause low sperm
counts, decreased sperm motility, and abnormal sperm forms, small
penises, undescended testicles (risk factor for testicular cancer),
abnormal testicles.

Hormonal imbalances: Hormone problems affecting sperm count include
thyroid problems, low testosterone levels, elevated FSH, and excess
prolactin (see next entry).

Hyperprolactinemia (excess prolactin): can inhibit GnRH, resulting in
lower LH and testosterone. Also low FSH.

Idiopathic oligospermia: A fancy way of saying, "You don't have much
sperm, and we have no idea why."

Immune problems: Both men and women can have immune reactions to
sperm. There is a lot of controversy about how prevalent this
is. Immune reactions to sperm in the man (autoimmune) can be a problem
post-vasectomy, but may also have other causes. Anti-sperm antibodies
in the male are often indicated by hyperviscosity which may inhibit
forward progression. In mild cases, anti-sperm antibodies in the male
or female (alloimmune) may be overcome by IUIs, for which the man will
be asked to ejaculate into a cup with a special preparation in it. If
IUI does not work, or if the problem is considered too severe, IVF may
be necessary, with ICSI likely for male anti-sperm
antibodies. Predisone, a steroid, may be given to the party producing
the antibodies.

Impotence: One of the less common causes. Note: impotence is a
*medical* problem. There are a variety of medical causes that can
contribute, including diabetes mellitus, certain required medications
such as antidepressants, etc. Sexual advice from friends is generally
*not* welcome. Some useful advice on impotence can be found at
http://www.impotence.org. The drug Viagra, according to the
manufacturer, does not appear to have any negative impact on
sperm. See http://www.viagra.com/hcp/pro_pack_insert.htm.

Infection: Postpubertal mumps, and, occasionally, venereal diseases
such as gonorrhea and chlamydia can harm male fertility. Also,
recurrent infections such as prostatitis can lower sperm count and

Klinefelter's Syndrome: Men with Klinefelter's syndrome have two X
chromosomes and one Y chromosome, rather than the normal one X and one
Y. They are generally tall and thin, with small testicles. More
information can be found at http://www.globalwebsol.com/vv/ and
http://www.genetic.org . Both sites include listserv and support group

Lifestyle factors: These include factors which raise the temperature
of the scrotum (such as the use of hot tubs or long baths), or harm
sperm production. A variety of medicines and recreational drugs can
decrease male fertility. These include alcohol, marijuana, cocaine,
cigarettes, anabolic steroids, sulfasalazine, cimetidine (Tagamet,
used for ulcers), nitrofurantoin (used for UTIs), anti-hypertensive
drugs (specifically calcium channel blockers), aspirin, Dilantin (for
epilepsy), colchicine, and antidepressants (note that some of these
drugs should *not* be simply discontinued, because they may be
required for other serious medical problems). Exposure to certain
chemicals, such as lead and arsenic, and many types of paints or
varnishes, can also adversely affect male fertility.

Obstruction: Can occur at various points, blocking sperm from getting
out. Treated surgically. Often may be easier to work around
obstruction by doing MESA or TESA instead of trying to repair

Prior surgery: The vas may be damaged during surgery fo hernia repair,
orchiopexy, and even during varicocelectomy.

Retrograde ejaculation: Can be caused by certain medications,
surgeries, and nerve damage (for example, from diabetes
mellitus). Sperm goes in the wrong direction and can be found in the

Sexual Dysfunction: Reported in up to 20% of infertile men. May
include decreased sexual desire, inability to maintain an erection,
and premature ejaculation. This could result from low testosterone or
performance anxiety.

Trauma to testicles: Injury to testicles, such as from being hit,
followed by atrophy. May also be the result of having the mumps and
develop bi-lateral orchitis.

Undescended testicle: If the testicles do not descend during puberty,
their body temperature may be too high, reducing quality and quantity
of sperm production. Rare.

Varicocele: An enlarged vein in the scrotum, which causes pooling of
blood and an elevated temperature. This one is
controversial. According to some, it is one of the most common and
readily treatable causes of male infertility. Others say that
varicocele is also common among fertile men, and question the
connection with infertility and the need for treatment. Large
varicoceles that go untreated can cause permanent damage to the
testicles. This can lead to testicular failure or atrophy. Testicular
failure is indicated by an elevated FSH and means that the testicles
are starting to stop producing sperm. Testicular atrophy is indicated
by small testicle size and often leads to lower testosterone levels.
This affects sperm counts and can also lead to the need for
testosterone replacement therapy as the man ages. Note: Testosterone
replacement _should not_ be used while pursuing fertility treatments
as it will make the brain think it doesn't need to make testosterone
and sperm counts will diminish even further. Description of surgery
with graphics is available at

Vasectomy reversal: Though vasectomies are meant as a permanent means
of birth control, it turns out that they can often be
reversed. However, it is easier to reverse them if not too much time
has passed since the vasectomy. The more time has passed, the more
likely it is that the man will have an immune reaction to his own


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