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What causes male infertility?
Male infertility exists if the man's semen contains no spermatozoa
(azoospermia), too few sperm (oligospermia), poor quality
spermatozoa or a high percentage of abnormal spermatozoa.
Also, sperm antibodies and infections are serious factors.
Infertility can also be caused by an anatomical or physiological/psychological
problem so that the man fails to ejaculate his semen into
the vagina.
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What causes a complete absence of sperm
in the semen?
This occurs either because no spermatozoa are produced by
the testes or because they are not ejaculated during orgasm.
In turn, the latter may arise because the tubes leading from
the testes to the seminal vesicles are blocked.
Complete failure of the testes to produce spermatozoa is rare
and accounts for less than 5 percent of cases of male infertility.
It arises either because the pituitary gland does not produce
the necessary hormones to stimulate the testes (male hypogonadotrophic
hypogonadism) or because the testes, are unable to respond
to these hormones (primary testicular failure). Primary
testicular failure may be caused by genetic defects, undescended
testes physical injury to the testes or mumps (if it occurs
after puberty). Very often the reason for primary testicular
failure in a particular man is not clearly obvious.
Blockage of the tubes leading from the testes to the urethra
may sometimes be genetic or caused by injury, but is usually
because of infection leading to scarring of the tubes. In
less than 1 percent of the men the muscles that pump semen
through the penis do not act in a coordinated way so that
the sperm enter the bladder and mix with the urine instead
of getting into the vagina. This condition, called retrograde
ejaculation, may be caused by certain drugs, such as the
drugs used to treat high blood pressure, nerve damage (for
example due to diabetes mellitus) or it may follow an operation
to remove the prostate gland.
- Is there any treatment for azoospermia?
It depends on the cause.
Infertility caused by primary testicular failure cannot
be treated except by donor insemination. On the other hand,
male hypogonadotrophic hypogonadism is easily treated. It
can be distinquished from primary testicular failure by
the presence of small soft testicles with a low blood FSH
level unlike primary testicular failure where the testes
are usually firm and the FSH level is elevated.
Treatment of hypogonadotrophic hypogonadism consists of
taking bromocriptine if the blood prolactin level is high,
or if it is not, having hMG and hGG injections to stimulate
the testes or using an LHRH pump to stimulate the patient's
own pituitary to produce FSH and LH.
Retrograde ejaculation is usually treated by recovering
live sperm from the urine after masturbation and performing
artificial insemination.
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