Infertility in Men
No pregnancy occurs since there would be no intercourse without erection. But, the pregnancy chance is not related to premature or late ejaculation. The important thing is that sperm departs from the vagina towards the uterus and finds the oocyte, passing through the tubes. That is, if there is ejaculation (discharge of sperm), there is a chance of pregnancy.
Some rheumatic diseases and drugs used in the treatment disrupt the production of sperm. This subject has been reviewed in detail in the immunological infertility section
The presence of the urinary meatus near the junction of the penis and the body prevents sperm to be discharged into the vagina.
Some men have congenitally fewer sperm. Therefore, the number of discharged sperm is also small. The number even decreases to zero over time.
In the presence of a testicular tumor, the production of sperm drops even if chemotherapy or radiotherapy has not been initiated. Therefore, every patient diagnosed with testicular tumor should have his sperms stored by ‘sperm cryopreservation’ if he desires to have a child. After the treatment of the tumor, the cryopreserved sperms are thawed and used in IVF treatment. In cases where chemotherapy or radiotherapy has been performed, it becomes difficult to obtain sperm. In very challenging cases, sperm can even be separated from the removed testicle itself due to tumor.
Varicosele is the abnormal enlargement of the diameter of the vein draining dirty blood from the testicles. As it is known, testicles are situated in a scrotum outside the body. Because they need to be in a cooler environment than the body to be able to produce good sperm. In the presence of varicosele, the temperature of the testicle increases, and sperm production is affected from that since there will be plenty of blood in the enlarged vessel. However, this effect is more likely to occur in the presence of severe (Grade III) varicosele rather than mild and moderate varicocele.
The absence of hormones such as FSH, LH, or elevated levels of the milk hormone impairs the sperm production. The missing hormones are replaced or elevated hormone levels are reduced in the treatment.
When an obstruction occurs in the ducts due to infection or surgery, sperm cannot come out and accumulates behind the obstructed site. Sometimes this obstruction is due to congenital absence of the ducts. In such a case, it is possible to perform IVF by obtaining sperm using PESA (percutaneous epididymal sperm aspiration) or TESA (testicular sperm aspiration) techniques.
The white cells in the sperm produce some secretions to fight against bacteria. These secretions and chemicals also damage the sperm cells. However, this condition mostly poses an obstacle in spontaneous pregnancies. Because, sperms are irrigated and cleaned from such factors as much as possible during inoculation or IVF.
Sperm production is impaired in testicles that do not descend into the scrotum and remain in the groin after birth. Compared with the scrotum, the body temperature plays a role in such a case. Therefore, undescended testicle cases should be noticed and operated before puberty. The success rate of correction surgeries performed after the puberty is lower.
Why Does Infertility Occur In Men?
Some gene defects inherited from the family or chromosomal disorders such as XXY (Kleinefelter) reduce the number of sperm, or even decrease it to zero. The hope to find sperm in the mosaic type Kleinefelter cases is more than complete cases.
It depends on the congenital absence of sperm stem cells. Sperm cannot be found even with TESA and TESE procedures. These patients do not have a chance for IVF.
For today, not all the causes leading to low number of sperm or sperm weakness have been fully clarified. Although some risk factors such as being a driver profession, wearing tight clothes, bakery labour, working in paint-furniture manufacturing, drinking alcohol, smoking have been determined, not everyone working in the same profession, and even in the same workplace, have infertility, and some men develop infertility, even though there is no risk. Therefore, in today’s infertility treatment, the selection of technique is based on the condition of available sperm.