Infertility in men

Infertility is defined as inability of a couple to achieve conception after a year of unprotected, adequate regular sexual intercourse. Adequate sexual intercourse means 2-3 times of sexual intercourse. This is only possible in couple co-habiting. Sexual techniques too are very important consideration.

Infertility affects 1 in every 10-12 couples in Nigeria. Diagnosis requires a thorough assessment of both partners. There are numerous causes of infertility. It is only after the cause has been established/identified that treatment will be effective. It is a wasteful venture to treat or provide solution to cases of infertility without knowing the cause.

CAUSES

The causes of infertility can be broken into 4 broad groups

• Male factor only……………occurs in 33% of people with infertility
• Female factor………………occurs in 33% of people with infertility
• Both male and female factor occurs in 33% of people with infertility
• Unexplained factors ……….occurs in less than 1% of people with infertility
• Male factor this is due to conditions/problems in man.
• Female factor. This is due to conditions/problems in woman.
• Both male and female factor…this are due to problems/conditions in women.
• Unexplained/unidentified factors. In threes group of people no cause is identified after investigations .this occurs in very few people less than 1%.

SPECIFIC CAUSES

• Congenital factors …..Chromosomal abnormality, Klinefelters syndrome, congenital albescence of testiclec, Undescensed testes, Hypoplastic testes abnormal formation of the vas and epipydymis
• Acquired factors…..Trauma to the pelvis, to the scrotum.Surgeries like prostratectomy, neurologic dysfunction, Orchidectomy, Radiotherapy to the perineum, chemotherapy (anticancer drugs), and bilateral testicular lesion.
• Infections…. Mumps orchitis, Gonococcal infection, Chlamydia infection, staphylococcus.
• Chronic illness…like chronic renal failure, diabetes.neurologic dysfunction.
• Endocrine ….Hyperaldorenalism, Hypopituitarism, Hyperprolactinaemia.
• Physiological …Extreme temperature to the testicles e.g. nylon underwear’s
• Varicocoele ….also increase scrotal temperature. This is the anatomic abnormality found in the male resulting from abnormal dilation of vein.

MANAGEMENT

History

History of infection with mumps in childhood, history of groin surgery, history of gonococcal infection and other STDS, history of undescended testes, history of cancer, history of radiotherapy and chemotherapy.

Examination for gyneacomastia, smooth face due to low testosterone, feminine voice, absent hair distribution in the pubic area, truncal obesity.

Testicles are examined, scrotum also examined for varicoeceles, epidydimis also examined

Examined the phallus size not important and check the urethral meatus to see if they are present

INVESTIGATION

Seminal fluid analysis this is one of the most important test in investigation of men for infertility. The following had to be followed when doing seminal fluid analysis:

Abstain from sexual intercourse3-5 days before the test, Collection better by masturbation, Collect sample in a tight container, Deliver sample to the lab 10-15 minutes.

Things like sperm count, sperm motility, viability, sperm antibody are checked semen may also be examined for any form of infection.

Normal seminal fluid analysis

• Volume….2-6 mls
• Color….normal/cream colored
• Microscopic….1-3 WBC/hpf
• Ph……7-8
• Sperm count above 20 million/ML
• Sperm morphology….normal above60%
• Sperm motility …above 50 %( 1-3hrs)
• Sperm antibody…..also checked.

Other test like urinary MCS or urethral swab test will have to be done to check for infection like staphylococcus, Chlamydia and gonococci infection

Hormonal analysis…hormones like prolactin, testosterone are checked

Treatment will depend on the cause of the infertility.

Questions/ clarifications will be entertained by the author…..08037202050