Anatomic Causes of Male Infertility
The reproductive system may seem straightforward – just connect a sperm with an egg, right? However, reproductive success depends on the proper function of several factors for both male and female partners. Your anatomy is one key piece of the puzzle that must function correctly in order to conceive naturally.
Male-factor infertility may stem from various anatomic causes. Testicular development or damage, obstructions of the genital tract and prior vasectomy all affect your fertility. Whether these abnormalities were present at birth or developed due to past surgeries, infections, or trauma, your Inovi fertility specialist can guide you to a male infertility treatment that will likely result in a successful pregnancy.
One fairly common anatomic problem affecting male fertility is one or more undescended testicles. Prior to birth, a male’s testicles should move from the abdomen down into the scrotum. If this does not occur, many testicles will still descend on their own within the first six months after birth. When testicles do not descend naturally, surgery is an option. If this surgery is not performed when the male is an infant or adolescent, it is possible he may never become fertile.
Healthy sperm require temperatures a few degrees below body temperature, which is why they reside in the scrotum, hanging away from the rest of the body. When one or more testicles remain lodged in the abdomen, sperm count and quality is hindered, and the testicle(s) can actually lose the cells that make sperm.
While surgery to correct undescended testicles in an infant or adolescent is quite effective in improving their future fertility, surgery is not likely to improve the fertility of a grown man since his sperm production has been compromised. However, if only one testicle is undescended, it is possible that you can conceive naturally by way of the sperm in your other testicle.
Primary & Secondary Testicular Failure
Other testicular issues that affect fertility are primary and secondary testicular failure. Primary testicular failure is simply testicles’ lack of sperm production, despite normal hormone levels and ejaculatory volume. It is usually cause by a congenital condition, past cancer treatments, mumps, undescended testicles, or testicle trauma. Although there is no effective treatment to restore fertility in a man with primary testicular failure, assisted fertility treatments may be an option.
Secondary testicular failure occurs when the pituitary gland or hypothalamus in the brain are responsible for endocrine (hormone) imbalances that affect sperm production. These imbalances are often corrected with certain medications for male infertility treatments.
Testicular atrophy, or shrinkage of one or both testicles, can have a profound affect on male fertility. Over time your testicles naturally shrink due to loss of germ cells (that produce sperm) and Leydig cells (that produce testosterone). Smaller testicles may mean reduced testosterone and sperm levels, resulting in loss of fertility. It is important to note that this change in size is different than that caused by temperature changes; rather testicular atrophy is caused by various factors, including age, excessive alcohol consumption, diseases, hormone imbalances, etc. Depending on the cause, male infertility treatments may be available to restore your fertility.
Vas Deferens & Ejaculatory Duct
If a semen analysis shows azoospermia, or absent sperm, along with low ejaculate volume, further testing may indicate a blocked vas deferens or ejaculatory duct. Called Obstructive Azoospermia, blockages of the reproductive tract account for about 40% of cases in which a male has no sperm present in his semen. A urologist is able to perform an ultrasound that is used to discover any possible obstructions.
Obstructions of the male reproductive tract can be either congenital (present from birth) or acquired, and they may include one or more segments of the reproductive tract. Congenital causes of obstructive azoospermia include congenital bilateral absence of the vas deferens (CBAVD) and idiopathic epididymal obstruction. Acquired causes of obstructive azoospermia include vasectomy, infection, trauma, or iatrogenic injury.
Obstructive azoospermia can often be treated successfully with surgical reconstruction. If reconstruction is not an option, sperm retrieval followed by In Vitro Fertilization (IVF) may be performed to achieve pregnancy.
If an obstruction of the reproductive tract is not present, retrograde ejaculation may be the cause of male infertility. Retrograde ejaculation occurs when semen enters the bladder rather than coming out through the penis, resulting in a “dry” orgasm. A urinalysis is used to identify this disorder by checking for semen in your urine directly after ejaculation.
Some medications used to treat depression, high blood pressure, and other conditions may be the cause of retrograde ejaculation. If this is the case, your Inovi fertility specialist may suggest stopping a particular medication to see if you begin ejaculating normally. If retrograde ejaculation is not medication-induced, there may be hope in the form of male infertility treatment. The drugs used for this condition help keep the bladder neck muscle closed during ejaculation.
If you experience dry orgasms but no semen is found in your urine, you might have a problem with semen production. Damage to the prostate or semen-producing glands from surgery or radiation treatment may be the cause.
Prior Vasectomy & Male Fertility
Primarily used as a form of birth control, a prior vasectomy can understandably cause fertility issues. During a vasectomy, the tubes that carry sperm, called the vas deferens, are cut or blocked so sperm no longer mixes with a man’s semen. Post-procedure, you can expect to experience the same volume of semen with each ejaculation, but that semen will contain no sperm and, therefore, will not cause pregnancy.
Although vasectomies are meant to be permanent, vasectomy reversal surgery is available. However, this surgery can be complicated and costly, and it isn’t always effective. Factors that contribute to vasectomy reversal success include length of time since a vasectomy, partner age, fertility issues prior to vasectomy, and type of vasectomy.
An average of 90% of men who undergo a vasectomy reversal will regain sperm within three to six months. It may take longer to reach a favorable sperm count, but as soon as sperm return, pregnancy is possible. The majority of couples with no other fertility complications can conceive within a year.
Another option to achieve pregnancy after a vasectomy is through sperm retrieval and In Vitro Fertilization (IVF). This options is less invasive for the male partner, and is a great option for couples, especially those couples with additional fertility complications that lend themselves to IVF as a means to pregnancy.