Dr. Rahul Gupta

What is male infertility? reproduction (or making a baby) is a simple and natural experience for most couples. However, for some couples it is very difficult to conceive. A man’s fertility generally relies on the quantity and quality of his sperm. If the number of sperm a man ejaculates is low or if the sperm are of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy. Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male. How common is male infertility? infertility is a widespread problem. For about one in five infertile couples the problem lies solely in the male partner. It is estimated that one in 20 men has some kind of fertility problem with low numbers of sperm in his ejaculate. However, only about one in every 100 men has no sperm in his ejaculate. What are the symptoms of male infertility? in most cases, there are no obvious signs of infertility. Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye. Medical tests are needed to find out if a man is infertile. What causes male infertility? male infertility is usually caused by problems that affect either sperm production or sperm transport. Through medical testing, the doctor may be able to find the cause of the problem.

About two-thirds of infertile men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that are made do not work properly.

Sperm transport problems are found in about one in every five infertile men, including men who have had a vasectomy but now wish to have more children. Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen.

Other less common causes of infertility include: sexual problems that affect whether semen is able to enter the woman’s vagina for fertilisation to take place (one in 100 infertile couples); low levels of hormones made in the pituitary gland that act on the testes (one in 100 infertile men); and sperm antibodies (found in one in 16 infertile men). In most men sperm antibodies will not affect the chance of a pregnancy but in some men sperm antibodies reduce fertility.

Known causes of male infertility

Sperm production problems• chromosomal or genetic causes

• undescended testes (failure of
The testes to descend at birth)
• infections
• torsion (twisting of the testis in scrotum)
• varicocele (varicose veins of the testes)
• medicines and chemicals
• radiation damage
• unknown causeblockage of sperm transport• infections
• prostate-related problems
• absence of vas deferens
• vasectomysexual problems
(erection and ejaculation problems)• retrograde and premature ejaculation
• failure of ejaculation
• erectile dysfunction
• infrequent intercourse
• spinal cord injury
• prostate surgery
• damage to nerves
• some medicineshormonal problems• pituitary tumours
• congenital lack of lh/fsh (pituitary problem from birth)
• anabolic (androgenic) steroid abusesperm antibodies• vasectomy
• injury or infection in the epididymis
• unknown cause

The male reproductive system

The male reproductive system is made up of the testes, a system of ducts (tubes) and other glands that open into the ducts. The brain plays an important part in the control of the male reproductive system.

A side view showing the main parts of the male reproductive system

The pituitary gland and the hypothalamus, located at the base of the brain, control the production of male hormones and sperm. Luteinising hormone (lh) and follicle stimulating hormone (fsh) are the two important messenger hormones made by the pituitary gland that act on the testes.

Two messenger hormones act on the testes

The testes (testis: singular) are a pair of egg-shaped glands that sit in the scrotum next to the base of the penis on the outside of the body. The testes make sperm and the male sex hormone testosterone. It takes about 70 days for sperm to become mature and able to fertilise an egg.

When released from the testes, the sperm spend two to 10 days passing through the epididymis where they gain the vital ability to swim strongly (become ‘motile’), and to attach to and penetrate (get into) the egg.

At orgasm, waves of muscle contractions transport the sperm, with a small amount of fluid, from the testes through to the vas deferens. The seminal vesicles and prostate contribute extra fluid to protect the sperm. This mixture of sperm and fluid (the semen) travels along the urethra to the tip of the penis where it is ejaculated (released).

One of the more severe illnesses included in the larger group of diseases known as inflammatory bowel disease (IBD), Crohn's disease is typically a long-lasting, chronic condition. The intestine or bowel, most commonly the colon and the lower part of the small intestine, are either marked by sores or get inflamed and ulcerated. It is a common occurrence in adolescents and in young adults.

Types

Crohn's disease is subdivided into five types, each having its own set of symptoms:

1. Ileocolitis - The most common type, it affects the colon and the ileum and results in considerable weight loss as well as diarrhea and cramps.
2. Gastroduodenal Crohn's disease - People who suffer from this type of disease have their stomach and duodenum affected and many experience symptoms like nausea, loss of appetite and weigh loss.
3. Crohn's colitis - This involves only the stomach, and can cause joint pains, rectal bleeding, skin lesions and diarrheas,
4. Ileitis - This type affects the ileum and the symptoms are identical to those of ileocolitis.
5. Jejunoileitis - In this type, the jejunum gets affected and general symptoms include the formation of fistulas, diarrhea, intensive back pain as well as areas of inflammation.

Causes

Despite the uncertainty as to the nature of the specific causes of Crohn's disease, there have been a few possible causes which have been identified. These include:

1. Immune system problems
2. Genetic disorders
3. Environmental factors, such as:-
   • Certain edibles
   • Viruses or harmful bacteria
   • Smoke

Symptoms

The primary symptoms of Crohn's disease include the following:

1. Diarrhea: This can occur for about 10 to 20 times a day in more severe cases.
2. In rare cases, there may be blood in your stool.
3. In more intense cases, you may even develop a fever.
4. Cramping and intermittent belly pain.
5. Anemia, due to a reduction in iron levels caused by bloody stools.
6. Weight loss.
7. Erratic appearance of small tears in the anus, called anal fissures. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.