Male infertility: all possible causes

Eight out of ten Italians have never visited a urologist. 95 percent of them say they “have no problems.” And if more than 40 percent of girls under twenty have already been to the gynecologist, less than 5 percent of peers have been to the corresponding male specialist.

Unfortunately, there are often problems. And if once they were often identified at the visit for military service, today it is more frequent that they are discovered years later: when the couple is looking for a child who does not arrive.

Male infertility can in fact also be caused by silent or too long neglected pathologies, which an andrological examination could have identified and resolved early.

In one case on between the fault is man’s

We speak of infertility when conception does not occur after at least 12 months of regular unprotected intercourse.

It represents a problem with a strong social impact: according to the World Health Organization in industrialized countries about 10-20% of couples suffer from fertility problems, and in at least 35% of cases it is the man who has a reduced reproductive capacity.

Infertility is distinguished from sterility, which is ascertained when there is a total absence (azoospermia) or drastically insufficient (crypto-azoospermia) of sperm in the seminal fluid or when there is no ejaculation (aspermia) or the spermatozoa present in the seminal fluid are not viable.

The causes of infertility can be different: air pollution, an incorrect and unbalanced diet, use of certain drugs, smoking, alcohol abuse, psychophysical stress, risky sexual behaviors and other pathophysiological factors.

Numerous treatments are available to increase the chances of natural conception, and it is estimated that a third of infertile men, with adequate care, can have a natural paternity, provided that action is taken as soon as possible.

“Today there is a worrying increase in male pathologies of the reproductive and sexual sphere”, confirms Giario Conti, director of Urology of the S. Anna Hospital and national secretary of SIUrO, who, with AURO the Italian Urologists Association, is collaborating with SAM – Men’s Health, the project of the Umberto Veronesi Foundation to promote the prevention of typically male diseases and support, through research grants, doctors and scientists working to fight the diseases that affect men the most.

“They range from varicocele, which affects about one in four boys from 15 to 25 years of age, to the increasingly frequent sexually transmitted diseases, to benign prostatic hypertrophy, the increase in volume of the gland that can occur in all men, as early as 35 years”.

“They are pathologies due in most cases to wrong lifestyles” adds Conti “if neglected, they can undermine the quality of life with important consequences such as impotence and infertility. For these reasons, prevention is essential from a young age, learning to recognize suspicious symptoms, so as to intervene promptly”.

Male infertility can be determined by various causes:

• pre-testicular (missed or reduced sperm production due to inadequate gonadotropin secretion),
• testicular (primary testicular pathologies, cryptorchidism),
• post-testicular (by obstructed sperm transport along the excretory pathways, by ejaculatory disorders, by immunological factor …).

Other factors that can cause infertility are:

• uro-seminal infections. Inflammatory and infectious states of the seminal tract can damage sperm, seminal canals, prostate and seminal vesicles due to the presence of germs and white blood cells.
• heat sources. Too tight synthetic pants can increase the temperature in the genital area and affect fertility.
• epididymitis. It is an acute or chronic inflammation of the epididymis, an organ located behind the testicle, important for the production of seminal fluid.
• varicocele. It consists in the dilation of the veins of the scrotum. In 85 percent of cases the disorder is localized in the left testicle, in 11 percent it is bilateral and only in 4 percent of cases in the right testicle. Often it does not give any symptoms, until localized pain and, above all, infertility appear (in 50 percent of cases it can damage the DNA of sperm).
• antisperm antibodies. Their presence reduces the fertilizing capacity of sperm and can hinder their transit into the female genital tract.
• erectile dysfunction. Erection-related dysfunctions are linked to 5 percent of infertility cases.
• sexually transmitted diseases. They are pathologies caused by various microorganisms (viruses such as HIV and HPV, bacteria such as Chlamydia, fungi such as Candida, protozoa such as Trichomoniasis) that pass from one sexual partner to another. They affect the entire population and infections are frequent, especially among adolescents and in the 20-40 age group.
• medications. Anticancer drugs, those for the treatment of hypertension or hypercholesterolemia represent a risk factor.
• lifestyles. Tobacco or cannabis smoke damages the DNA integrity of sperm and reduces sperm count and motility. Other risk factors are sedentary lifestyle, overweight, obesity, poor diet, alcohol and drug intake, environmental agents (pesticides, solvents, plastics, paints, electromagnetic radiation).

The diagnosis takes place in this way

The diagnosis of male infertility starts from an evaluation of the qualitative and quantitative characteristics of the sperm through a specific examination: the spermiogram.

Hormonal tests are added to the hematological tests, aimed at evaluating the hormones that stimulate production.

Scrotal echocolordoppler and transrectal prostate ultrasound are useful for assessing the morphology of the testicles and prostate, the possible presence of masses, nodules, inflammations and other pathologies.

In cases where there is a total absence of sperm in the ejaculate or a severe reduction it is useful to perform a testicular biopsy.

The goal of therapies is to improve the quality of the patient’s semen, to determine an increase in the probability of natural conception.

When this does not happen, it still serves to improve the probability of success of assisted reproduction techniques or allow the use of less complex techniques such as uterine insemination.