INFERTILITY

e fertility is a complex process. In order for the female partner to become pregnant, the following conditions must be present:

• Seminal fluid must be produced . Proper growth and development of the male reproductive organs is required during puberty. At least one of the testes must function regularly and the body must produce testosterone and other hormones to generate and maintain sperm production.

• The spermatozoa must mix with the seminal fluid . The spermatozoa are produced at the testicular level and transported through the vas deferens to the seminal vesicles where they meet the seminal fluid that will be expelled from the penis at the moment of ejaculation.

• The seminal fluid must contain an adequate quantity of spermatozoa . The chances of fertilization of the egg are reduced if the number of spermatozoa present in the seminal fluid is low. The sperm count is defined as low if it is less than 15 million sperm per mL of semen or less than 39 million per ejaculate.

• The shape and motility of the spermatozoa must be normal . If the motility or morphology of the spermatozoa is abnormal, they may not be able to reach the egg and penetrate it to fertilize it.

Medical causes

Male infertility can be caused by various problems or therapies.

Some of these are:

• The varicocele . It is the most common cause of reversible male infertility. Varicocele is the dilation of the veins that drain blood from the testicle. The exact reason why varicocele causes infertility is not known, but it may be related to an abnormality in the temperature regulation of the testicles. Varicocele involves a change in the quality of the ejaculate. Treatment of varicocele can improve the characteristics of the spermiogram.

• Some infections can interfere with proper sperm production or cause blockages that block the passage of sperm. These infections include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections such as gonorrhea and HIV.

• Ejaculatory problems . Retrograde ejaculation occurs when seminal fluid travels to the bladder rather than exiting the penis at the time of orgasm. There are several causes that can generate retrograde ejaculation, including diabetes, spinal injuries, certain medications, and bladder or prostate surgery.

• Anti-sperm antibodies . Anti-sperm antibodies incorrectly identify sperm as harmful external agents and attempt to eliminate them.

• The tumors (not only those testicular) can have a direct impact on male reproductive organs also acting on the glands that release hormones related to reproduction, such as the pituitary.

• One problem in some men is that one or both testicles fail to descend into the scrotum during fetal development . This exposes you to an increased risk of infertility, as well as testicular cancer

• Hormonal imbalances . Infertility can result from abnormalities affecting hormonal systems such as the hypothalamus, pituitary, thyroid, and adrenal glands. Inadequate testosterone secretion (male hypogonadism) as well as other hormonal imbalances can cause infertility.

• Obstruction of the seminal passages . There are different structures responsible for the passage, transport and accumulation of spermatozoa. These can become blocked for various causes, including accidental surgical injuries, previous infections, trauma or abnormal development as occurs for example with cystic fibrosis or other genetic diseases.

• Chromosomal defects . Hereditary problems such as Klinefelter syndrome, characterized by the presence of two X chromosomes and one Y chromosome (rather than one X chromosome and one Y chromosome) in male individuals, cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility are cystic fibrosis, Kallmann's syndrome and Kartagener's syndrome.

• Problems of a sexual nature . These include erectile dysfunction, premature ejaculation, pain during intercourse or problems of a psychological or relational nature that interfere with sexual activity.

• This digestive disorder, caused by gluten sensitivity, can lead to male infertility. Fertility can improve by adopting a gluten-free diet.

• Some medications . Testosterone replacement therapy, anabolic steroids, chemotherapy drugs, some antifungals, anti-ulcer drugs, and other medications can inhibit sperm production and reduce male fertility.

Environmental causes

Exposure to certain environmental elements such as heat, toxins and chemicals can reduce the production or function of spermatozoa. Specifically, the causes include:

• Industrial chemical agents such as benzene, toluene, xylene, pesticides, herbicides, organic solvents, paints.

• Exposure to heavy metals such as lead or other heavy metals.

• Radiation or X-rays .

• Overheating of the testicles . High temperatures can impair sperm production and function. Frequent use of saunas or hot baths could temporarily worsen sperm counts. In addition, sitting for a long time, wearing tight clothing or working for long periods with the laptop on your lap can slightly reduce sperm production.

Health, lifestyle and other causes

Other causes of male infertility are:

• Use of doping substances . Taking anabolic steroids can cause shrinkage of the testicles and a reduction in sperm production.

• Use of drugs . The use of cocaine or marijuana can reversibly reduce the number and quality of semen.

• Consumption of alcohol . Alcohol consumption can lower testosterone levels, cause erectile dysfunction, and reduce sperm production.

• Smokers have lower sperm counts than non-smokers . Passive smoking also has a negative impact on fertility.

• Emotional stress . Stress can interfere with certain hormones needed for sperm production. Severe or prolonged emotional stress, including the stress caused by fertility problems, impacts sperm counts.

• Obesity . Obesity can damage fertility in several ways, affecting the production of sperm itself or causing hormonal imbalances that reduce fertility.