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Male infertility: Current concepts, causes and management (2) by Prof. Oladapo Ashiru

Fertility doctors are noticing a drop in sperm count and motility, which makes it harder for couples to make babies. Other factors attributed to this include:

Chromosome defects:  Inherited disorders, such as Klinefelter’s Syndrome, a condition in which a male child is born with two X chromosomes and one Y chromosome instead of one X and one Y, cause the abnormal development of the male reproductive organs.

Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome, and Kartagener’s syndrome.

Celiac disease: A digestive disorder caused by sensitivity to gluten, Celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.

Certain medications: Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications can impair sperm production and decrease male fertility.

Prior surgeries: Certain past surgeries might prevent a man from having sperm in the semen when he ejaculates. These may include vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and significant abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, an operation can be rendered either to reverse these blockages or to retrieve sperm directly from the epididymis and testicles.

Environmental and other causes

Sperm production or function can be affected by over-exposure to certain environmental elements, including: Industrial chemicals: Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials, and lead might contribute to low sperm counts.

Heavy metal: Exposure to lead or other heavy metals also can cause infertility.

Radiation or X-rays: Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal following exposure to X-rays. With high doses of radiation, sperm production can be reduced permanently. It is being reported that keeping mobile phones in the pocket near the upper thigh where it is close to the testicles is very harmful to sperm production, with resulting low sperm count and morphology.

Overheating the testicles: Elevated temperatures impair sperm production and function. The testicles require a heat slightly less than the body’s average temperature for healthy function. Sitting for long periods, wearing tight clothing, working on a laptop computer for long periods and frequent use of hot tubs might increase the temperature in your scrotum and slightly reduce sperm production.Ø Emotional stress: Severe or prolonged emotional stress, including anxiety about fertility, might interfere with hormones needed to produce sperm.

Sperm testing issues. Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation, was produced too soon after an illness or stressful event, or did not contain all of the semen you ejaculated because some were spilled during collection. For this reason, results generally are based on several samples taken over some time.

Management

A clinician to check for possible causes of varicocele, testicular atrophy, undescended testis, and other abnormalities does a detailed medical and sexual history, as well as complete physical examination.  A seminal fluid analysis is done to assess the sperm parameters accurately. Usually, patients are advised to abstain from intercourse for at least two to seven days before doing this test for optimal results. Further testing, including hormone profile and scrotal ultrasound, may be done primarily to check for other underlying causes.

In our centre, we also recommend bio-energetic testing to determine food allergies, environmental toxins, or the presences of pathogens.

Treatment

Depending on the underlying cause, patients can benefit from various types of drugs. The following commonly used drugs help:

Gonadotrophins: Gonadotrophins, especially human chorionic gonadotrophin, have been used successfully in treating some patients with azoospermia, especially those with underlying hormonal imbalance.

Anti-Estrogens: Drugs like clomiphene citrate, tamoxifen have also been used in patients with oligospermia/azoospermia. These drugs used in patients with idiopathic oligozoospermia as well as patients with low levels of the male hormone- testosterone.

Dietary supplements and antioxidants: The use of antioxidant therapy in the treatment of patients with male infertility is associated with statistically significant improvements in sperm parameters. It is because many of these antioxidants are at the different stages of sperm production. Co-enzyme Q10, for example, has been shown to significantly improve sperm concentration, motility, and morphology in patients undergoing treatment.

Other drugs used include aromatase inhibitors like Anastrozole and cyclic steroids (for immune suppression). It is important to note that these drugs can be combined to get better results. The clinician has to identify the underlying causes and appropriate medication to use.

To be contd.

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