What are the causes of male fertility?



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What are the causes of male fertility?

Dr. Kenan Omurtag, Washington University Infertility and Reproductive Medicine Center: Guys who have low sperm counts, but there’s still sperm there, so: counts that are below the reference range. There could be a myriad of reasons.

One of the first things we’ll do is if the count is low, and this is still variable from physician to physician, it could be as low as 10 million. Most physicians will start doing a genetic workup less than; a workup on the male, if it’s less than five million.

So, first what you look for is you look for hormonal problems. It might be similar to in the female. You know, could there be some pituitary tumor? Could there be an abnormal thyroid problem?

So, you’ll check lab work to see.

And then if there is no sperm in the ejaculate, then you have to rely on your labs and your genetic workup.

So, if there is no sperm in the ejaculate, you have to then figure out: Is it an obstructive problem? So, is the plumbing blocked? Or is it a non-obstructive problem? Which would be akin to testicular failure. OK?

So, if you break those out, an obstructive problem means that the guys is still making sperm, but the sperm can’t make its way from the testicle out the urethra.

And there can be a lot of reasons for that. The guy could have some underlying minor mutation of cystic fibrosis and his vas deferens, which connect the testicle to the urethra, are not present. Either one or both.

They could have had a vasectomy. That’s something I see a fair amount of, actually. Men who have had vasectomies and either they’ve tired to reverse them and they failed or they don’t want to do a reversal and they just want to go forward because they know they’re making sperm in the testicle. “Can we just get the sperm?”

There can be ejaculatory duct obstructions. So, obstructions closer to the expulsion point, I guess, if you will, that can be fixed, actually, surgically, by urologists.

So, the obstructive problems kind of fit in that category.

The non-obstructive problems, if you have no sperm in your ejaculate, and you have blood levels LH, FSH, that are high and testosterone that is low, that increases your risk of having some possible genetic abnormality.

So, it’s important for the guy to have what’s called a karyotype to make sure there’s nothing abnormal genetically.

It’s also important to look for what are called Y chromosome microdeletions. So, there are specific deletions in the Y chromosome that are associated with azoospermia.

And, again, azoospermia is there’s no sperm in the ejaculate.

Those are, as far as what do I see most frequently, when I check the box of male factor, most of the time it’s because the gentleman has a count that’s less than the reference range, but there’s still sperm in the ejaculate.

There are a ton of; there’s a lot of speculation that there’s probably genetic problems that we just haven’t discovered yet that could be the cause of these very low semen parameters.

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Source: What are the causes of male fertility?

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