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Infertility is the inability of a couple to have a child,
despite having unprotected sexual intercourse for more than one year. Of the
many causes leading to infertility, male partner is responsible in about
one-third of cases.
Causes of Male infertility
Male infertility can be the result of either insufficient or absent production
of sperms or blockage in the transport of the sperms/semen.
Hormonal abnormalities are known to decrease sperm production.
These can occur due to abnormalities in the thyroid, the pituitary, or local
defects in the testes, failing to recognize the hormones, and thus,not making
sperms. Fortunately, most of these conditions can be treated with 'exogenous'
hormones.
Genetic diseases where the patient has been born with
defects in hormonal production or action, are more difficult to treat - an
obvious reason is that we do not know who has this error until it is too late.
Sperm production starts in the testes around puberty (11-15 years), and most
males do not marry until their 20's, by then the 'defects' are set in, and it is
almost impossible to reverse the errors.
Testes Malfunction
The testes are privileged organs, which means that they are protected from the
normal blood supply. Any disruption to this 'privilege' can adversely affect
sperm production. An example being a massive injury to the testes with a
football or cricket ball, resulting in swelling and internal bleeding, or mumps
in a teenager.
Pathway malfunction
After sperm production, comes the need to transport the sperms to penis. A
collection of multiple tubes, namely the epididymis, vas deferens, ejaculatory
ducts, and seminal vesicles transport and prepare the sperms for their eventual
function of fertilizing the egg. A disruption at any level of this pathway, can
result in absent sperm in the semen. It must be noted that BOTH the pathways
should be disrupted at the same time for infertility to occur, one functioning
testis with an intact pathway is enough to make a male fertile. This pathway can
be disrupted from birth, due to defective growth, or by diseases, such as
tuberculosis.
In most cases, the interruption of the pathway is not a certificate of
disaster - there are methods to bypass the need for the pathway, such as
directly extracting the sperms from the testes - a method known as 'Testicular
Sperm Aspiration.' The sperms are extracted from the testes, then bathed in a
fluid which prepares them for fertilizing the egg, and then directly injected
into the eggs extracted from the woman, a process known as In Vitro
Fertillisation/ IVF.
Ejaculation issues
However, there are some patients, who, despite having functioning testes with
functioning pathways, are unable to father children because of two major
problems, either an inability to 'ejaculate' (which can result from an injury to
the nerves of the pelvis from surgery or an accident) or an inability to
'ejaculate' sperm-containing semen within the vagina of the female because of
impotence or premature ejaculation. An inability to ejaculate,
anejaculation, is treatable through 'artificial ejaculation' or
'electro-ejaculation' which is done by applying a small electric current to the
prostate resulting in ejaculation - the ejaculate is collected and deposited
into the vagina of the female.
Premature ejaculation is ejaculation which occurs within one
minute of the erect penis entering the vagina, or outside the vagina - this
besides causing emotional stress to both partners, and prevents proper
'insemination' of the vagina. Behavioural therapy and medication has been found
useful to treat this condition. Impotence can have many causes, psychological,
resulting from marital disharmony or stress, medication-related and vascular,
resulting from interruption of blood supply to the penis. Most cases of erectile
dysfunction in young males are psychological and can be treated by counseling
and medications.
Ways of Treatment
To summarize, male infertility has many causes, but modern science has lessened
the haziness in its diagnosis and treatment. From injectable hormones to orally
taken tablets, to simple life-style changes, there is almost treatment for every
cause of male infertility, except the rare congenital causes. Modern research is
intensely focusing on these conditions, and we appear to be on the threshold of
curing them, thanks to the sequencing of the human genome and the use of Big
Data to analyse the genes involved in sperm production.
The future of male infertility is bright !
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