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The condition is highly under-diagnosed by virtue of the “inflated” male ego-“they could never be the problem”!
90% of cases are due to low sperm counts,poor sperm motility or both with the remaining 10% ranging from anatomical problems,hormonal imbalances and genetic defects.
As is the case in women infertility in men can result from physical problems in the reproductive organs like the testes,the vas deferens,ejaculatory duct,the prostrate,the urethra and the penis. However,there are also general lifestyle factors associated with infertility including obesity,abuse of alcohol and drugs,certain medicines,wearing tight clothes,riding bicycles for long periods,smoking and exposure to radiation which affect the production of semen in one way or the other.
Problems that affect the functioning of the testes include conditions that affect the temperature around the testes for instance enlarged veins(varicocele),hot environments like hot showers and kitchens,infections like mumps,undescended testes,tumours and genetic disorders.
The tubes through which sperms are transported may get blocked especially after a bout of Sexually Transmitted Infections.Reverse movement of semen during an ejaculation whereby instead of the ejaculate leaving the penis it moves back to the bladder can also compromise the tubes.
An enlarged or inflamed prostrate can lead to swelling that blocks the movement of sperm.
Erectile dysfunction and premature ejaculation are also common challenges affecting men and causes of infertility though indirectly if a man is unable to get an erection or sustain one,he is conversely unable to deliver sperm to the egg despite him leaving healthy/viable sperm.Premature ejaculation on the other hand may produce semen that is not rich in sperm.
An infertility diagnosis in men begins with a thorough look at the mans history and physical examination. Typically infertility is suspected if pregnancy is not achieved after one year of unprotected intercourse.
Physical examination involves analysis of the semen whereby the quality and quantity is measured in each ejaculate with the quantity being between 1.5-5 ml.Quality is measured by the number of sperm which should be more than 20 million with anything lower considered as a low sperm count(Oligospermia). The semen may also not contain sperm at al a condition known as Azoospermia.
Other quality parameters will include;
- Acidity and liquidity of the semen
- Sperm motility which is the movement of sperm-at least 60% of sperm should exhibit normal movement.
Sperm morphology which is the appearance Normally sperm has 3 distinct parts-Head,Mid-piece and a tail.60% of sperm should have a normal appearance for semen to be considered healthy /normal.
Will depend on the cause and options include;
- MEDICAL- Amyriad of medications for hormonal conditions exist with some tried to retrograde ejaculation.
- SURGERY- In the case of varicocoeles or blocked tubes
- DIET AND LIFESTYLE CHANGES-Help cut down weight in obesity cases and avoidance of smoking and use of other recreational drugs.
- INTRA-UTERINE INSEMINATION
- INVITRO FERTILISATION
THE SPERM JOURNEY
Begins in the testicles in a pouch called the scrotum.The scrotal sac hangs the testes away from the warm body to allow the testes make sperm in a cool environment. The sperm then moves to a set of small tubes called the epididymis where they are stored as they mature.
During intercourse,the sperm leave their storage area and move to the back of the urethra where they are incorporated into semen,which is made up of fluid that provides nutrient for the sperm.The sperm will need this semen for the long journey to the fallopian tubes.
The final stage is the expulsion of the semen through a process called ejaculation in which a contraction of muscles pushes out the semen via the urethra and out of the penis.The semen finds its way into the female reproductive system.Upon fertilization of an egg,a foetus is the formed
FACTS TO REMEMBER
- Sperm can survive in the female reproductive system for 72 hours
- Some women have allergies to sperm;their bodies attack the sperm and destroy it which is a rare cause of infertility.