Male infertility may be due to a number of factors. The investigation of infertility should be done by experts, who may counsel the man properly on the type and number of tests to be done to identify and then treat any problems.

 

·         Ejaculatory dysfunction and / or Sexual dysfunction

 

Some couples may be infertile because they do not have intercourse often enough. Thus, no sperm are present in the female genital tract at the time of ovulation therefore not allowing fertilization. 

 

Ejaculatory dysfunction is the inability of a man to have or maintain an erection, sufficient to complete sexual intercourse. This may be due to psychological factors, or to certain chronic conditions such as diabetes mellitus, multiple sclerosis, thyroid disease, epilepsy, atherosclerosis, and renal failure. It can also be caused by spinal cord injuries or damage to nerves during surgery in the abdomen, as well as by certain pharmaceutical substances.

 

Premature ejaculation and retrograde ejaculation also belong to this category.

 

·         Iatrogenic factors

 

Some drugs may inhibit sperm production; these include chemotherapy agents (which are cytotoxic), anabolics and more.

 

Infertility may also occur as a result of interventions that can damage the vas deferens such as prostatectomy, inguinal hernia or hydrocele surgery, etc..

 

·         Congenital abnormalities

 

Genetic disorders include defects at the chromosome or the gene level.

 

Several genetic syndromes are associated with male infertility, and this is also why contribution from an expert is necessary. It should be added here that some genetic abnormalities may be transmitted to the male offspring of these patients.  

 

This category includes men who were born with cryptorchidism which was not surgically corrected before puberty, or men who were born with congenital absence of the vas deferens, as well as men who are carriers or who suffer from cystic fibrosis, or men with Kleinefelter or Kartagener syndromes, etc..

 

·         Acquired testicular lesions

 

Damage to the testicles may be caused by various diseases, auxiliary gland infections, or trauma.

 

Diseases that may cause damage to the testicles after puberty are:

 

Mumps (parotitis), tuberculosis, gonorrhea, chlamydial infections, typhus, syphilis, brucellosis, filariasis, schistosomiasis.

 

Trauma may be caused by accident, or by surgical procedures. Testicular torsion is considered as trauma, if not treated promptly.

 

·         Varicocele

 

It is the condition in which the veins carrying blood away from the testicles are dilated, and become swollen from blood that can not be drained. As a consequence, the temperature inside the testis increases to levels detrimental to the process of spermatogenesis.

 

Varicoceles are present in 20% of the male population, usually on the left side.

 

·         Endocrine causes

 

These are hormonal disorders, caused by damage to the pituitary gland (LH, FSH, PRL) or the hypothalamus (GnRH).  These lesions may be acquired or congenital.

 

·         Idiopathic (unexplained) infertility

 

In about 25% of men, the infertility observed may not be attributed to any apparent cause.