Male Infertility
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Low Sperm Count
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Male Infertility

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Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. Male infertility is commonly due to deficiencies in the semen and semen quality is used as a surrogate measure of male fecundity.


It is important to note that infertility and impotence are quite different entities. Failure to discern the difference between the two is a needless cause of embarrassment to most men who stay away from andrology clinics because of the stigma that goes with the latter term.

Impotence means an inability to attain or sustain erections for satisfactory sexual intercourse.

The term has no bearing whatsoever on the fertility status of the man. It is thus possible for a totally impotent man to be potentially fertile and it will be possible to produce a pregnancy in the wife of such a man by insemination of the husband's semen.

Infertility, on the other hand, means an inability to produce children. This usually results from the husband's semen being infertile or sub-fertile. Most infertile men are perfectly normal in terms of potency and have very satisfactory sexual relations with their partners.

What are the main causes of male infertility?

The commonest reason, is a low sperm count, which can be attributed to various causes : -
  • Idiopathic i.e., when the exact cause is not known.

  • Varicocele - It is a swollen varicose vein in the scrotum, most commonly on the left side. Blood accumulated in the swollen testicular veins leads to increased temperature in the testis & damages sperm production.

  • It can be diagnosed, by asking the patient to stand erect and cough . The cord like structure from which the testis hangs i.e., the spermatic cord, feels like a "bunch of worms", on palpation.

  • Duct blockage - Infection like gonorrohea, TB, filariasis; on surgery for hernia/hydrocele may lead to blockage of the passage between the testes and the penis. In this case sperms will be absent from the semen(azoospermia).

  • Hormonal imbalance - Hormonal imbalance due to pituitary or adrenal gland can lead to infertility.

  • Substance Abuse - Exessive intake of alcohol and/or drugs leads to decrease in liver function and increase in levels of the hormone Estrogen which in turn suppresses sperm production.

  • Testicular factors - like twisting of testis leading to compromised blood supply; undescended testes when the testes lie in the abdomen; and damage due to exercise or heat can decrease sperm production. Testes lie outside the body in the scortum because they can produce sperms in a cooler environment. So clothes like tight jeans, nylon briefs, and hot baths/saunas, lead to damage to sperm production.

Diagnosis of Male Infertility

Quality of sperm is determined by semen analysis. After abstinence for 72 hours, the man provides the semen by masturbating into a sterile container or into a special condom during intercourse, and bringing the specimen to the doctor's office or hospital within two hours of collection.

Men with low sperm counts may not have trouble fathering a child, while men with high sperm counts may. The quality of the sperm, as seen under a microscope, is the most important factor. The sperm must be moving rapidly and easily, and it must have few abnormalities.

Other tests may include blood tests to evaluate for possible endocrinologic (hormonal) problems.

The doctor will also conduct a physical examination to determine whether there is a condition that could affect sperm production.

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