Male Infertility Information
THE MALE REPRODUCTIVE SYSTEM &
The sperm is the sex cell which is produced by the male. Sperms are capable of active movement and they are suspended in a fluid called seminal fluid.
The male reproductive system is made up of the testes within which sperms are produced and a rather complicated system of tubules through which sperms are transported. The reproductive organs of the male are both inside and outside the abdomen. The parts of the male reproductive system include-
The testes – which is the organ that produces the sperms
The duct ( tube ) system, which is made up of the epididymis and the vas deferens which store and transport the sperms
The accessory glands, which include the seminal vesicles and prostate gland which produce the fluid part of the semen which in turn provide nourishment to the sperms.
The penis which is the male sexual organ
In an adult, the two testes produce and store millions of tiny sperm cells. The testes are oval-shaped and grow to be about 5 cm x 3 cm in diameter. They contain thin, highly coiled tubes called seminiferous tubules within which sperms are produced. The testes also produce a hormone called testosterone. Testosterone is the hormone that produces a deep voice, bigger muscles, and body and facial hair, and it also stimulates the production of sperm.
From the testes arise two coiled tubes called the epididymis. There is one epididymis on each side. This is where sperms are stored temporarily after they are produced from the testes. The two epididymis (one from each side) join the vas deferens which is a muscular tube, one on each side. The vas deferens receives the sperms from the epididymis.
The epididymis and the testes hang in a pouch-like structure outside the abdomen called the scrotum. This bag of wrinkled skin helps to regulate the temperature of testes, which need to be kept cooler than body temperature to produce sperm. The scrotum changes size to maintain the right temperature. When the body is cold, the scrotum shrinks and becomes tighter to hold in body heat. When it’s warm, the scrotum becomes larger and more relaxed to get rid of extra heat.
As the vas deferens from both sides travel into the abdomen they are joined by sac like structures called the seminal vesicles. The vas deferens and seminal vesicles join together to form the ejaculatory ducts which empty the sperms into the urethra. This is the final tube which carries sperms through the penis to the outside.
This is a picture of a mature sperm. It has a head which contains important genetic material and that is the portion which enters the egg and fertilizes it. The neck or midpiece provides energy for movement and the tail helps the sperm to swim towards the egg.
How do we know if you have the correct number of sperms?
We do a test called a semen analysis. This is done after you have abstained from intercourse for 2-3 days. We look at your semen sample under a microscope to check if you have adequate numbers of sperms which move and look normal. We say that your semen test is satisfactory if – you have more than 15 million sperms, and if more than 50% move rapidly and more than 4% have a normal appearance.
Why should my sperm numbers, capacity to move and appearance be normal?
Abnormal sperm parameters can cause delay in conception and very low numbers are associated with infertility.
How often are men the reason for infertility?
In about 40% of infertile couples the male is either the only reason or also contributes to the infertility with the female.
Can a man have no sperms at all in his semen?
Yes. Some men have no sperms at all in their semen. This is called azoospermia.
What are the reasons for reduced sperm numbers?
Often it is difficult to find a reason. These men are said to have idiopathic defects- i.e: no cause identifiable.
The known causes of disordered sperm production are –
Infections of the testes ( mumps) and sexually transmitted infections
Certain medicines like – sulfasalizine (taken for bowel inflammation), Phenothiazines ( taken for psychiatric illnesses) ,immunosuppressants ( taken after transplant surgery) and medicines used to treat cancer
Diabetes, thyroid and other endocrine defects.
Injury to the testes or operations to that area
Varicocele – this is an increase in the size of the veins inside the scrotum making the testes warmer by increasing its blood flow. As stated earlier, this can result in reduction in sperm production.
Being overweight, smoking and excess alcohol can reduce sperm numbers and activity
Why do some men have no sperms in their semen?
This may be because of no production or may result because of blockage of the duct system described above. Production may not occur when there are certain hormone defects or when the man has an abnormal number of chromosomes. The duct system may be blocked by damage due to infection or a part of the duct may be absent from birth. Very often, we cannot identify a reason for absent sperms
What is the treatment for sperm defects?
This depends on how severe the problem is.
With a slight reduction in sperms an IUI (intrauterine insemination) will be advised. Here we do a ‘sperm preparation’. By this process, the dead and inactive sperms and bacteria if present are removed and the good sperms are made very active. These sperms are then placed within the woman’s uterus. This procedure increases your chance of getting pregnant.
With very few sperms we may advise an IVF or an ICSI. For further information please read the booklet on IVF and ICSI
What can be done when no sperms are present?
When no sperms are present in the semen, we will examine the testes to see if they are of normal size. Then we usually advise a hormone test (FSH) which will give us an idea as to whether you may have sperms within your testes or not. Of course, the only test which can confirm this is a testicular biopsy.
If sperms are present, we can do a small surgical procedure (read about TESE and MESA in booklet) wherein we can remove them from the testes and use them to fertilize the egg.
If however you cannot afford the above procedure or we do not find sperms in your testes, you can choose to have donor sperms.
Will IVF with sperms taken from the testes or epididymis be as successful as that taken from the semen?
Using sperms from the semen, nearly 75% of eggs are fertilized. This falls to about 70% when sperms from the epididymis are used and to about 65% when sperms from the testes are used. Though the chance is lesser, it is important to remember that it is the only chance of you having your biological child.
Are there any other reasons for male infertility?
Another reason may be sexual dysfunction. A few men may have a problem with ejaculation and therefore be unable to have intercourse. Any doubts regarding this can be discussed in detail with your doctor.
Dr. Vani Sundarapandian
Medical Director, Jananam Fertility Center
What the Male Reproductive System Does
The male sex organs work together to produce and release semen into the reproductive system of the female during sexual intercourse. The male reproductive system also produces sex hormones, which help a boy develop into a sexually mature man during puberty.
When a baby boy is born, he has all the parts of his reproductive system in place, but it isn’t until puberty that he is able to reproduce. When puberty begins, usually between the ages of 10 and 14, the pituitary gland — which is located near the brain — secretes hormones that stimulate the testicles to produce testosterone. The production of testosterone brings about many physical changes. Although the timing of these changes is different for every guy, the stages of puberty generally follow a set sequence.
During the first stage of male puberty, the scrotum and testes grow larger.
Next, the penis becomes longer, and the seminal vesicles and prostate gland grow.
Hair begins to appear in the pubic area and later it grows on the face and underarms. During this time, a male’s voice also deepens.
Boys also undergo a growth spurt during puberty as they reach their adult height and weight.
A male who has reached puberty will produce millions of sperm cells every day. Each sperm is extremely small: only 1/600 of an inch (0.05 millimeters long). Sperm develop in the testicles within a system of tiny tubes called the seminiferous tubules. At birth, these tubules contain simple round cells, but during puberty, testosterone and other hormones cause these cells to transform into sperm cells. The cells divide and change until they have a head and short tail, like tadpoles. The head contains genetic material (genes). The sperm use their tails to push themselves into the epididymis, where they complete their development. It takes sperm about 4 to 6 weeks to travel through the epididymis.
The sperm then move to the vas deferens, or sperm duct. The seminal vesicles and prostate gland produce a whitish fluid called seminal fluid, which mixes with sperm to form semen when a male is sexually stimulated. The penis, which usually hangs limp, becomes hard when a male is sexually excited. Tissues in the penis fill with blood and it becomes stiff and erect (an erection). The rigidity of the erect penis makes it easier to insert into the female’s vagina during sexual intercourse. When the erect penis is stimulated, muscles around the reproductive organs contract and force the semen through the duct system and urethra. Semen is pushed out of the male’s body through his urethra — this process is called ejaculation. Each time a guy ejaculates, it can contain up to 500 million sperm.
When the male ejaculates during intercourse, semen is deposited into the female’s vagina. From the vagina the sperm make their way up through the cervix and move through the uterus with help from uterine contractions. If a mature egg is in one of the female’s fallopian tubes, a single sperm may penetrate it, and fertilization, or conception, occurs.
This fertilized egg is now called a zygote and contains 46 chromosomes — half from the egg and half from the sperm. The genetic material from the male and female has combined so that a new individual can be created. The zygote divides again and again as it grows in the female’s uterus, maturing over the course of the pregnancy into an embryo, a fetus, and finally a newborn baby.
Things That Can Go Wrong With the Male Reproductive System
Boys may sometimes experience reproductive system problems, including:
Disorders of the Scrotum, Testicles, or Epididymis
Conditions affecting the scrotal contents may involve the testicles, epididymis, or the scrotum itself.
Testicular trauma. Even a mild injury to the testicles can cause severe pain, bruising, or swelling. Most testicular injuries occur when the testicles are struck, hit, kicked, or crushed, usually during sports or due to other trauma. Testicular torsion, when one of the testicles twists around, cutting off its blood supply, is also a problem that some teen males experience, although it’s not common. Surgery is needed to untwist the cord and save the testicle.
Varicocele. This is a varicose vein (an abnormally swollen vein) in the network of veins that run from the testicles. Varicoceles commonly develop while a boy is going through puberty. A varicocele is usually not harmful, although it can damage the testicle or decrease sperm production. Take your son to see his doctor if he is concerned about changes in his testicles.
Testicular cancer. This is one of the most common cancers in men younger than 40. It occurs when cells in the testicle divide abnormally and form a tumor. Testicular cancer can spread to other parts of the body, but if it’s detected early, the cure rate is excellent. Teen boys should be encouraged to learn to perform testicular self-examinations.
Epididymitis is inflammation of the epididymis, the coiled tubes that connect the testes with the vas deferens. It is usually caused by an infection, such as the sexually transmitted disease chlamydia, and results in pain and swelling next to one of the testicles.
Hydrocele. A hydrocele occurs when fluid collects in the membranes surrounding the testes. Hydroceles may cause swelling in the scrotum around the testicle but are generally painless. In some cases, surgery may be needed to correct the condition.
Inguinal hernia. When a portion of the intestines pushes through an abnormal opening or weakening of the abdominal wall and into the groin or scrotum, it is known as an inguinal hernia. The hernia may look like a bulge or swelling in the groin area. It can be corrected with surgery.
Disorders of the Penis
Disorders affecting the penis include:
Inflammation of the penis. Symptoms of penile inflammation include redness, itching, swelling, and pain. Balanitis occurs when the glans (the head of the penis) becomes inflamed. Posthitis is foreskin inflammation, which is usually due to a yeast or bacterial infection.
Hypospadias. This is a disorder in which the urethra opens on the underside of the penis, not at the tip.
Phimosis. This is a tightness of the foreskin of the penis and is common in newborns and young children. It usually resolves itself without treatment. If it interferes with urination, circumcision (removal of the foreskin) may be recommended.
Other Disorders of the Penis
Paraphimosis. This may develop when a boy’s uncircumcised penis is retracted but doesn’t return to the unretracted position. As a result, blood flow to the head of the penis may be impaired, and your son may experience pain and swelling. A doctor may use lubricant to make a small incision so the foreskin can be pulled forward. If that doesn’t work, circumcision may be recommended.
Ambiguous genitalia. This occurs when a child is born with genitals that aren’t clearly male or female. In most boys born with this disorder, the penis may be very small or nonexistent, but testicular tissue is present. In a small number of cases, the child may have both testicular and ovarian tissue.
Micropenis. This is a disorder in which the penis, although normally formed, is well below the average size, as determined by standard measurements.
If your son has symptoms of a problem with his reproductive system or he has questions about growth and sexual development, talk with your doctor — many problems with the male reproductive system can be treated.
Reviewed by: Steven Dowshen, MD
Date reviewed: November 2007
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