MALE INFERTILITY

INFERTILITY IN THE MALE

Male reproductive ability begins at about age 16.After approximately age 45 , fertility decreases, although men over 80 have fathered children.
Male infertility may due to the following causes:
1. Spermatozoal abnormalities : The normal values of semen [spermatic fluid] are as follows:
Volume:2.5-5 ml; pH:7.4; viscosities: moderate thin after 30 minutes. Motility [26.5 degree C] : More than 70 % motile at ejaculation; 60 % at 2 hours;25-40 % at 6 hours. Count: 50-120 million / ml. Morphology: Fewer than 30 % abnormal spermatozoal head. Color: Whitish, semi-gelatinous fluid.
Key diagnostic test is a semen analysis: Sperm counts of less than 13 million / ml, motility of less than 32 %, and less than 9 % normal morphology are associated with subfertility.[Harrison’s Manual of Medicine, 2005, p 837] .
High fertility is assume to exist when the sperm count approaches 185 million / ml.[Ralph C. Benson .Obstetrics & gynecology, 1971, p667].
Spermatozoa survive longest in alkaline cervical secretions and are destroyed quickly if they remain in the acid vaginal fluid. Motility is arrested at pH 6.0 and motility does not return after sperms have been exposed to a pH less than 4 and will die.
2. Endocrine: Hypopituitarism or Hypogonadism and hypothyroidism are associated with
infertility.
3. Most instances of mechanical obstruction [congenital, inflammatory, or traumatic] in
epididymides and vas deferens occur here.
4. Varicocele may increase scrotal temperature and thus impair spermatozoal maturation.
5. Infection: Sexually transmitted disease such as gonorrhoe, syphilis, chlamydia,
trichomoniasis may cause infertility.
6. Erectile dysfunction [ED] is the failure to achieve erection, ejaculation or both..
It effects 10-25 % of middle age and elderly men. Diabetic, atherosclerosis and drug related cause account for more than 80 % of cases of ED in older men.

7. EXAMINATION AND DIAGNOSIS