Infertility is defined as inability of a couple to conceive after 12 months of unprotected sexual intercourse. It effects over 5 millions couple alone in the U. S. and many times more in the world. Because of unawareness of treatments, only 10% seeks help from professional specialist. I have spent much of our time to discuss the female infertility and unexplained causes of female infertility in previous series, we will focus the infertility on the other partner-male infertility. In reality, approximate about 90% of male infertility are as result of sperm abnormalities.
Sperm abnormality is defined as a condition of low sperm count and/or poor sperm quality.
A. Risk factor
1. Sexual transmitted Diseases
Most bacteria infect the reproductive system through unprotected sexual intercourse and are happened mostly to women and men with several partners.
When a man get older the levels of testosterone start to drop and the levels of the by-product prolactin of testosterone of men increases stimulating the production of the enzyme 5-alpha reductase that causes the conversion of testosterone to gihydro-testosteronescausing, leading to many problems such as erectile and abnormal sperm production.
A good living lifestyle may be helpful for preventing diseases and preserve health but times the good living lifestyle also a cause of hormone imbalance, leading to lower sperm count and/or low sperm quality.
4. Environment effects
Long-term exposure to certain types of toxins and chemicals (such as herbicides and pesticides) due to occupation may increase the risk of hormone imbalance that affects the function of testicle, leading reduce sperm count and/or sperm quality.
Varicocele is an enlarged varicose vein in the spermatic cord that connects to the testicle. It can effect the sperm condition as it raises the testicular temperature.
6. Sluggish liver
Liver is important for regulating the balance of essential fatty acid. Our daily today contains more meats and high levels of saturated fat and trans fat which interfere the liver function, leading to over production of certain hormone disrupting normal function of male reproductive organ such as low sperm count, erectile dysfunction.
7. Medical condition
Certain medical condition can causes the reduction of sperm count and effecting the low quality sperm, such as any severe injury or major surgery, diabetes, HIV, etc.
B. Causes of sperm abnormality
Causes of sperm abnormality is still unknown, but expects suspect that it may be attributed to the followings:
Sperm abnormality may be inherited.
2. Testicular enzyme defect
A congenital enzyme defect that interfere with normal process of the testes in sperm production as resulting of inability of the test in responding to hormone stimulation.
3. Immune system
Immune system plays an important role in fighting the forming of free radical and foreign invasion such as bacteria and virus. Any infection or allergic reaction in the body may cause over production of antibody leading to immune system attacking fetus and the sperm which interferes the sperm quality movement and sperm cervical invasion.
Biking may be a healthy sport but biking off the mountain road it may injure the penis and cause the scrotum problem including lower sperm production and interfering with natural selection in the body. It is advice for people to take precaution to avoid swelling pain or damaging the reproductive system.
5. Medical condition
Medical condition such as azoospermia which reduces the level of sperm in his semen caused by blocking of the reproductive tract.
6. Hormone imbalance
Hormone imbalance in a male can interfere with the production of testosterone, leading to low sperm count and/or low sperm quality.
C. Diagnosis of sperm abnormality
1. Low Sperm Count (Oligospermia).
Sperm count of that lower than 10 million per ml is considered as a factor that cause infertility of 10 -15 % of male population. Azoospermia is defined as a complete absence of sperm cells in the ejaculation. There also some case of which lower sperm count is caused by structure in the sperm passage. Although the volume of sperm is still in dispute as some experts may refer low sperm count of that less 20 millions per mL but agree that sperm count are varies widely overtime, even day.
2. Poor Sperm Motility (Asthenospermia)
Poor sperm motility is defined as a condition of movement of sperm. Any movement that is not normal such as slow, not in a straight line, having difficulty to invade the cervical mucus or penetrate the hard outer shell of the egg is considered as poor sperm motility. Experts suggest that over 50% of the sperm in any ejaculation should be motile and show forward movement.
3. Abnormal Sperm Morphology (Teratospermia)
Sperm morphology is the study of the structure and shape of the sperm. In order to ensure the success in egg fertilization, sperm should have more than 50% of normal size, oval head and long tail.
If the sperm abnormality is causes by structure problem as we mentioned in some other articles in series of overcome infertility, than surgery may be required. In other case, it can be effectively treated with the following;
1. Hormonal deficiency
If the hormonal deficiency is the causes of low sperm abnormality and depending which hormones have effect the production of sperm, patient may be given
a) Luteinizing hormone (LH)
LH stimulates testosterone production from the interstitial cells of the testes.
b) Follicle-stimulating hormone (FSH)
FSH stimulates testicular growth and enhances the production of an androgen-binding protein to sustain the maturing sperm cell.
2. Clomiphene citrate
Using Chomiphere citrate to treat mild sperm abnormalities in an attempt to improve the semen have been very controversy (Adverse effect of clomiphene citrate on sperm morphology. by Shanis B, Check JH, Bollendorf A. Department of Obstetrics and Gynecology, University of Medicine/Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, http://www.ncbi.nlm.nih.gov/pubmed/1953195). and some clinic trails have shown no improvement in the rate of pregnancy with either placebo or clomiphene group.
3. Genetic defect
There is currently without any effective treatment for sperm abnormality caused by genetic defects. Artificial insemination may be the only possible
a) Intra cervical insemination
Intra cervical insemination( ICI) is defined as a advance technological infertility treatment by placing the male partner sperm directly into the female partner cervix, thereby increasing the chance of sperm swimming through the uterus and into the Fallopian tube. ICI is less expensive than other artificial insemination and can be performed by your reproductive specialist at his or her office.
b )Intrauterine insemination
Unlike intra cervical insemination, intrauterine insemination (IUI) is defined as placing the warmed prepared sperm into the woman’s uterus 2 -3 days before and after ovulation with the purpose of getting the sperm closer to the egg, thereby increasing the chance of fertilization.
c) Gamete intra Fallopian tube transfer (GIFT)
Gamete intra fallopian tube (GIFT) is simple ART (Assisted Reproductive Technology) technique and defined as placing the mature eggs at the far end of the Fallopian tube of the female partner together with the male partner sperm.
d) Zygote intra fallopian tube transfer
Similar to Gamete intra fallopian tube (GIFT), Zygote intra fallopian tube transfer (ZIFT) is defined as placing the zogote (the fertilized but undivided egg) directly into the woman’s fallopian tubes, in order to maximize the chance of fertility.
e) Tubal embryo transfer (TET)
The operation is carried out as a day-case procedure under a general anesthesia with the use of medical laparoscopy. Unlike ZIFT, after the eggs are collected and allowed to fertilized with the male partner sperm, the zogotes are cultivated in the lab for 2 days and the embryos are replaced into the female partner fallopian tube.
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