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Physical Problems A variety of physical problems can cause male infertility.  These problems either interfere with the sperm production process or disrupt the pathway down which sperm travel from the testes to the tip of the penis.  These problems are usually characterized by a low sperm count and/or abnormal sperm morphology.  The following is a list of the most common physical problems that cause male infertility: Variocoele: A varicocele is an enlargement of the internal spermatic veins that drain blood from the testicle to the abdomen (back to the heart) and are present in 15% of the general male population and 40% of infertile men.  These images show what a variocoele looks like externally and internally.  A varicocele develops when the one way valves in these spermatic veins are damaged causing an abnormal back flow of blood from the abdomen into the scrotum creating a hostile environment for sperm development.  Varicocoeles may cause reduced sperm count and abnormal sperm morphology which cause infertility.  Variococles can usually be diagnosed by a physical examination of the scrotum which can be aided by the Doppler stethoscope and scrotal ultrasound.  Varicocoele can be treated in many ways (see treatment section), but the most successful treatments involve corrective surgery. Other testing may be needed based on circumstances, including testicular biopsy, genetic testing, and imaging (Table 36–8,10,19,20). In order to conceive, your sperm must be:  Highly concentrated — normally, there should be at least 15 million sperm in every ml of semen5  Moving well (motile) — a lashing tail helps your sperm to swim to your partner’s egg  Normally shaped — healthy sperm should be shaped like a streamlined tadpole  You may find that your semen contains a very low number of sperm (oligozoospermia), or no sperm at all (azoospermia).

The use of Epididymal and Testicular Spermatozoa for Intracytoplasmic Sperm Injection: The Genetic Implications for Male Infertility. (PDF, 8 MB) Human Reproduction, 1995. Causes of infertility include male factors, ovulatory dysfunction, uterine abnormalities, tubal obstruction, peritoneal factors, or cervical factors. The Fate of Non-absorbable Intraureteral Suture. (PDF, 233 KB) The Journal of Urology, 1973. Prolactin inhibits the production of GnRH from the hypothalamus and LH and FSH from the pituitary.

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As they respond to hormones the same way as they would do in the uterus, that is by growing and shedding cyclically, endometriosis can cause both fallopian tube and ovarian scarring. Diagnosis and Management of Hypogonadism, Infertility, and Impotence. (PDF, 13 MB) Chapter 22 of textbook,Male Reproductive Dysfunction, 1986. Prolactin stimulates milk production during breastfeeding. Transplantation of Rat Kidneys with Acute Tubular Necrosis into Salt-loaded and Normal Recipients. (PDF, 2 MB)Surgery, 1975.

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Spermatogonia and Sertoli cells lie on the basement membrane of the seminiferous tubules. In this condition, semen ejaculates backwards into the bladder instead of out the penis.

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Infertility is due to hypogonadotropic hypogonadism. The progestins that can be used and the doses are as follows: Medroxyprogesterone acetate (eg, Depo-SubQ Provera 104; administer 104 mg SC q3mo or q12-14wk) Megestrol acetate (eg, Megace 20-40 mg PO qd for up to 2 months) Norethindrone acetate (eg, Aygestin 15 mg PO qd for 6-9 months) [145, 146, 147, 148, 149, 150] The androgens used are 17-ethinyl testosterone derivatives (eg, danazol 400-800 mg PO divided BID; not to exceed 9 months) [151, 152, 153] The GnRH agonists used are as follows: Leuprolide acetate (eg, Lupron 3. It does not affect the couples' life only, but it also affects the healthcare services and social environment [4]. Medical management: - Ovarian suppression of minimal and mild endometriosis diagnosed as the cause of infertility in women does not enhance fertility and should not be offered. It is said to be the most reliable way of confirming whether ovulation has occurred.[12] Women may also use ovulation predictor kits (OPKs) which detect the increase in luteinizing hormone (LH) levels that usually indicates imminent ovulation. The patient's electrolyte levels must be checked to consider the need for diuretics. Cervical factors are also thought to play a minor role, although they are rarely the sole cause.