Environmental Factors Occupational or other long-term exposure to certain types of toxins and chemicals (such as herbicides M a l e F a c t o r I n f e r t i l i t y and pesticides) may reduce sperm count by either affecting testicular function or altering hormone systems. Estrogen-like and hormone-disrupting chemicals such as bisphenol A, phthalates, and organochlorines are particular potential concerns. Sperm motility is the sperm's ability to Chronic exposure to heavy metals such as lead, Causes cadmium, or arsenic may affect sperm quality. move. If movement is slow, not in a These chemicals generally affect men who have straight line, or both, the sperm have M a l e F a c t o r difficulty invading the cervical mucus or long-term and intense exposure to them. At this More than 90% of male infertility cases time, there is no strong evidence supporting a seri- are due to low sperm counts, poor sperm penetrating the hard outer shell of the egg. If 60% or more of sperm have nor- ous harmful effect on fertility in men who have quality, or both. The remaining cases of I n f e r t i l i t y mal motility, the sperm is at least aver- normal limited exposure to these chemicals. male infertility can be caused by a num- ber of factors including anatomical prob- age in quality. If less than 40% of sperm The Causes ... lems, hormonal imbalances, and genetic are able to move in a straight line, the Medical Conditions defects. condition is considered abnormal. Sperm that move sluggishly may have genetic or other defects that render Medical conditions that can affect male fertility Sperm Abnormalities include any severe injury or major surgery, diabe- them incapable of fertilizing the egg. tes, HIV, thyroid disease, Cushing syndrome, heart Poor sperm motility may be associated attack, liver or kidney failure, and chronic anemia. Sperm abnormalities can be caused by a with DNA fragmentation and may in- Certain types of medications can impair sperm range of factors, including congenital crease the risk for passing on genetic diseases. production. birth defects, disease, chemical expo- sure, and lifestyle habits. (See Risk Fac- Abnormal Sperm Morphology tors section.) In many cases, the causes (Teratospermia). Morphology refers to Infections in the Urinary Tract or Genitals. Infec- of sperm abnormalities are unknown. shape and structure. Abnormally shaped tions that may affect fertility include prostatitis sperm cannot fertilize an egg. About 60% (inflammation in the prostate gland), orchitis (in the of the sperm should be normal in size and testicle), semino-vesculitis (in the glands that pro- Sperm abnormalities are categorized by shape for adequate fertility. The perfect duce semen), or urethritis (in the urethra), perhaps whether they affect sperm count, sperm sperm structure is an oval head and long by altering sperm motility. Even after successful movement, or sperm shape. They include: tail. antibiotic treatment, infections in the testes may leave scar tissue that blocks the epididymis. Dr. Raymond Mansoor Retrograde Ejaculation • Low Sperm Count (Oligospermia). A Cancer and Its Treatments. Birth rates among cancer B Sc , MB BS , DM (O&G) FACOG sperm count of less than 20 million/mL survivors are only 40 - 85% of normal rates. Certain is considered low sperm. Azoospermia Retrograde ejaculation occurs when the muscles of the bladder wall do not func- cancers, particularly testicular cancer, impair sperm Obstetrician & Gynaecologist refers to the complete absence of sperm cells in the ejaculate, and accounts for tion properly during orgasm and sperm production, often severely. Cancer treatments such as Tanner St. & Corn Alley 10 - 15% of cases of male infertility. are forced backward into the bladder chemotherapy and radiation can damage sperm quality Partial obstruction anywhere in the long instead of forward out of the urethra. and quantity, causing infertility. The closer radiation P.O. Box 1361W passages through which sperm pass can Sperm quality is often impaired. treatments are to reproductive organs, the higher the St. John's reduce sperm counts. Sperm count var- ies widely over time, and temporary low risk for infertility. There is also some evidence that male Retrograde ejaculation can result from Antigua counts are common. Therefore, a single infertility is itself a risk factor for testicular cancer. several conditions: Tel: (268) 463 2232/3 test that reports a low count may not be Information contained in this booklet is meant for a representative result. Fax: (268) 562 8128 informational purposes only and should not substitute • Surgery to the lower part of the bladder the visit to your doctor nor his/her advice for your • Poor Sperm Motility (Asthenospermia). email : [email protected] or prostate (the most common cause of health care. April 2017 M a l e F a c t o r I n f e r t i l i t y retrograde ejaculation) the penis. Low semen levels in ejaculate may be are unimpaired. Emotional Stress. Stress may interfere associated with structural abnormalities in the Kartagener syndrome, a rare disorder that is as- with certain hormones involved with • Diseases such as diabetes and tubes transporting the sperm. sociated with a reversed position of the major sperm production. multiple sclerosis organs, also causes impaired sperm motility. Hormonal Deficiencies Risk Factors Testicular Overheating. Overheating, • Spinal cord injury or surgery such as from high fevers, saunas, and Hypogonadism is the general name for a severe hot tubs, may temporarily lower sperm Varicocele • Medications such as alpha blockers deficiency in gonadotropin-releasing hormone count. used for enlarged prostate glands, (GnRH), the primary hormone that signals the pro- tranquilizers, certain antipsychotics, cess leading to the release of testosterone and A varicocele is an abnormally enlarged and twist- Substance Abuse. Cocaine or heavy or blood pressure medications may other important reproductive hormones. Low levels ed (varicose) vein in the spermatic cord that con- marijuana use can temporarily reduce also cause temporary retrograde of testosterone from any cause may result in defec- nects to the testicle. Varicoceles are found in the number and quality of sperm. Chem- ejaculation. tive sperm production. about 15% of all men and in about 40% of infertile ical compounds in marijuana that may men, although it is not clear how much they affect fertility or by what mechanisms. They can raise impair the sperm's ability to swim and Hypogonadism is uncommon and is most often testicular temperature, which may have effects on also inhibit their ability to penetrate the Structural Abnormalities present at the time of birth. It is usually the result of egg. Anabolic steroid use can shrink sperm production, movement, and shape. rare genetic diseases that affect the pituitary gland. testicles and decrease sperm produc- These conditions may include selective deficiencies tion. Heavy drinking may also impair Any structural abnormalities that dam- of the hormones FSH and LH, Kallman syndrome, Age fertility. age or block the testes, tubes, or other or panhypopituitarism, in which the pituitary gland reproductive structures can affect fails to make almost all hormones. Hypogonadism Age-related sperm changes in men are not abrupt, fertility. Smoking. Cigarette smoking may affect can also develop later in life from brain or pituitary but are a gradual process. Aging can adversely sperm quality. gland tumors or as a result of radiation treatments. affect sperm counts and sperm motility (the Cryptorchidism. Cryptorchidism is a sperm's ability to swim quickly and move in a condition usually seen in newborn Genetic Disorders straight line). The genetic quality of sperm de- Obesity. Obesity may impair hormonal infants in which the testicles fail to clines as a man ages. levels and adversely affect fertility. descend from the abdomen into the Certain inherited disorders can impair fertility. Ex- scrotum. Cryptorchidism is associated amples include: Sexually Transmitted Diseases with mild to severe impairment of Bicycling. Bicycling may affect erectile sperm production. function. Pressure from the bike seat Repeated Chlamydia trachomatis or gonorrhea may damage blood vessels and nerves • Cystic fibrosis can cause missing or obstructed infections are the sexually transmitted diseases that are responsible for erections. Moun- Hypospadias. This is a birth defect in vas deferens (the tubes that carry sperm). most often associated with male infertility. Such tain biking, which involves riding on off- which the urinary opening is on the infections can cause scarring and block sperm road terrain, exposes the perineum (the underside of the penis, can prevent • Polycystic kidney disease, a relatively common passage. Human papilloma viruses, the cause of region between the scrotum and the sperm from reaching the cervix if not genetic disorder that causes large cysts to form on genital warts, may also impair sperm function. anus) to more extreme shocks and vi- surgically corrected. the kidneys and other organs during adulthood, brations and increases the risk for inju- may cause infertility as the first symptom if cysts Lifestyle Factors ries to the scrotum. A padded or con- develop in the reproductive tract. toured bike seat set at the proper height Blockage in the Tubes that Transport and angle can help reduce this risk. Sperm. Some men are born with a Nearly any major physical or mental stress can blockage or other problems in the • Klinefelter syndrome is marked by two X and one temporarily reduce sperm count. Some common epididymis or ejaculatory ducts that Y chromosomes (the norm is one X and one Y), conditions that lower sperm later affect fertility. Some men lack the which leads to the destruction of the lining of the count, temporarily in nearly all seminiferous tubules in the testicles during puber- vas deferens, the tube that carries cases, include: sperm from the testicles out through ty, although most other male physical attributes .