Male Sterility

INCIDENCES In the industrialised countries, according to recent epidemiological information, approximately 20% of couples at the fertile age have difficulties in procreating. It is considered that the male factor, associated or apart from the female one, is present in approximately 40-50% of the cases of infertility. In Italy, in consideration of an annual marriage rate of approximately 300,000, one may make an approximate estimate of 2 million people beginning health procedures due to facing a sterility problem - therefore, this reveals a pathology which assumes its own veritable social dimensions, too underrated by the Public Health system. Causes As far as the male causes of infertility are concerned, frequent assume an ingravescent character in the time and become decisive because of the current social tendency to procrastinate the search for the right moment for pregnancy.

Therefore, as may happen to the woman, the delay in the wedding age certainly constitutes the principle factor of sterility in the industrialised countries.

In the following table, the principle causes of male infertility accordingly refer to personal case studies (observed in 600 cases of male infertility)

Andrological pathologies in male infertility are shown to be:

(individual or in association with others, %)

clinical varicocele 19.3% (=varicose veins of the testicles)
infection of the seminal tracts 14.7% (prostatitis, epididimitis, vescicolitis, urethritis etc)
testicular hypotrophy without evident causes 11% (reduction in the testicle development)
testicular retractibility, former or active 8.8% (=the testicles which come back to or up from the abdomen)
scrotal hypoplasia with a "high" location of the gonads 8.5% (=small testicle placed too close to the abdomen with a consequent augmentation of temperature)
infraclinical varicocele 7.3% (small varicose veins of the testicle)
environmental, professional, iatrogenic (that is, drug-related) damage 3.3%
former criptorchidism of one or both testicles (undescended testes) 2.7% (=testicles that do not descend in the scrotal sac at the moment of birth, which or is cured too late or not at all)
acquired obstruction of the seminal pathways [tracts] 0.6% (=inflammatory and infectious factors which compromise the perviousness of the seminal pathways impeding the leaking of spermatozoa from the testicles)
secondary hypogonadism (completed or strained form) 0.9% (=low level of testosterone from endocrinological causes)
dysgenic causes 0.3% (irreversible, from the chromosomes)
chriptorchidism 0.6% (=absence of testicle in the scrotal sac due to being retained in the abdomen)
immunological factors 0.6% (=presence of antibodies against the spermatozoa often after local infections which take place for a long time without diagnosis)

Environmental Factors

- Pesticides which are extremely harmful to sperm production, have also been discovered in the flesh of Polar Bears in the South Pole. This serves to demonstrate how homogenically diffuse they are in the food chain throughout the planet!

- In the last fifty years, the species "homo sapiens" has had a great deal to do with a quantity of isotopes which are ionised in the high atmosphere and are clearly derived from a global sum of cosmic radiation of our planet from his origin!! It is derived principally from fall-out due to experiments, war and power plants. Even today the isotopes from Hiroshima and Nagasaki in the atmosphere as well as from our French friends in various atolls and various Chernobils (just think of how many possible Chernobils there may be that we do not know about!!!!) How much more can tissue possesses a high cellular chemical transformation and how much more considerable is the damage of radiation! A testicle produces 120 million new cells a day!! Therefore, it is extremely sensitive. It is not by chance that testicular tumours have reached a vertiginous level in the last 20 years!

- Estrogens are always used - also illegally, in the raising of slaughter house animals (increasing the animal's weight by about 30% !!!): this does not create a problem in the female animal but an excessive amount of estrogen in the male produces damage to the development of the testicle and its spermatogenesis (sperm production).

-Current sexual habits bring a considerable increase in minor genital infections (prostatitis, vescicolitis, and urethritis) from common germs. This may not bring full-blown venereal disease but if neglected and made chronic, it carries obstructive damage to the female tubes and to the male seminal vescicles !!! It is necessary to encourage the use of the condom for this problem as well!

-According to some, the many hours of driving that we are used to, the excess fat in our diet, and the sedentary lifestyle, and are responsible for the augmentation of chronic, prostate, and inflammatory pathologies so frequently present in the infertile male as well as in the absence of certain infection.

- Cigarette smoke carries a direct and progressive harm to the motility of the spermatozoa; it has been amply documented from hundreds of written studies.

What are the diagnostic means?

The alterations of the seminal parameters are a simple symptom! It is always necessary to define the cause in order to apply an adequate therapy.

1) The history of the patient is fundamental in order to reveal possible damaging elements in his life habits (smoking, alcohol, narcotics, a life rhythm which is too intense with too few hours of sleep, sexual habits, etc.) and risk in his professional life and in his environment (excessive heat, radiation, solvents, pesticides, estrogens in his food, anabolic steroids, magnetic fields, etc.)

2) The semen examination: This must ALWAYS be carried out in a laboratory that is specialised and executed SOLELY according to the World Health Organisation standards. This is an element of the diagnostic and prognostic fundamentals and therefore should be absolutely reliable! It is always a good idea that the patient follow through with at least two examinations in order to discriminate the pathology from that which are merely physiological oscillations in the production of sperm.

3) The dosage of hormones in the functioning of the reproductive activity are now available at any laboratory.

4) Research into possible infections of the seminal paths (spermioculture).

5) Ecographical appraisal of the testicles, prostrate and seminal vescicles (always to be followed-through by a clinical research specialist).

6) Eco-colour - scrotal Doppler: This is the only means to a true and reliable diagnosis to point out varicocele, which we have seen as one of the main causes (approximately 20%).

7) In selected cases, the Andrologist will point out other assessments aimed at an in- depth look at seminal examination, a chromosome map, immunological tests, studies of the spermatozoa in electronic microscope, etc.

The Therapy Therapy obviously comes from the diagnosis. There are pharmacological as well as surgical therapies which, if applied well, are capable of resolving most male cases and lead to an improvement of the seminal parameters. One must consider that the most frequent sterile couple is one in which there is a small male factor and a small female one; put together, these factors may induce sterility!

Assisted Reproduction The male situation in which assisted fertilisation is suggested or in which it is not possible to apply a simple therapy anymore: The most frequent cases are characterised by a big reduction in the quantity of spermatozoa which is not susceptible to therapy or walls of the seminal paths in which the spermatozoa must be taken directly from the testicle are obstructed. Naturally also, when this recurs with assisted fecundity for female causes, the male must be studied and yield to a therapy to obtain the maximum quality of seminal samples which can be used in the reproductive laboratory.

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