Infertility, male
Male infertility may be suspected whenever a couple fails to achieve pregnancy after about 1 year of regular unprotected intercourse. Between 40% and 50% of infertility problems in the United States are totally or partially attributed to the male. (See also “Infertility, female,” page 443.)
Causes
Factors that cause male infertility include:
varicocele, a mass of dilated and tortuous varicose veins in the spermatic cord
semen disorders, such as volume or motility disturbances or inadequate sperm density
proliferation of abnormal or immature sperm, with variations in the size and shape of the head
systemic disease, such as diabetes mellitus, neoplasms, liver or kidney disease, or viral disturbances, especially mumps orchitis
genital infection, such as gonorrhea, tuberculosis, or herpes
disorders of the testes, such as cryptorchidism, Sertoli-cell–only syndrome, varicocele, ductal obstruction (caused by absence or ligation of the vas deferens or infection), hydrocele (collection of fluid in the testes), or infection (orchitis and epididymitis).
genetic defects, such as Klinefelter’s syndrome (chromosomal pattern XXY, eunuchoidal habitus, gynecomastia, and small testes) or Reifenstein’s syndrome (chromosomal pattern 46XY, reduced testosterone, azoospermia, eunuchoid-ism, gynecomastia, and hypospadias)
immune disorders, such as autoimmune infertility and allergic orchitis
endocrine imbalance (rare) that disrupts pituitary gonadotropins, inhibiting spermatogenesis, testosterone production, or both; such imbalances occur with Kallmann’s syndrome, panhypopituitarism, hypothyroidism, and congenital adrenal hyperplasia
chemicals and drugs that can inhibit gonadotropins or interfere with spermatogenesis, such as arsenic, methotrexate, medroxyprogesterone acetate, nitrofurantoin, monoamine oxidase inhibitors, and some antihypertensives
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