When men suspect that the cause of infertility may be due not to their female partners but themselves, it necessitates investigation into the underlying cause. Anatomy plays a key role in the diagnosis of sperm production issues. Thus, a comprehensive investigation of the pertinent anatomical structures is warranted. The causes for decreased male fertility may be pre-testicular, testicular, or post-testicular in origin.
Pre-testicular means there may be a problem in the hormonal balance in your body because the hypothalamus and pituitary in the brain controls testis sperm and testosterone production. Tumors of the pituitary or other nearby structures inside the brain may result in decreased production of testosterone and sperm.
Testicular means there is a congenital or acquired reason for the testicles to not produce adequate numbers or normal sperms. An example of a testicular issue is varicocele, a disorder in which the pampiniform veinous plexus in the scrotum is abnormally enlarged. The pathogenesis of this condition is similar to that of varicose veins, where defective valves within the inner walls of the veins allow for retrograde backflow of blood. Compression by an external structure, such as a tumor, scar tissue, or an adjacent enlarged blood vessel is another cause. The condition impairs the supply of oxygen-rich blood and nutrients to the testes, compromising normal testicular function.
Testicular trauma is another anatomical issue that can lead to decreased sperm production. Since the scrotum is not surrounded by muscle, bone, or other protective structures, it is easily struck, hit or crushed. Most testicular trauma injuries occur in the context of contact sport or hand-to-hand combat. Wearing an athletic support with a cup can prevent the occurrence of testicular trauma, and is recommended for men and boys engaging in contact and collision sports, as well as martial arts.
Testicular torsion, in which the spermatic cord is twisted, obstructing the blood supply and causing ischemia, or injury due to lack of oxygen. Congenital malformations of the processus vaginalis account for the vast majority of cases that result in testicular torsion. This is known as the “bell-clapper deformity,” in which the testis is free floating within the tunica vaginalis of the scrotum.
Post-testicular means there is an obstruction of the male reproductive tract that the sperm cells have to travel from the testis to the tip of the penis. These conditions include previous vasectomy, which can be reversed by another surgery. The ejaculatory duct may also be obstructed by congenital malformation or genetic defects. Also, previous inflammation or infection of the genital tract can cause scarring, adhesions or obstruction. Sexually transmitted diseases may cause male infertility in the Philippines, especially since many cases go undiagnosed, untreated, or undertreated.
The treatment for male infertility will vary between patients, depending on the etiologies in question. Treatment may include assisted reproductive technologies, such as artificial insemination, in-vitro fertilization, microsurgical fertilization such as intracytoplasmic sperm injection, drug therapy and surgery.