Male Infertility

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Testicular disease may result in male infertility

Male infertility is the result of failure of the production of mature motile spermatozoa.
Initial tests involve analysis of a sample of semen for the presence of spermatozoa.

In some cases no spermatozoa are seen in the ejaculate.
A number of conditions are recognized as being responsible, the most common being: destruction of testicular tissue or scarring in ducts as a result of inflammatory disease, e.g. following infection; congenital absence of vas deferens or seminal vesicles; or the presence of cryptorchid testes. The chromosomal disorder, Klinefelter's syndrome (XXY), is associated with severe atrophy of testicular tubules and absent germ cells. Serum levels of FSH are elevated in cases of failure of the testis, in which case no function can be expected.

Other disorders are associated with abnormally small numbers of spermatozoa. Endocrine causes, particularly disease of the hypothalamic/pituitary axis and oestrogen excess (endogenous or exogenous), must always be suspected. Germ cells are very sensitive to abnormal environment and are easily damaged; they are particularly sensitive to the effects of systemic chemotherapy and irradiation. For normal germ-cell development and maturation to take place, the testicular temperature should be lower than core temperature. Exposure to high temperature, either through maldescent or an environmental cause, may result in infertility.

In some cases the cause of reduced spermatozoa production is uncertain after investigation, and testicular biopsy may be performed for diagnosis. Sometimes the seminiferous tubules show a complete absence of germ cells, being lined only by Sertoli cells. Alternatively, early stages of spermatogenesis may be normal, but the late stages leading to the formation of mature spermatozoa are defective (so-called maturation arrest).
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