Causes of Infertility
Causes of infertility include a wide range of physical as well as emotional factors. Approximately one-third to a half of all infertility is due to a ‘male’ factor. A ‘female’ factor – scarring from sexually transmitted infection or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumour, or transport system abnormality from the cervix through the fallopian tubes is responsible for 40-50 per cent of infertility in couples. The remaining 10-30 per cent of infertility cases may be caused by contributing factors from both partners, or no cause may be identified.
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Increased risk for infertility can be associated with the following conditions and factors in men:
- Varicoceles
- Undescended testes
- Retrograde ejaculation
- Poor sperm development
- Infections
- Medication
- Recreational drug use
- Chronic medical conditions
- Trauma
- Lifestyle factors
- Testosterone deficiency
Undescended Testes
This affects nearly 1 per cent of males. Our testes start to develop high up in our belly area and have usually come down, or ‘descended’, by the time we are born. However, if they fail to descend they are known as undescended testes. This increases the lifelong risk of testicular cancer. For this reason undescended testes are always ‘brought down’ surgically into the scrotal sac if they have not descended themselves by the age of two.
However, despite this, men with a history of undescended testes still have reduced fertility, even when it is one-sided. This is because it appears that there is reduced ability to produce sperm levels in both the normally descended and the undescended testis.
Retrograde Ejaculation
This results from failure of the bladder neck to close during ejaculation so that sperm goes up into the bladder instead of out through the penis. Clues to this condition may include cloudy urine after ejaculation or reduced or even ‘dry’ ejaculation. It may result from bladder surgery or a disease that affects the nervous system.
Infections
Mumps infection can cause swelling and inflammation of the testicles. This is known as orchitis and can have a long-term effect on sperm levels and fertility. Mumps orchitis is usually one-sided but sometimes it can affect both testicles. A complication of this condition is that the testicles can shrink and waste away. Other infections that can affect fertility include sexually transmitted infections, such as chlamydia, and infections like E. coli in the semen, which can affect sperm motility (movement). General infections of the body can also temporarily affect sperm production and lead to reduced fertility.