Male Fertility

Question 1

Normal sperm sample contains

Answer 1

• Semen volume of 1.5 ml or
  more— pH of 7.2 or more.
• 15 million+ spermatozoa per ml.
• 39 million spermatozoa per
  ejaculate or more.
• 40% or more motile or 32% or
  more with progressive (straight
  line / large circles) motility.
• 58% or more live spermatozoa.
• 4% or more with normal morphology

Question 2

Structural abnormalities

Answer 2

• Congenital defect of testes or ejaculatory tract.
• Undescended testes ― ↓ sperm count and quality due to heat.
• Testicular cancer ― caused by the disease or treatment that
  damages sperm and causes changes in testosterone levels.
• Surgery or injury to testes such as testicular torsion,
  being kicked; bicycle injury.
• Ischaemic damage to the testes e.g., sickle cell anaemia.
• Infections (STIs and post-pubertal mumps) cause
  permanent damage to the testes, vas deferens or
  epididymis. Impacts transport of semen to ejaculatory ducts.

Question 3

Hormonal abnormalities

Answer 3

• Hypogonadism ― ↓ function of gonads and
  ↓ production of sex hormones. Causes:
  tumour, illegal drugs, or Klinefelter syndrome
  (a genetic condition where an additional X
  chromosome interferes with male sexual
  development and ↓ testosterone).
• Obesity → Increased peripheral conversion
  of testosterone to oestrogen (aromatisation)
  and decreased luteinising hormone.
• Cushing syndrome → Increased cortisol results in low sperm count.

Question 4

Other health conditions effecting fertility

Answer 4

• Diabetes mellitus ― neuropathy, neurogenic impotence,
  and retrograde ejaculation (= semen in bladder).
• Haemochromatosis = ↑ iron in body ― systemic inflammation,
  iron deposits in pituitary and gonads →
  hypogonadism and androgen deficiency.
• Scrotal varicocele― blocked / enlarged veins
  → ↑ scrotal temperature = ↓sperm production.
• Acute and chronic illnesses ― associated with a suppression of
  gonadotropin release, possibly through an increase in dopamine
  and opiate levels and an increase in cortisol production.

Question 5

Medications and drugs effecting fertility

Answer 5

• Sulfasalazine— a disease-modifying anti-rheumatic drug
  (DMARD), often used for RA, ulcerative colitis and Crohn’s disease
  → side effect is ↓ sperm count but only whilst taking the drug.
• Anabolic steroids — increase levels of testosterone
  in the body but can impair the body’s own production
  of the hormone. ↓ sperm count / sperm mobility.
  If used long term, damage can be permanent.
• Chemotherapy— can severely reduce sperm production.
• Medical drugs, alcohol, cigarettes, caffeine and marijuana
  reduce sperm count, concentration and motility.