Unfortunately, 12-15% of all sexually active couples are infertile. The male factor infertility can be identified in 50% of cases, either alone or in combination with the female factor. In previous studies that analyzed numerous male patients, the causes of male infertility were identified from the most common to the rarest: varicocele, idiopathic obstruction, female factor, cryptorchidism, immunology, ejaculatory dysfunction, testicular insufficiency, drug effects / radiation, endocrinology and others.
However, despite recent technological and modern diagnostic advances, idiopathic infertility becomes a common diagnosis. Approximately 25% of male patients do not have an identifiable cause of male infertility. Despite this, many recognizable causes of male infertility are treatable or preventable. Thus, a thorough understanding of these conditions remains paramount. This blog post contains a brief overview of the causes of male infertility, divided into the etiology of pretesticular, testicular and post-testicular nature.
The majority of the causes of male infertility may be either preventable or treatable.
Pre-testicular causes of male infertility exert their negative effect via imbalances in the hormonal milieu of sperm production. Sexual function is also negatively impacted with effects seen at the level of erectile function, ejaculatory function, and sexual desire,
Varicocele is a common modifiable cause of male infertility and negatively affects global testicular function through oxidative stress,
Severe oligospermia or azoospermia requires genetic screening, given their high associated prevalence of Klinefelter’s syndrome, karyotypic abnormalities, and microdeletion of the Y chromosome,
Many testicular causes of male infertility (radiation, toxins, environmental factors, genital tract inflammation, varicocele, and testicular hyperthermia) lead directly to sperm DNA damage.
The etiologies of male infertility are robust and varied. It must be remembered that the majority of the causes of male infertility are either preventable or treatable. This fact, along with a growing body of evidence suggesting infertility may have implications for overall health, highlights the importance of an evaluation for all male partners of couples struggling to conceive.
While idiopathic infertility still comprises a large portion of the men evaluated for problems with reproduction, this percentage will likely continue to decrease in the future with scientific advancements, particularly in the field of genetics. It is crucial that reproductive urologists have an understanding of the causes of infertility in men so as to provide the optimal management of couples struggling to conceive.