Impotence and sterility, with aberrations of the sexual function and sex-gland implantation
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The term PCD describes the genetic defect differentiating it from other acquired defects Carson et al. Seminal analysis in primary CDS demonstrates a normal number of viable but immotile spermatozoa. Spermatozoa of patients with PCD have usually decreased motion to varying degrees or are even completely motionless with defective morphology. ICSI represents currently the only therapeutic approach to this condition but with poorer outcomes Abu-Musa et al.
These abnormalities may also enhance the risk of genetic defects in the offspring, and the genetic evaluation of the spermatozoa is highly suggested prior to ICSI procedures Abu-Musa et al. Maturation process of spermatozoa demands their interaction with proteins that are synthesized and secreted by the epididymis Toshimori Posttranslational changes of existing sperm proteins are crucial for the spermatozoon to acquire its fertilizing potential.
Phosphorylation and glycosylation are common posttranslational changes that sperm proteins undergo during their passage through the epididymis resulting in modifications in protein function resulting to the development of mature spermatozoa Cornwall Reactive oxygen species ROS play a key role in the physiology of the sperm function. Normal quantitative profiles of ROS are involved in the initiation and development of several sperm functions including sperm hyperactivation, sperm capacitation, and acrosome reaction de Lamirande and Gagnon ; Griveau et al.
On the other hand, an overproduction of ROS leads in oxidative damage of sperm membrane lipids, sperm proteins, and sperm DNA Alvarez and Storey ; Aitken resulting in decreased motility, damaged acrosomal membranes, and thus inability of the spermatozoon to fertilize the oocyte. Poor sperm and decreased motility have been associated with mutations in the mitochondrial DNA Ruiz-Pesini et al. Mitochondrial DNA is exclusively inherited by the oocyte, and therefore there is an interesting probability that some types of male infertility are transmitted only through the mother Danan et al.
The term immune infertility refers to spontaneously occurring antibodies which bind to antigens of the spermatozoa impairing the interaction between sperm and oocyte. The expression of antisperm antibodies is associated with certain HLA classes Omu et al. Abnormalities in the development of the formation of the blood—testis barrier may result in the formation antisperm antibodies Bohring and Krause Antisperm antibodies are observed in men with testicular tissue injury i.
Other common reasons include infections and obstruction of sperm transport, for example, in men after vasectomy or in men diagnosed with CF or congenital agenesis of VD. In all these later conditions, the immune equilibrium within the testis may be altered Sotolongo ; Vazquez-Levin et al. The diagnostic approach is based mainly on mixed antiglobulin reaction test and immunobead binding test that are used for detection of antisperm antibodies. Antisperm antibodies may affect sperm motility and viability, sperm—oocyte interaction, early embryonic development, embryonic capacity for implantation, and fetal development Ohl and Naz ; Chiu and Chamley Antisperm antibodies also affect sperm capacitation process, spermatozoal ability to undergo the acrosomal reaction and to bind to and penetrate the zona pellucida of the female gamete Shibahara et al.
Currently, there is no standardized therapeutic option, and the actual clinical meaning of antisperm antibodies in infertile men is still debatable Silva et al. However, a significant increase in pregnancy rates was found among antisperm antibody-positive men receiving prednisolone for more than 3 months compared to placebo group Hendry et al.
In addition assisted reproductive technologies are the treatment of choice for male infertility associated with antisperm antibodies. Other systemic medications that have been proposed include immunosuppressive agents azathioprine or intravenous cyclophosphamide and intravenous immunoglobulin Silva et al. Bacterial pathogens in seminal plasma can reduce sperm motility, induce apoptosis or necrosis, alter sperm morphology, and thus affect directly sperm quality Villegas et al.
Impotence and sterility, with aberrations of the sexual function and sex-gland implantation
Major bacterial sexually transmitted disease organisms affecting semen include Chlamydia trachomatis , Neisseria gonorrhoeae , Mycoplasma spp. Other pathogens include protozoal infections mainly Trichomonas vaginalis and viral infections such as human papillomavirus , herpes simplex virus , hepatitis B and C viruses , and human cytomegalovirus Dejucq and Jegou ; Kalichman et al. Antiviral and antiretroviral therapies may also induce testicular damage with deleterious effects on sperm quality Lorusso et al. Erectile dysfunction, rather than infertility cause, represents a factor making conception very difficult.
For the majority of men, erectile dysfunction is a greater problem than infertility. The enormous success of phosphodiesterase type 5 inhibitors in the modern industrial world and the plethora of aphrodisiac potions around the world suggest that for most men, the desire for erections is a more immediate and pressing concern than maximizing their fecundity. Furthermore, erectile dysfunction may lead to psychological distress, feeling of sexual failure, and lower self-esteem Wibowo et al. Functional blockages such as functional obstruction of the SV, spinal cord injury, or sympathetic nerve injury.
Ejaculatory duct obstruction EDO has been originally diagnosed in men with azoospermia with complete ductal obstruction, but a larger number of patients have oligoasthenospermia; the latter is characteristic of partial EDO. Functional EDO is a form of ejaculatory dysfunction with a similar presentation but without physical blockage Walsh and Turek Spinal cord injury SCI patients and patients after retroperitoneal lymphadenectomy experience ejaculation problems especially when the sympathetic centers which regulate the ejaculation T9—T11 and L2—L3 are damaged Chehensse et al.
Sympathectomy including bilateral removal of the T12—L2 paravertebral sympathetic ganglia is commonly associated with impaired ejaculation Courty and Franchebois ; Rose In men with SCI, spermatozoa can be collected by electroejaculation using a rectal probe or can be surgically retrieved from the epididymis or the testis Brackett et al. Premature ejaculation as defined by the International Society for Sexual Medicine may be lifelong or acquired Serefoglu et al. Treatment with tricyclic antidepressants or serotoninergic uptake inhibitors combined with sexual counseling can be very effective Turek Delayed ejaculation and anejaculation are more common as men age and have multiplex organic and psychogenic reasons.
Retrograde ejaculation or anejaculation due to surgical procedures on the retroperitoneum, bladder, or pelvis may also cause infertility Turek Hypospadias affects 0. The European Surveillance of Congenital Anomalies demonstrates a trend in raising incidence of hypospadias over a period of 10 years Loane et al. The association between reduced semen quality and hypospadias is well documented.
The most likely explanation is that fathers with reduced semen quality and their sons with hypospadias share the same susceptibility genes that govern their reproductive function Skakkebaek et al. Skip to main content Skip to sections. Advertisement Hide. Download reference work entry PDF. Testosterone secretion by testicular Leydig cells is impaired if LH and FSH stimulation is absent, and spermatogenesis is compromised.
The major diagnostic categories include isolated hypogonadotropic hypogonadism IHH and pituitary disease Fig. Open image in new window. Varicocele Varicocele represents a vascular abnormality of the venous drainage system of the testes. The abnormally dilated veins may concern either the pampiniform or the cremasterium plexus. The post-testicular causes of infertility include obstruction or stricture of the ductal system of the male reproductive tract Fig. In contrast with testicular disorders, post-testicular abnormalities are commonly treatable.
Thus, restoration of fertility potential may be possible. A certain number of patients present a history of chronic sinusitis, nonprogressive bronchitis, and pneumonia in infancy but their main complaint as adults is infertility Augarten et al. The semen parameters are similar as in men with CF disease Oates and Amos VD aplasia is accompanied by epididymal tail aplasia and several anatomical or functional abnormalities of the SV Mercier et al. Table 1 Cystic fibrosis gene CFTR mutations in men with various disorders of the seminal ducts and seminal vesicles.
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Hypothalamic-pituitary-testicular function in end-stage non-alcoholic liver disease before and after liver transplantation.
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Causes of suspected epididymal obstruction in Chinese men. Gonadotropin dynamics in XX males. Pirgon O, Dundar BN. Vanishing testes: a literature review. J Clin Res Pediatr Endocrinol. Laparoscopy for nonpalpable testes in childhood: is inguinal exploration also necessary when vas and vessels exit the inguinal ring? Testicular dysfunction in human immunodeficiency virus-infected men. Male reproductive function in uraemia: efficacy of haemodialysis and renal transplantation. Rescue of testicular function after acute experimental torsion. Pusch H. Fortschr Med. Two novel missense and one novel nonsense CFTR mutations in Iranian males with congenital bilateral absence of the vas deferens.
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