Ductal and Structural Abnormalities
Often times, a man may experience infertility due to structural problems in his reproductive organs. When organs or ducts have not developed properly or damage has occurred resulting in a blockage, it can cause a variety of fertility difficulties, ranging from lack of sperm in ejaculate to failure to produce sperm at all.
There are many tubes and ducts that a man’s sperm needs to travel through before it can leave the body. If there is a blockage in any of these tubes, it can result in male infertility, a condition known as obstructive azoospermia. The male reproductive ducts can become blocked for any number of reasons. Scar tissue that results after surgery to this area or an infection is a common reason as these adhesions act as barricades, preventing sperm from being able to join with a man’s semen. Men who have had a vasectomy are also classified as having obstructive azoospermia.
If male infertility is caused by a blockage, there are a variety of surgeries that can be performed in order to reverse any damage. Men who have had a vasectomy will require a vasectomy reversal in order to regain their fertility. However, in situations where damage to the reproductive ducts is too extensive, surgical retrieval of the sperm may be necessary. Collected sperm can then be used in ICSI with IVF or IUI.
Congenital defects refer to structural problems in the reproductive system that a man may have been born with. Because part of their reproductive system has not formed or developed properly, difficulties with fertility can result.
Men who are born without a vas deferens have a fairly rare condition known as congenital absence of the vas deferens (CAVD). Although the man’s testicles function and produce sperm normally, because he lacks the vas deferens tubes, sperm is not able to join his semen.
While there is no way to replace a man’s vas deferens, men diagnosed with CAVD can have their sperm surgically removed and used in ICSI-assisted IVF. However, because men with CAVD are more likely to be carriers of cystic fibrosis, you may want to consider using PGD during your IVF.
Affecting between one in 150 and one in 350 male births, hypospadias is a common congenital defect. In men affected by hypospadias, the urethral opening (known as the meatus), which is normally found on the tip of the penis, is located on the underside of the penis. About 70% of those affected by hypospadias have their urethral opening located near the head of the penis but the opening can be located as far down as near the scrotum. A slight curvature to the penis is also associated with this condition as is an improperly formed foreskin. About 8% of those affected by this condition will also have an undescended testicle. While this defect is usually quite mild, in some cases the effects are more severe and can result in the penis curving downwards significantly, making sex virtually impossible.
Although milder instances of hypospadias are often left alone, as they do not interfere with sexual and reproductive functions, more serious cases can be treated through surgery. Depending on the extent of the damage one or several surgeries may be required to reposition the meatus and straighten out the penile shaft. Surgery can be done at a fairly young age, with many pediatric urologists preferring to perform the surgery between the ages of three and 18 months.
During fetal development, the testicles begin to form in the abdomen before descending into the scrotum. In about three to four per cent of births, though, this descent fails to occur. In the majority of cases, this problem is naturally corrected within nine months of birth. However, boys who have at least one undescended testicle by age one will likely require surgery to correct the problem.
Not correcting this testicular problem can result in male infertility later in life. Regardless of whether the testicle descends into the scrotum or not, any man with undescended testicles at birth is thought to be at an increased risk of developing testicular cancer.
Other Congenital Defects
Not all congenital problems are treatable, thereby contributing to male infertility. One such defect is Kleinfelter’s syndrome whereby a man has an additional ‘X’ chromosome. This extra chromosome results in abnormally small testes with poor function as well as azoospermia.
Man affected by Steroli-cell only syndrome, a very rare defect, will also have azoospermia. In men with Steroli-cell only syndrome, the necessary sperm producing cells are lacking thereby resulting in a poor reproductive function. While neither of these conditions can be effectively treated, men with either of these problems may still father a child by using TESE.