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Testicle diseases and how they affect the male fertility

Testicle diseases and how they affect the male fertility

Infertility is described by the World Health Organization (WHO) as “a disease of the reproductive system defined by the inability to achieve a clinical pregnancy after 12 months or more of regular unprotected sex.” Therefore, male infertility refers to infertility originating in the male (20% as a single factor and up to 50% as a mixed factor: male and female). Recent data suggests that male infertility not only serves as a biomarker of individual health (increased risk of cancer, cardiovascular, metabolic and autoimmune diseases). But also, as a marker of cancer risk for family members.

Which are the male infertility symptoms?

Male infertility does not have a specific symptom, this is why, most of the time, is discovered when the couple goes for a fertility study. However, depending on the origin, it could have a very varied clinical manifestation:

  • Sexual dysfunction: problems in erection, ejaculate, alteration in libido among   others
  • Tumours or lumps in the testicles
  • Pain and / or increased testicular volume
  • Anatomical alteration in penis or testicles

When should you see your doctor?

As we already mentioned, male infertility tends to be asymptomatic; Although, if an infertility problem is detected, we must seek professional help, go to a specialized centre. There, the possible causes will be assessed and, if possible, treat it. We also know that up to 15% of the causes are idiopathic (we don’t get to know a cause that explains infertility). Still, you should check for any of the aforementioned signs / symptoms.

What are the causes of male sterility and / or infertility related to the testicles?

The causes can be divided into: Pre-testicular, testicular, post-testicular, environmental causes, sperm origin alterations and unhealthy lifestyles

MALE INFERTILITY CAUSES LINKED WITH TESTICLES

Endocrine causes or pretesticular origin causes · Diabetes
· Thyroid problems: Hyper and Hypothyroidism
· Hyperprolactinemia
· Hypogonadism: hypogonadotropic / hypergonadotropic
Testicle origin medical causes
Genetics: In infertile men, the incidence of chromosomal alterations can be 12.6% compared to 0.6% in men without fertility problems (SEF)
· Klinefelter syndrome, the most frequent, in whose karyotype we find an extra X chromosome: XXY
· Microdeletions of the Y chromosome
· Cystic fibrosis

Infections:
· Epididymitis (Infection of the Epididymis)
· Orchitis (inflammation of the testicles)
· STIs (Infections caused by sexually transmitted diseases)

Cancer: Alterations in the sperm analysis could be related to testicular Cancer (Increases the risk up to 20 times) and could be related to testicular cancer in first degree relatives and thyroid cancer in first and second degree relatives

Others: Cryptorchidism (undescended testicles), Hydrocele (accumulation of fluid in the scrotum), Varicocele (dilation of the veins that drain the testicles, present in 15% of the general male population and 40% in men who consult for infertility)

Post-testicular origin medical causes

· Immune infertility
· Retrograde ejaculation
· Erectile dysfunction
· Obstruction of the sperm passages
· Hypospadia


Enviromental casuses

· Industrial chemicals
· Exposure to heavy metals
· radiation or X-rays
· Excessive heat in the testicles


Sperm origins alterations

· Azoospermia: Total absence of sperm in a seminal sample
· Oligozoospermia: Decrease in number of sperm
· Cryptozoospermia Severe decrease in sperm count (below 100,000/ml)
· Asthenozoospermia: Decreased sperm motility
· Teratozoospermia: Alteration in sperm morphology
· Necrozoospermia: Absence of live sperm in the ejaculate


Lifestyle

· Consumption of alcoholic beverages, tobacco, drugs
· Emotional stress
· Depression
· Overweight / Obesity: Related to hormonal alterations (secondary to excess adipose tissue) and increased DNA fragmentation.

How can we diagnose male sterility and / or infertility?

The first thing we have to do is go to a specialist, usually the Urologist who will carry out an adequate anamnesis and physical examination; In addition, he will request a seminal study (Sperm analysis) which is the main test in the diagnosis and treatment of male fertility; Furthermore, as additional tests you could request:

What is the treatment for male infertility?

The treatment for male infertility is the etiological treatment (Hypogonadotropic hypogonadism, infection,); that is to say, of the cause that originates it.

Although, when it comes to an idiopathic cause, the treatments that are available are empirical, of efficacy not demonstrated by scientific works with an adequate level of evidence:

  • Medical hormonal treatments
    • Antibiotic therapy
    • Antioxidants
    • Psychological support of problems in sexual relations
    • Surgery: Testicular biopsy (TESA, TESE, MicroTESE, etc)

In most cases, the etiological treatment is not enough and it is necessary to resort to Assisted Reproduction Techniques (artificial insemination, in vitro fertilization, use of donated sperm, etc.) to be able to achieve the objective so longed for by couples, which is the have a healthy child at home.

BIBLIOGRAPHY:

  • Male infertility as a window to health. Jeremy T. Choy, Michael L. Eisenberg. Fertility and Sterility® Vol. 110, No. 5, October 2018
  • Manual de andrología. Sociedad española de fertilidad (SEF). 2011. ISBN: 978-84-7877
  • Recent advances in understanding and managing male infertility. Jonathan Fainberg, James A. Kashanian. F1000Research 2019, 8(F1000 Faculty Rev):670 Last updated: 28 NOV 2019
  • Male Infertility Best Practice Policy Committee of the American Urological Association & Practice Committee of the American Society of Reproductive Medicine. (2006). Report on optimal evaluation of the infertile male. Fertility and Sterility®, 86, S202–S209
  • Report on optimal evaluation of the infertile male. The Male Infertility Best Practice Policy Committee of the American Urological Association and the Practice Committee of the American Society for Reproductive Medicine. Fertility and Sterility® Vol. 86, Suppl 4, November 2006

Dr Carlos Alvarado gynaecologist at Instituto Bernabeu

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