Pre-testicular factors of male infertility – an introduction

Infertility can be due to problems with either the male or female partner, or both. On the male side, some of the factors are sperm defects – low sperm production, abnormal function or blockages that hinder the transport of the sperm. Other causes may be due to injuries, health problems, lifestyle and environmental issues.

The 3 main causes of male infertility can be defined as pre-testicular, testicular and post-testicular functions.

Today, we will look at the pre-testicular factors.

Pre-testicular means that fertility issues originate outside the reproductive system which hinder adequate support of the testes. They are known as extra-gonadal endocrine disorders originating in the pituitary, hypothalamus or adrenals. A systemic problem could progress from hormonal imbalances, psychological problems, genetic disorders, poor health, obesity, the wrong diet and ageing.

Some of the causes of pre-testicular factors are given below:
Hormone imbalance:

  • Hypogonadism: is the reduction of hormone secretion, or the absence of it, affecting the physiological function of the testes.
  • Increased prolactin hormone: A high concentration of the prolactin hormone in the blood affects the testicle function and decreases the production of testosterone and sperm production. Low testosterone levels result in diminished levels of energy, muscle mass, blood count and sex drive.
  • Tumours in the pituitary gland: This gland, located in the brain, makes the hormones. Any abnormalities in the pituitary gland can cause hormonal imbalance preventing normal testicles from producing sperm. A pituitary tumour can lower LH (luteinizing hormone) and FSH (follicle stimulating hormone) levels which can result in low sperm production or azoospermia (no sperm production).

Genetic disorders: These are caused by changes to the chromosomes or genes. A chromosomal translocation is when the chromosomes which fit tightly together to form the DNA are changed and do not fit together.

  • The Robertsonian translocation is a common genetic abnormality which many people are not even aware of having. Their lives are normal and healthy but difficulties may arise when trying to conceive.
  • A genetic hypothalamic disorder can result in a deficiency of the gonadotropin-releasing hormone (GnRH). This hormone is essential to secrete LH and FSH from the pituitary gland.

Illnesses or injuries: Health issues and treatments can also affect male fertility.

  • Varicocele: where the testicle veins are swollen.
  • Untreated Coeliac disease: This is when the small intestine is extremely sensitive to gluten, which causes difficulty in digesting food. In males, this disease can lead to a reduction in semen quality, hypogonadism and hyperprolactinemia (fasting levels in a person at least 2 hours after waking up). Hyperprolactinemia could cause impotence and a loss of libido.
  • Surgeries and medication: Some surgeries like vasectomy, prostate, scrotal and abdominal surgeries can affect the male reproductive organs. Removal of cancers and nonmalignant tumors can also lead to low functioning of the organs. Sometimes, radiation or chemotherapy can affect fertility. Certain medications such as long term steroid use, some arthritis and ulcer drugs can reduce sperm production.
  • Infections: can meddle with sperm health and production or can lead to blockages hindering the transport of sperm. Genital urinary tract infections lead to Epididymitis (inflammation of the epididymis) caused by gonorrhea, tuberculosis, Orchitis (inflammation of the testicles) caused by mumps and tuberculosis. Urethritis (inflammation of the urethra) caused by gonorrhea and chlamydia.

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Lifestyle factors:
Smoking, alcohol and drugs:

  • Tobacco smoking can be harmful as it increases the intake of cadmium which is chemically similar to zinc and may replace it in DNA polymerase. While zinc is of major importance in sperm production, if replaced by cadmium, it can damage the testes.
  • High alcohol intake results in lowering testosterone levels, follicle stimulating hormone and luteinizing hormone. It also raises estrogen levels, which decrease sperm production and can result in shrinking of the testes, causing impotence.
  • Drug influence can reduce concentration of sperm in the semen and also affect the shape and motility of the sperm.

Excessive exercise: Moderate exercise is good for general health but strenuous exercise like horseback riding or gradient bicycling can harm the sperm count. Since excessive exercise decreases testosterone, the sperm count is lowered.

Treatment: Many of the causes of these pre-testicular factors can be treated by surgical intervention, lifestyle changes and medical therapy.

Conclusion: The trusted way to identify pre-testicular issues is to have a medical and physical examination carried out by an andrologist. Blood tests and hormone analyses will follow. These will clarify the details of sperm production – in terms of concentration, volume, appearance and motility. The results of this test will enable the specialist to suggest the method of treatment and for the couple to decide on the same.

2021-11-16T05:14:32+00:00