Causes of Male infertility, Erectile dysfunction, Gynecomastia

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Male infertility[edit | edit source]

Male infertility

Infertility is defined as the inability to produce sufficient quantity and quality of sperm.

Normal ejaculate volume is 2–5 ml, with > 20 million sperm/ml, and adequate motility.

Disorders of sperm include:

  • decreased number: oligospermia (< 20 million/ml), azoospermia (no sperm), caused by reduced spermatogenesis, obstruction in transport, or radiation
  • impaired motility (e.g. marijuana use)
  • defects outside the male body, such as inability to penetrate cervical mucus or fertilize the oocyte
  • presence of anti-sperm antibodies
  • defective genetic information

Causes[edit | edit source]

Pretesticular causes

These involve hormonal dysregulation:

  • hypogonadotropic hypogonadism with decreased testosterone, FSH, and LH
    • congenital hyposecretion
    • doping with testosterone suppressing FSH and LH
    • alcohol causing decreased testosterone
    • obesity leading to conversion of testosterone to estrogens
  • adrenal cortex hypofunction
  • thyroid disorders

Testicular causes

Klinefelter's syndrome

These directly affect the testes:

  • testicular atrophy, impaired spermatogenesis
  • cryptorchidism
  • infections, torsion, radiation, cytostatics
  • drugs (marijuana, alcohol)
  • genetic causes: Klinefelter syndrome (XXY), Y chromosome microdeletions
  • increased scrotal temperature

Posttesticular causes

These involve sperm transport:

  • vas deferens abnormalities (atresia, agenesis, post-inflammatory scarring)
  • varicocele
  • retrograde ejaculation into the bladder
  • hypospadias, epispadias

Ejaculate composition disorders

  • decreased seminal fluid
  • presence of immunoglobulins against sperm

Erectile dysfunction[edit | edit source]

common causes of erectile dysfunction

Defined as the inability to achieve or maintain an erection sufficient for satisfactory intercourse, or painful erection and related disorders.

Types:

  • complete: present in all situations (including masturbation and nocturnal erections)
  • incomplete: occurs only in certain situations (e.g. during intercourse)

Causes are multifactorial, including genetic factors, psychological influences, stress, partner-related factors, and neurological components.

It may be:

  • primary (since birth)
  • secondary (loss of previously normal function)

It can also occur as a side effect of medications, such as antidepressants or drugs used for ADHD.

Gynecomastia[edit | edit source]

gynecomastia

Gynecomastia is enlargement of male breast tissue.

Types:

  • true gynecomastia: hyperplasia of glandular tissue
  • false gynecomastia: fat deposition

Cause is typically increased estrogen activity:

  • tumors of testes or kidneys producing estrogens
  • hypothyroidism
  • Klinefelter syndrome (XXY)

References[edit | edit source]

  1. ZÁMEČNÍK, Josef. Patologie 1–3. 2. přepracované vydání. Praha : LD, s.r.o. – Tiskárna Prager, 2024. 950 s
  2. SILBERNAGL, Stefan a Florian LANG. Atlas patofyziologie. 2. české vydání. Praha : Grada, 2012
  3. MARUNA, Pavel, et al. Zkušební testy z patologické fyziologie. 1. vydání., duben 2015.
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