Causes of Male infertility, Erectile dysfunction, Gynecomastia

Male infertility

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

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

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

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

  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.