Sunday, December 26, 2010

How do infections cause male infertility ?

The most common cause of azoospermia in India was previously smallpox. This infection injured the epididymis, leading to ductal obstruction. Fortunately, this particular disease is now of historical importance only, as it has been wiped out. Tuberculosis also harms the epididymis, causing azoospermia. Nevertheless, making the correct medical diagnosis of tuberculous epididymitis can be quite difficult, since it is often a silent as well as indolent disease. Gonorrhea, chlamydia, syphilis along with other STDs ( sexually transmitted diseases) might also create chaos with the man's genital system; leading to irreparable injury to its epithelium (inner lining).

Mumps may also cause orchitis (inflammation of the testis) - particularly when this impacts younger males. This may result in significant harm to the testes, creating testicular failure if it damages both ovaries. However, do remember that not every boy who gets mumps will have sperm problems as an adult.

How about other genital tract infections? Many patients ( and their doctors!) worry when the semen analysis report shows pus cells or WBCs ( white blood cells) . This condition is called pyospermia or leucocytospermia. Do remember that a few pus cells in the semen are quite normal and this finding does not mean you have a semen infection. Also, fertile men will often have round cells in their semen. These are not pus cells, but are sperm precursor cells ( spermatocytes). However, many labs are not capable of differentiating between pus cells and sperm precursor cells. They report these round cells as pus cells and doctors will then start antibiotic treatment to "treat" this infection. This is a complete waste of time and money!

Many doctors will perform a semen culture as well when the semen sample contains numerous pus cells. If the examination is positive, then therapy with antibiotics will be implemented. However, many of the organisms grown in these culture reports are not really pathogenic organisms at all, but just normal commensals which colonise the genital tract and are found in normal fertile men as well. The connection between the existence of bacteria inside the semen and male infertility continues to be cloudy. Do the bacteria actually result in the infertility? Will dealing with the infection assist in improving fertility? Many more questions than answers, once again! In my opinion, treating most of these "abnormal reports" does not help to improve the man's fertility at all.

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