What causes infertility in men

Male azoospermia may be caused by vas deferens obstruction, testicular spermatogenic dysfunction, endocrine abnormalities, chromosomal defects or iatrogenic damage. The specific cause needs to be determined through medical examination.

1. Vas deferens obstruction:

Congenital absence of the vas deferens or blockage of the vas deferens caused by acquired inflammation or surgical injury will hinder sperm discharge. Commonly seen after epididymitis and vasectomy, semen examination shows normal semen volume but no sperm. Treatment requires microsurgical anastomosis or assisted reproductive technology.

2. Spermatogenic dysfunction:

The testicle itself cannot produce enough sperm, which may be related to cryptorchidism, mumps orchitis, and radiation damage. The testicular volume of such patients is usually small, and hormone tests show elevated follicle-stimulating hormone. Some cases can be improved through hormone replacement therapy, and severe cases require artificial insemination with donor sperm.

3. Endocrine abnormalities:

Hypothalamic-pituitary-gonadal axis dysfunction can affect sperm production, such as Kallman syndrome, hyperprolactinemia, etc. It manifests as low testosterone levels, which may be accompanied by decreased sexual desire and poor development of secondary sexual characteristics. Hormone-modulating treatment that targets the underlying cause may restore spermatogenesis.

4. Chromosomal defects:

Klinefelter syndrome 47, XXY and other chromosomal abnormalities can lead to testicular hypoplasia, and hyaline degeneration of the seminiferous tubules can be seen under the microscope. This type of patient is usually accompanied by signs such as tall body size and breast development, which can be diagnosed through genetic examination. Fertility depends on donor sperm or adoption.

5. Iatrogenic injury:

Treatments such as tumor radiotherapy, chemotherapy, and retroperitoneal lymph node dissection may permanently destroy the seminiferous epithelium. Chemotherapy drugs such as alkylating agents are significantly toxic to germ cells. It is recommended that men with fertility needs undergo sperm cryopreservation before treatment. After injury, residual sperm can be found through testicular puncture.

It is recommended that patients with azoospermia give priority to a reproductive medicine center for systematic evaluation, including semen analysis, sex hormone testing, scrotal ultrasound and genetic screening. Avoid harmful factors such as high temperature environment and ionizing radiation in life, and appropriately supplement trace elements such as zinc and selenium. For irreversible azoospermia, psychological counseling and couples counseling can help adjust fertility expectations, and modern assisted reproductive technology can still provide some patients with fertility opportunities.