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The testicular causes for abnormalities in sperm include:
(1) Thermal exposure
Heat potentially damages spermatogenesis or the sperm stored in the epididymis. Normally the scrotal sac hangs from the body so that its contents are actually a few degrees cooler than the man’s core (central) body temperature.
Situations associated with increasing the scrotal temperature include the presence of a varicocele, frequent long hot baths, tight fitting underwear that pull the testes up to the body, undescended testes, and sitting (especially on heated seats) for long periods of time (such as a truck driver might do).
A varicocele is a dilatation of the pampiniform venous plexus in the spermatic cord. Varicoceles occur in 10-15% of all men (regardless of fertility) and in up to 25-30% of infertile men.
(2) Testicular surgery
Removal of a testicle, surgical correction of undescended testes (orchiopexy), repair of testicular torsion, treatment for cancer of the testicle, testicular biopsy, or surgery involving the vas deferens (vasectomy, reanastomosis of blocked portions of the vas deferens) can impair sperm function.
(3) Infections
Mumps orchitis, venereal diseases, prostatitis or epididymitis involving the testes or accessory glands (such as prostate) can reduce testicular function. The dead sperm, infectious material and inflammatory cells may result in an increase in a family of molecules known as “oxygen free radicals” that may further damage the remaining sperm.
(4) Radiation (especially involving the pelvis)
The testes are much more sensitive to radiation than the ovaries, so that relatively low levels of radiation can result in an arrest in sperm production. This arrest is occasionally transient with normal sperm production possibly occurring months to years later.
(5) Trauma
The testes and its blood supply can be damaged either during physical activity (such as sports) or during surgery that is performed in the vicinity of the testicular blood supply.
(6) Substance abuse
Cigarettes, alcohol, elicit drugs (cocaine, opioid compounds, marijuana) or anabolic steroids (for muscle building) can result in poor quality sperm.
(7) A general insult to the testes
High fever or viral infection can affect the sperm for up to 3 months following the event. This is because it takes about 3 months to produce and release a mature sperm
(8) Testicular cancer
Testicular cancer is associated with abnormal sperm concentration in about 50% of men prior to chemotherapy. Following treatment with either chemotherapy or radiation it often takes up to 5 years for a return of function.
(9) Medications
Chemotherapeutic agents, cimetidine, certain antibiotics (such as erythromycin, tetracycline, nitrofurantoin, sulfasalazine), spironolactone, and aldomet are known to compromise sperm. If a drug interaction is suspected then switching to a comparable alternative medication or discontinuing the medication (only if acceptable to the prescribing physician) might result in improvement in the sperm quality.
(10) Toxins
Pesticides or some industrial chemicals especially if used in conditions with poor ventilation can alter sperm quality
(11) Chromosomal abnormalities
Factors active in early development can result in abnormal testicular development, including the Sertoli only syndrome, congenital anorchia (absence of the testes), Klinefelter’s syndrome (XXY karyotype), and XX males (crossover of the “testes determining factor” onto an X chromosome)
(12) DES exposure in utero
There is a possible association between DES exposure and male factor infertility according to available research. More information about this association is needed.
Available Case Reports:
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