Ductal and Structural Abnormalities
When you are trying to get pregnant and it's just not happening, one of your first thoughts may be "What's wrong?" If it's been less than a year, don't fret because 80% of couples will eventually conceive in that time frame. However if you have been trying to get pregnant for over a year without success, you may be diagnosed with fertility problems. There are many causes of infertility among a couple, and it can be wither on the woman or man's side or both. Male infertility is commonly caused by structural abnormalities in the man's reproductive organs. There are a number of common male ductal and structural abnormalities, either acquired through damage or congenital defects.
There are many ducts in a man's reproductive tract that his sperm needs to travel through in order to leave his body. A blockage in any of these tubes can lead to a condition called obstructive azoospermia, which causes male infertility. Blockages may be casued by any number of reasons, including scar tissue as a result of surgery and infection. These types of adhesions act as barricades, preventing sperm to join with the semen. Men who have had vasectomies are also classified as having obstructive azoospermia. Duct blockages may be reversed by surgery or vasectomy reversal. Where damage is too extensive, sperm may need to be surgically retrieved so that is can be used in ISCI.
CAVD is a rare condition more fully known as congenital absence of the vas deferens (CAVD). The man's testicles will still function to produce sperm normally, but because of a lack of vas deferens tubes, it cannot join with the man's semen. Men diagnosed with CAVD may have their sperm surgically removed to be used in ISCI. However, men with CAVD are also more likely to be carriers of cystic fibrosis, so genetic therapy is often used in conjunction with assisted reproduction.
Hypospadias is a common congenital defect, affecting 150 of 350 male births, where a male baby is born with a misplaced urethral opening. The urethral opening (known as the meatus) is normally found on the tip of the penis, but in men affected by hypospadias it is located on the underside of the penis. Around 70% of men with hypospadias have a urethral opening located near the head of the penis, but in extreme cases it may be located as far down as the scrotum. A slight curvature of the penis and improper formation of the foreskin is also associated with this condition as is an undescended testicle. While this defect is usually mild, in some cases the effects are more severe and can result in the penis curving downwards significantly, making sex virtually impossible. Mild cases of hypospadias don't normally affect sexual and reproductive functions and are therefore left alone, but more serious cases can be treated through surgery between the ages of 3 and 18 months.
During fetal development, the testicles form in the abdominal cavity before descending into the scrotum. In three to four percent of births, this decent fails to occur, though this is normally naturally corrected within the first nine months after birth. If this doesn't occur, boys with at least one undescended testicle by the age of one will likely undergo surgery to correct the abnormality. If this problem is not corrected, it can result in male infertility later in life. Men who have had undescended testicles at birth are thought to be at a greater risk of developing testicular cancer.
Untreatable Congenital Defects
Some congenital defects are untreatable, making the male infertility that goes with them untreatable also. One example of this is Kleinfelter's syndrome, where a male has an additional "x" chromosome. This results in abnormally small testes with poor function and also azoospermia. Men with Steroli-cell only syndrome, a very rare defect, lack sperm-producing cells and also have azoospermia, resulting in untreatable interfility. Men with either of these conditions may still father a child using reproductive technology.