Male Infertility Glossary
The following is a list of some of the most commonly used terms in diagnosis and treatment, along with their definitions and how they relate to male infertility.
Anejaculation: Disorder in which no semen is
produced. Common causes are spinal cord injury, diabetes, and multiple
Assisted Reproductive Technology (ART): A couple having difficulty reproducing naturally may require technological interventions in order to achieve pregnancy. Advances in assistive reproductive technology have astonishingly increased the likelihood of achieving fertilization and are routinely incorporated into the treatment of infertile men. It is fair to state that gamete micromanipulation has dramatically and fundamentally influenced the current treatment of male-factor infertility. Significantly improved diagnostic and treatment modalities have fundamentally enhanced the prognosis for infertile men. These exciting advances have created a new approach in the treatment of male infertility and provide realistic hopes for many men who were previously told that they could never experience fatherhood.
Azoospermia: Azoospermia is the complete absence of sperm in the semen and has many causes. Obstructive azoospermia implies that there is a blockage in the genital tract yet normal testicular production of sperm. If the cause is non-obstructive, there is a significant diminution in sperm production within the testicle. Obstructive azoospermia accounts for about 40% of all cases of azoospermia. Obstruction may be either congenital or acquired. A common cause of obstruction is a prior infection, which results in scarring of the ductal structures. Congenital obstruction can be due to either a malformation or the absence of the vas deferens.
Obstruction of the male reproductive tract can often be corrected by an operation, but is not always an option. In this situation, it may still be possible for the man to father children by removing a few sperm from his reproductive system via a testicular biopsy, and using the retrieved sperm for in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI)
Finding the cause of the obstructive azoospermia is helpful for several reasons. It allows your physician to decide whether you are a candidate for surgical treatment. If your obstruction is not surgically treatable, your doctor might be able to suggest other treatment options for you or your partner. If there is a major medical or genetic disorder underlying the azoospermia, it may be important to identify these disorders. It is also important to know whether the genetic problem may be passed on to your children (see CBAVD).
Arimidex: A medication in tablet form, initially used to treat breast cancer. The drug is also helpful in medically treating male infertility. If you have been on this medication for more than 1 year, please be sure to contact your doctor.
CAH: Congenital adrenal hyperplasia. This is an
uncommon cause of male infertility. It is an inherited inability to
produce sufficient amounts of certain enzymes, which results in hormone
deficiencies. This is often successfully treated with hormone
CBAVD: Congenital bilateral absence of the vas deferens. The genetic abnormality that may be associated with obstructive azoospermia occurs in some men who are born without the vas deferens. About two-thirds of men who have CBAVD have a genetic mutation that can cause cystic fibrosis if they initiate a pregnancy with a woman who has the same genetic mutation. Therefore, if you have CBAVD, genetic testing and counseling should be sought to help you and your partner understand the risks of passing this defect to your children.
Erectile Dysfunction (ED): A form of sexual dysfunction characterized by an inability to develop or maintain an erection. Causes can be psychological or physiological,
though studies have shown that most cases are indeed physiological. There are a number of different
PDE-5 agents that your physician can prescribe to help remedy erectile dysfunction.
There are also options for patients who do not wish to use drug therapy.
Generally, these patients opt for an external vacuum device, and 75% are able to
achieve a functional erection. This is a tube, which slips over the penis,
creates an airtight seal at the base, and then decreases the pressure within the
tube. This decrease in pressure in the erectile tissue causes it to fill with
blood, resulting in an erection. A rubber constriction band is then placed
around the base of the penis, maintaining the erection.
Risk of ED increases with age, decreasing testosterone levels, high
blood pressure, diabetes mellitus, high cholesterol, and cardiovascular
disease. Lifestyle choices can also contribute to ED (lack of exercise,
drug and alcohol abuse, and smoking). These risk factors lead to the
degeneration of penile blood vessels, which restricts the flow of blood
into the penis and increases the rate at which blood leaks out.
Improving overall health can correct mild ED.
Estradiol: This is the most potent estrogen. It regulates the production of GnRH by inhibiting its release. This, in turn, down-regulates the production of LH and FSH.
Follicle Stimulating Hormone (FSH)
Hyperprolactinemia: An increased production of
prolactin from the pituitary gland can cause infertility and
erectile dysfunction. This can be caused by
medications or a tumor in the pituitary. If the cause is medication,
discontinuing use will generally lead to a return to normal levels of
Human Chorionic Gonadotropin (hCG)
Hypogonadotropic Hypogonadism: a condition in which sperm
production is hampered due to deficient levels of LH and FSH. This is usually
due to a hypothalamic or pituitary disorder. Kallman’s Syndrome is a genetic
cause of hypogonadotropic hypogonadism and results in decreased production of
GnRH, which in turn results in decreased levels of LH and FSH. This condition
can also result from pituitary tumors (these tumors are non-malignant lesions
that can generally be removed), anabolic steroid use, and head trauma.
In-vitro Fertilization (IVF)
Infection: An infection of the genital tract is
contributory in approximately 2% of infertile men, and is usually
diagnosed with a semen analysis or culture. The cultures most commonly
ordered are chalmydia, mycoplasma/ureaplasma, and general bacterial.
Severe infections of the epididymis and testes can cause testicular
atrophy. Additionally, chronic prostatitis can cause obstruction of the
ejaculatory ducts. The infection or inflammation can often be remedied
with antibiotics or non-steroidal anti-inflammatory medications.
Intracytoplasmic sperm injections (ICSI): Intracytoplasmic sperm injection is the technique whereby a single sperm is microinjected directly into the cytoplasm of the ovum. Today, couples with severe male-factor infertility routinely utilize ICSI when undergoing IVF treatment. ICSI has become the preferred treatment for utilizing retrieved epididymal and testicular sperm. Men with congenital absence of the vas deferens as well as men with irreparable obstruction are routinely treated with ICSI.
Intrauterine Insemination (IUI)
Kleinfelter’s Syndrome: A condition characterized by
a karyotype of 47 XXY, which is the addition of an extra X chromosome.
Generally patients with Kleinfelter’s have small testicles and suffer
from hypogonadism and infertility.
Lutenizing Hormone (LH)
MRI (of the pelvis, abdomen, or prostate): Magnetic resonance imaging is used to visualize the internal details of the specified body structure. It provides a more detailed picture than an ultrasound
and can be used to diagnose a large variety of ailments.
Oligoasthenospermia: Oligospermia with decreased motility
Oligozoospermia: A sperm concentration that is less than 20 million/mL, but still detectable (i.e., not azoospermic).
PSA: Prostate specific antigen. This is a protein produced in the prostate gland and is normally present in small quantities in the blood. Elevated levels of PSA can be indicative of prostate cancer.
Retrograde Ejaculation: A condition in which semen
flows toward the bladder instead of out through the urethra upon
ejaculation. This can be caused by surgeries, diabetes, spinal cord
injuries, medications (often anti-hypertensives, BPH medications, and
anti-depressants), or idiopathic issues.
Testicular sperm extraction/aspiration (TESE/A)
Ultrasound/sonogram (of the scrotum): A test in which high-frequency sound waves are used to visualize internal structures. This test is especially useful in diagnosing varicoceles.
Urine Culture: Testing the urine for the presence of bacteria. A culture that is positive for bacteria indicates an infection of the bladder, commonly a urinary tract infection (UTI). Such infections are usually easily treated with antibiotics.
The papiniform plexus is the group of blood vessels that provide the primary venous drainage for the testes. A varicocele can be compared to a varicose vein; it occurs when the papiniform plexus is dilated. Varicoceles are fairly common, occurring in over 10% of men, and in the general population usually do not seem to impair testicular function. However, about 40% of men seeking fertility treatment have varicoceles, so it is generally believed in these cases that the varicoceles can indeed impair the production of sperm.
Vas Deferens: A long tubular structure through which sperm travel from the epididymis to the seminal vesicle.
Vasovasostomy (vasectomy reversal)