Reduced sperm counts below the internationally defined thresholds in common
presentation. According to the 2015 ‘WHO’ reference ranges of semen parameters, a
normal sperm concentration is at least 15 million per each millilitre of semen. This condition
may be associated with other abnormal seminal parameters including abnormally reduced
sperm motility and increased shape aberrations (Collectively known as oligoastheno-terato-
zoospermia or referred to as OAT syndrome). Such situation may result in delayed
conception, sub-fertility, recurrent miscarriages, and total infertility (Because of
dysfunctional sperms). If count continues to drop progressively, sperm banking (Freezing) is
to be considered.
Azoospermia is defined as absence of sperms in the ejaculate (the seminal liquid may still
appear normal, yet is devoid from sperms). This can result from complete failure of sperm
production in the testis, or presence of an obstruction along the sperm pathways;
consequently hindering sperm passage. Differentiation between both types is crucial as each
has a different treatment strategy.
Testicular function includes testosterone secretion and sperm formation. Low testosterone or
the medical term commonly used ‘Hypogonadism’ is diagnosed when any of those functions is
hindered, but this term is commonly attributed to states of testosterone deficiency. Brain glands
(Hypothalamus and pituitary glands) release the first signal to testosterone secretion through
the Luteinizing Hormone (LH), conveying the message to the testes; and if properly functioning,
each testis obeys and responds by secreting testosterone hormone from group of specialized
cells called leydig cells. Testosterone has many functions including (but not limited to) the following:
• Supports the machinery of sperm formation inside the testes.
• Essential for most of spermatic functions including the integrity of sperm DNA, motility and fertilizing capacity.
• Plays an important role in male sexuality and libido (sexual drive).
• Essential for penile growth and health, making it crucial for sexual and erectile function.
• Enhances the metabolic functions of the body and augment fat burning.
• Being an anabolic steroid, it enhances muscular growth and repair.
• Maintains bone growth and integrity.
Retrograde ejaculation (i.e. passage of semen into the urinary bladder instead of being ejected
to the exterior)is diagnosed after the patient is advised to perform a urine sample after
ejaculating (also referred to as post-ejaculatory urine analysis) to confirm the presence of
sperms in the urine. Whenever no structural anomalies coexist (e.g. after prostate operations)
several medical treatments can be used to restore ejaculation, ultimately the scheduled use of
those medications at days of partner’s ovulation will enable the male to ejaculate normally in to
the vagina at times of highest fertility potential.
Rapid ejaculation could be easily managed nowadays with a specifically designed on-demand
medications that delay ejaculation for significant amount of time.
Anejaculation is considered when a patient fail to ejaculate either due to behavioural attributes
or secondary to medical conditions, like nerve damage due to diabetes or neurodegenerative
diseases. The use of an intense penile-vibrators can assist the patient attain significant
stimulation and hence climax and ejaculation.
A clinical condition where there is dilatation and tortuosity of the testicular veins due to damage
to their unidirectional valves, allowing blood to flow in directions, out-in and in-out. This
unfortunate phenomenon disturbs the testicular milieu by transmitting the blood temperature
(i.e., 37.2 degrees C) to the testis (normally the testicular temperature is lower than the core
body temperature to allow for normal sperm production). Warming of the testes threatens
sperm formation and may lead to reduction in testicular size. The dysfunctional veins release
toxins that eventually cause direct damage to the sperm forming cells. Varicocele are considered
a common cause of reversible infertility in males, and may be incriminated in few studies to
lower testosterone hormone. Predisposing factors for varicocele are prolonged standing, sitting
and pressure (Weight lifting).
