The infertility caused by the masculine factor represents a percentage of 25-50% of all infertile couples. This is why the man has to be tested ever since the beginning of the primary medical examination of the couple. The basic investigation should involve: man’s brief medical history, a physical examination, and a spermatogram which should lead, combined with its partner evaluation, to a correct diagnosis and adequate infertility therapy.
Infertility caused by the masculine factor is not a systemic unbalance but, most times, a syndrome resulting from acquired congenital diseases. The most common forms of sperm abnormalities are: oligospermia– sperm that has a very low number of sperm, asthenospermia– sperm low motility, teratospermia or teratozoospermia-abnormal sperm morphology.
Testicular abnormalities can lead to Leyding cells abnormalities and androgenic deficit, furthermore, seminiferous tubules dysfunctions and hypospermiogenesis may follow. Being more likely to appear the alteration of spermatogenesis than the androgenic biosynthesis alteration, the most frequent type of infertility is associated with normal clinical androgenisation.
Primary Testicular Affections
Dysfunctions in the testicular activity can be detected due to the circulatory increased levels of FSH and LH. These hormonal changes emerge because the hypothalamus and hypophysis receptors signal the negative testicular feedback perturbations. Feedback signals are also given by Gonadal steroid hormones, testosterone, estradiol, and a glycoprotein from seminiferous tubule- inhibine.
Klinefelter Syndrome, and its sexual divided chromosomal versions affects 0.21% of adult men, among the clinical manifestations of this condition are: small testicles, gynecomastia, or gynaecomastia, incomplete androginisation and infertility. From a histological point of view, the specialist can detect hyalinization of seminiferous tubules and an apparent increase in Leyding cells’ density. Peripheral blood karyotype is 47XXY, 10% of the patients present mosaicism 46 XY/ 47 XXY and also suffer from severe psychical diseases.
47XYY is a chromosomal sexual abnormality which develops with an incidence of 1case in 1000 men. In this case spermatogenesis differs radically and fertility is severely affected. In the clinical description of patients confronted with this genetic abnormality can be found: extreme height, they are exceptionally tall, behavioral derangements, also they present skeletal abnormalities, especially in maxillaries at tooth implementation areas, and they face a leukemia high risk.
Scientific researches have shown that spermatogenesis is genetically controlled by a sequence of the long arm of Y chromosome. Molecular studies on fertile/infertile men have shown the great importance of Y-chromosome sequence. It has also been shown that mutations on the gene which encodes the androgenic receptor, located on the X chromosome, can be the cause of infertility in the masculine phenotype but they rarely trigger this condition.