- Prevention is difficult because of the lack of understanding of the causes of most types of male infertility.
- Mumps orchitis is such a rare cause of infertility, immunization for this disease will have little impact. It is important to recognize that subfertility often is a couple problem, both partners contributing.
- Therefore, general factors that would change a society’s attitude to child-bearing could have an important impact on the frequency of infertility, for example, a trend toward having children at earlier ages.
- On the other hand, toxins and environmental factors known to cause defects of sperm production, such as dibromochlorobenzine, lead, benzene, ionizing radiation, and microwaves, are probably well controlled by environmental health measures.
Preventable Diseases and Conditions
Sexually transmissible infections.
- Postgonococcal epididymal obstructions appear to be the most important cause of infertility from sexually transmitted diseases.
- In countries where gonorrhea is treated promptly, postgonococcal epididymal obstruction is rare.
- On the other hand, it remains a common preventable cause of infertility in other countries.
Although undescended testes have been sought and treated aggressively over the past 50 years, previously undescended testes remain a common association of male infertility, affecting about 7 per cent of the men seen.
As discussed above, the effectiveness of varicocelectomy for sperm defects is controversial.
Vasectomy reversal and treatment for continuing infertility after attempted vasectomy reversal are now common. Better counseling about the limited effectiveness of vasectomy reversal is needed. Cryopreservation of semen before vasectomy in men who are uncertain about their need for future fertility should be promoted. Also, cryopreservation of semen after vasectomy reversal, if the quality is adequate, is worthwhile because restenosis of the vasovasostomy sites can occur.
Semen Cryopreservation before Loss of Fertility
Men about to have treatment for malignant conditions may have sperm cryopreserved before commencing chemotherapy or radiotherapy. While pretreatment semen quality may be too poor for AIH, ICSI now has improved the outlook for successful pregnancies. While the risks of having a child with a serious malformation or defect are difficult to estimate in humans semen collected during chemotherapy or radiotherapy must not be used because of the likelihood of induced mutations. Other illnesses that require treatment that might cause sterility include nephritis, prostatic disease, and inflammatory bowel diseases.
Infertile men with conditions such as orchitis or Young syndrome that might involve progressively declining semen quality should also store any live sperm that can be obtained as insurance for the future. A similar approach could be extended to adolescents with risk factors for infertility such as undescended testes in childhood, testicular torsion and also possibly, a family history of infertility or a father with a Yq microdeletion. While the frozen sperm are only used by a small proportion of men who store semen the service continues to provide insurance for future fertility. Some groups are offering to cryopreserve prepubertal testicular tissue prior to potentially sterilizing treatments in the expectation that effective techniques for transplantation or in vitro production of sperm will be developed in the future.