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The introduction of Intracytoplasmic Sperm Injection (ICSI) over the past five years has revolutionised the management of male infertility.

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems.

The procedure is done under a microscope using micromanipulation devices (micromanipulators, microinjectors and micropipettes). A holding pipette (on picture on left) stablizes the mature oocyte. from the opposite site a thin, hollow needle is pierced into the inner part of the oocyte, the oolemma. it is loaded with a single sperm that will be released into the oocyte. The pictured oocyte has an extruded polar body at about 12 o'clock indicating its maturity. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.

In natural fertilisation sperm compete and when the first sperm enters the egg cell, the egg cell blocks the entry of any other sperm. Concern has been raised that in ICSI this sperm selection process is bypassed and the sperm is selected by the embryologist without undergoing any specific testing. However, in mid 2006 the FDA cleared a device that allows embryologists to select mature sperm for ICSI based on sperm binding to hyaluronan, the main constituent of the gel layer (cumulus oophorus) surrounding the oocyte. The device provides microscopic droplets of hyaluronan hydrogel attached to the culture dish. The embryologist places the prepared sperm on the microdot, selects and captures sperm that bind to the dot. Basic research on the maturation of sperm shows that hyaluronan-binding sperm are more mature and show fewer DNA strand breaks and significantly lower levels of aneuploidy than the sperm population from which they were selected.

There is some suggestion that birth defects are increased with the use of IVF in general, and ICSI specifically. It is hoped that use of new device (PICSI) will lower the apparently elevated level of birth defects associated with ICSI.

Medical conditions - Causes of Male Infertility

There are various medical conditions that can cause infertility which include:

  • Diabetes
  • Pituitary gland disease
  • Hypothalamus disorder
  • Multiple sclerosis
  • Chlamydia
  • Prostatitis
  • Cushing’s syndrome
  • Hypogonadism
  • Mumps

There are two types of diabetes – Type 1 and Type 2 which are both to do with abnormally high levels in sugar in the bloodstream. Type 1 starts in childhood and is where the body is unable to produce any insulin.

Type 2 affects mainly older people and is where the body is unable to produce enough insulin. It is also known as ‘insulin-dependant’ diabetes.

How does this relate to infertility? A body of research has shown that there is a link between diabetes and male infertility. It appears to be the case that sperm produced by a man with diabetes are more damaged than those from a non-diabetic.

These damaged sperm are unable to fertilise an egg which leads to problems with conceiving.

Further studies are needed in order to determine the extent of the problem but it does seem to suggest that this will be a major cause of male infertility in the future.

Pituitary gland disease is classed as a hormonal problem and one of the many causes of male infertility. If it fails to send the correct signals to activate the testes then testosterone levels will drop which affects sperm production.

The hypothalamus is responsible for testosterone production but problems with this can reduce testosterone levels which directly impacts upon fertility levels.

Multiple sclerosis is a condition which affects myelin – the protective coating on nerve fibres which enable messages to be transmitted from the brain to the rest of the body. This myelin becomes damaged which then affects these messages.

In respect of male fertility, the layer of myelin on the nerves which control sexual response become damaged which disrupts this response, leading to problems with erection and ejaculation.

Chlamydia is a sexually transmitted disease (STD) which has come to our attention in recent years. It is most prevalent in young people and is a major area of concern for experts as it can have long term effects. And one of these effects is infertility.

It affects the quantity, shape and movement of sperm which damages male fertility.

Prostatitis is inflammation of the prostate gland which can cause permanent infertility if left untreated. Symptoms of this include painful ejaculation and urination.

Cushing’s syndrome is a hormonal disorder which is caused by excessive levels of cortisol in the body. Cortisol is produced by the adrenal glands and is responsible for a variety of functions which include: regulating blood pressure and the immune system, controlling blood sugar levels and an appropriate response to stress (‘fight or flight’).

But too much cortisol causes a whole range of problems which include:

  • Muscle weakness
  • Obesity
  • Water retention (around the ankles)
  • Reduced libido (and reduced fertility)
  • High blood pressure
  • Aches and pains
  • Excess thirst
  • Mood swings

Reduced libido (or lack of a sex drive) is likely to affect your sexual performance and ability to conceive.

Hypogonadism is a condition which can occur as a result of an injury or disease to the pituitary glands, hypothalamus or testicles. It can decrease the levels of the hormone gonadotrophin which in turn, lowers testosterone levels.

Lowered testosterone levels inhibit sperm production and may cause erectile dysfunction.

Mumps is a common childhood illness which usually causes no long term effects but, complications do happen. It is especially problematic for adult men as it can infect the testicles, causing orchitis which may cause sterility.

Around 20 to 30% cases of men with mumps experience orchitis. Symptoms of this include tenderness, swelling and a fever and it tends to occur a week after the outbreak of the disease.

Other general medical conditions which cause infertility include kidney disease, cancer, high blood pressure, stroke and coronary heart disease.

Failure to ejaculate - Causes of Male Infertility

Ejaculation problems include a failure to ejaculate, sperm retention or a flushing of sperm into the bladder instead (known as retrograde ejaculation).

Problems with ejaculation can be caused by the following:

  • Disease such as multiple sclerosis or diabetes
  • Paralysis (spinal cord injury)
  • Damage occurred during surgery
  • Psychological issues
  • Certain medications such as high blood pressure medication

Other ejaculation problems include premature ejaculation and delayed ejaculation. Premature ejaculation is the condition in which the man ejaculates too quickly during sexual intercourse. This is much more common than delayed ejaculation in which ejaculation doesn’t happen straight away even though you have a normal erection.

Prescription medicines - Causes of Male Infertility

A prescription medicine is designed to treat a particular complaint but many of them have side effects which can affect fertility. The use and indeed the overuse of these have been found to cause infertility.

What doesn’t help matters is when the medicine prescribed for a condition then causes another set of symptoms which impact upon fertility levels.

Problems to be aware of include:

  • Erectile dysfunction
  • Low sperm count
  • Hormone imbalance

If you are trying to conceive but require prescription medicines then discuss your concerns with your GP. He or she can recommend an alternative and the best way of changing from your current medication to a less risky one.

This also applies to over the counter medicines. These may seem fairly innocuous but they can have side effects, and one of these may be infertility. We tend to buy these assuming that they will cure whatever condition we have but they may not be the best option.

If you are thinking of doing this then check with your GP first before purchasing over the counter medicines from your local chemist or pharmacy.

At the end of the day you want to ensure that your reproductive system is in the best shape it can be when planning a family. So ensure that your lifestyle poses no or minimal risk to your fertility.

Another issue is that of cancer treatment: if you have been receiving radiation therapy or chemotherapy then this does affect fertility. In some cases it causes short term infertility but in others it can lead to long term infertility problems.

Cancer drugs can affect the quality and quantity of sperm produced as well as problems with ejaculation.

Speak to your GP or fertility specialist about this if you have to undergo chemotherapy or radiation therapy. He or she may advise you to store your sperm in a sperm bank prior to your cancer treatment which will help to preserve them.

Environmental issues (exposure to toxins etc) - Causes of Male Infertility

These refer to potential hazards at work, in the home and during leisure.

If you work with hazardous chemicals such as pesticides, solvents and fuels then consider that these have been linked to fertility issues so discuss this further with your employer. If you are bothered by this then see if your employer will allow you to change jobs or move to another department whilst undergoing fertility tests.

If this is not possible then ensure that you follow guidelines prescribed by your health and safety department, wear protective clothing if necessary and shower afterwards to remove any potentially damaging chemicals.

Other factors which can affect your fertility include a lack of activity and overheated environments. If you are inactive at work and tend to sit down for long periods of time then what happens is that your core temperature rises which overheats the testes and so reduces sperm count.

If you have a job which requires you to sit down for long periods of time then try to take short breaks. And wear loose fitting underwear such as boxer shorts which allows the testes to remain cool and the sperm healthy.

Another work related aspect is if your job requires you to do any heavy lifting or carrying. There is a risk of injuring your back or an abdominal strain (hernia) which may affect your fertility. If you do have to lift anything then take extra care whilst doing so or see if you can change duties in the meantime.

This equally applies to any manual work you may do around the home.

As regards leisure: certain sports especially contact sports such as rugby have a high risk of injury, for example to the groin area. Other equally risky sports include heavy weightlifting and endurance cycling. It may be a good idea to ease off on these or change to something less rigorous whilst trying to conceive.

Lifestyle issues - Causes of Male Infertility

These include diet, smoking, alcohol consumption and even the type of pants you wear!

Smoking lowers sperm count as well as affecting sperm quality so both the quality and quality of your sperm are affected. In fact, this sperm count can be 13 to 17% lower in men who smoke as compared to non-smoking males.

It can also damage the blood vessels within the penis which decreases blood flow and causes ineffective erections.

These are all good reasons to give up smoking if you and your partner are trying to conceive.

Visit our female infertility section to learn more about the effects of smoking on your partner.

Another aspect is alcohol: alcohol consumption can affect fertility in both men and women. Even a moderate amount of alcohol can have quite a drastic effect. With men it can reduce the size of the testicles, lower sperm count, decrease the quality of the sperm (more poor quality sperm), decrease libido and even cause impotence.

You may enjoy a few drinks after work or at the weekend when socialising but you need to look at your intake if you are trying to conceive. It is better to limit this to the occasional drink rather than on a regular basis.

This equally applies to your partner as drinking can also affect the woman’s fertility.

Your diet plays more of a part in fertility than you think. A healthy diet, rich in antioxidants, especially vitamins C and E are particularly crucial for fertility. They can boost sperm production, ensuring that these sperm are of a superior quality and likely to fertilise an egg.

Conversely, a diet which is lacking in certain vitamins and minerals, for example, zinc, can reduce the volume of semen produced by the male. A certain amount of semen is required for fertilisation and a diet which is deficient in zinc will affect this.

If you feel that you are lacking in zinc then introduce the following zinc rich foods into your diet:

  • Wheat germ
  • Seafood
  • Beef
  • Lamb
Other factors which can affect sperm count include: wearing tight underwear, riding a bicycle for a long period of time (the saddle puts pressure on the groin which can damage arteries and nerves) and drug use (cannabis, cocaine or steroids)

Vasectomy - Causes of Male Infertility

A vasectomy is a surgical procedure in which the vas deferens (the tube which carries sperm) is cut and tied off to prevent sperm from accessing the ejaculatory semen.

This won’t affect your sex drive or the ability to ejaculate but your semen won’t contain any sperm. You will still produce sperm but these cannot escape via your penis and are naturally absorbed by your body.

As a result of this many men consider this to be a permanent state of affairs and usually choose to have this operation if they are not planning on starting a family. It is also known as male sterilisation.

The procedure can be reversed via a vasectomy reversal operation but this is not a guarantee of future fertility.

If you have undergone this procedure and want it reversed check with your GP as success rates depend on the length of time between the original procedure and the reversal.

Blockage in the ejaculatory duct - Causes of Male Infertility

The ejaculatory duct is the part of the male reproductive system which enables sperm to travel from the epididymis to the ejaculatory fluid.

The ejaculatory duct consists of the epididymi and the vas deferens. The epididymi are two coiled tubes which store and transport sperm from the testes. This sperm then moves from the epididymi to the vas deferens, ready for ejaculation.

This is a straightforward process but in a small percentage of cases this duct becomes blocked which prevents the sperm from reaching your partner’s egg in order to fertilise it.

A blockage can be caused by a groin injury, congenital defect, vasectomy or a sexually transmitted disease (STD).

Surgery is required to remove the blockage and this generally has a high success rate.

Disease or trauma to the testicles - Causes of Male Infertility

An injury or disease to the testicles can reduce their function and so impact upon fertility. For example, a blow received playing sport or as a result of a fight.

This can affect the blood supply to the testicles which damages the ability produce sperm.

Viral infections such as orchitis (painful swelling of the testicles) can also mean a failure to produce sperm.

Surgery can be carried out to treat any of these but it is not a guarantee of fertility.

Variococele - Causes of Male Infertility

This is a medical condition which affects the blood vessels of the penis. These veins are designed to channel blood away from the penis and scrotum but if they become diseased then the ability to do so is affected.

These diseased veins look very similar to the varicose veins seen on the legs.

What happens is that these veins become enlarged and swollen which causes the blood to pool within them. This can then cause the temperature of the scrotum to rise which reduces the number of sperm in the testis.

If you develop variococele then it doesn’t automatically mean that you will become infertile but it does increase that risk.

Genetic disorders - Causes of Male Infertility

These are uncommon but do occur in men who have low or no sperms. Some of these are not immediately obvious but there is concern over one particular type of gene which causes problems with the Y-chromosome. This can be passed down to male offspring as a result of an assisted fertility technique such as intracytoplasmic sperm injection (ICSI). And this can lead to infertility.

Another genetic disorder is Klinefelters syndrome which leads to an extra Y-chromosome in men. It is also known as ‘trisomy’ and is characterised as XYY rather than the usual male XY configuration.

It is easy to assume that men who have this extra chromosome will be extra fertile but unfortunately the opposite is true. They tend to have serious fertility problems and are often classed as being sterile.

Abnormal/low sperm count - Causes of Male Infertility

Around 75% of cases of male infertility are due to a low or abnormal sperm count.

The medical term for low sperm count is oligospermia and this is now defined as 10 million/ml of semen although this figure used to be set at 40 million/ml. The reason for this is that if your female partner is young and healthy then a sperm count as low as 10 million/ml can still achieve conception.

Bear in mind that sperm counts do vary over time so a temporary low count is not uncommon. So, if you undergo a fertility test which reports a low sperm count then this may not be an accurate reading.

An abnormal sperm is one that it is abnormally shaped which makes it more difficult for that sperm to travel through the fallopian tube and fertilise an egg.

There are certain drugs such as anabolic steroids, sulfasalazine and chemotherapy medication which can cause a low sperm count.

Another factor is that of trauma or injury to the testicles. If you have sustained an injury to your testicles or have undergone surgery for testicular cancer then your sperm count will be affected.

Other aspects to take into account are sperm movement and shape. The shape and movement of a sperm can determine how likely it is to fertilise an egg. As you can guess a sperm which is oddly shaped or moves very slowly is unlikely to fertilise an egg.

The medical term for low quality sperm is dysspermia.

Ideally you need 60% normal sperm to guarantee fertility so quality can be more important than quantity.


Male infertility accounts for around 20 to 25% of infertility cases which is higher than many people think. It is easy to assume that infertility is a female problem, which is the traditional view, but it’s often the case that the man has the problem rather than the woman.

There are many reasons for male infertility which include the following:

  • Hormone disorders
  • Abnormal/low sperm count
  • Genetic disorders
  • Variococele
  • Disease or trauma to the testicles
  • Blockage in the ejaculatory duct
  • Vasectomy
  • Lifestyle issues
  • Environmental issues (exposure to toxins etc)
  • Prescription medicines
  • Failure to ejaculate
  • Medical conditions

There are a small percentage of cases in which there appears to be no obvious cause of infertility. These are known as ‘idiopathic’ cases.

Male infertility problems are often categorised into four areas: hormonal, structural, lifestyle and genetic. And many of these are related to each other. In other words, a genetic cause of infertility can also be related to a structural problem (e.g. damage to the male reproductive organs).

Hormone disorders

The reproductive endocrine system exists in a delicate state of balance which can easily be upset. The main hormones of this system are testosterone, follicle stimulating hormone (FSH) and luteinizing hormones (LH). These are responsible for male fertility.

Any problem in the central nervous system such as the adrenal glands or thyroid glands can minimise the production of LH and FSH which then impacts upon fertility. For example, a problem with the adrenal glands can cause low testosterone levels which also affect fertility.


What is listeriosis (Listeria infection)?

Listeriosis, a serious infection caused by eating food contaminated with the bacterium Listeria monocytogenes, is an important public health problem. The disease primarily affects pregnant women, newborns, and adults with weakened immune systems. It can be avoided by following a few simple recommendations.

What are the symptoms of listeriosis?

A person with listeriosis (listeria infection) has fever, muscle aches, and sometimes gastrintestinal symptoms such as nausea or diarrhoea. If infection spreads to the nervous system, symptoms such as headache, stiff neck, confusion, loss of balance, or convulsions can occur.

Infected pregnant women may experience only a mild, flu-like illness; however, infections during pregnancy can lead to miscarraige or stillbirth, premature delivery, or infection of the newborn.

How great is the risk for listeriosis?

In the United States, an estimated 2,500 persons become seriously ill with listeriosis each year. Of these, 500 die. At increased risk are:

  • Pregnant women - They are about 20 times more likely than other healthy adults to get listeriosis. About one-third of listeriosis cases happen during pregnancy.
  • Newborns - Newborns rather than the pregnant women themselves suffer the serious effects of infection in pregnancy.
  • Persons with weakened immune systems
  • Persons with cancer, diabetes, or kidney disease
  • Persons with AIDS - They are almost 300 times more likely to get listeriosis than people with normal immune systems.
  • Persons who take glucocorticosteroid medications
  • The elderly

Healthy adults and children occasionally get infected with Listeria, but they rarely become seriously ill.

How does Listeria get into food?

Listeria monocytogenes is found in soil and water. Vegetables can become contaminated from the soil or from manure used as fertilizer.
Animals can carry the bacterium without appearing ill and can contaminate foods of animal origin such as meats and dairy products. The bacterium has been found in a variety of raw foods, such as uncooked meats and vegetables, as well as in processed foods that become contaminated after processing, such as soft cheeses and cold cuts at the deli counter. Unpasteurized (raw) milk or foods made from unpasteurized milk may contain the bacterium.

Listeria is killed by pasteurization and cooking; however, in certain ready-to-eat foods such as hot dogs and deli meats, contamination may occur after cooking but before packaging.

How do you get listeriosis?

You get listeriosis by eating food contaminated with Listeria. Babies can be born with listeriosis if their mothers eat contaminated food during pregnancy. Although healthy persons may consume contaminated foods without becoming ill, those at increased risk for infection can probably get listeriosis after eating food contaminated with even a few bacteria. Persons at risk can prevent Listeria infection by avoiding certain high-risk foods and by handling food properly.

Can listeriosis be prevented?

The general guidelines recommended for the prevention of listeriosis are similar to those used to help prevent other foodborne illnesses, such as salmonellosis.

How can you reduce your risk for listeriosis?

General recommendations:

  • Thoroughly cook raw food from animal sources, such as beef, pork, or poultry.
  • Wash raw vegetables thoroughly before eating.
  • Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.
  • Avoid unpasteurized (raw) milk or foods made from unpasteurized milk.
  • Wash hands, knives, and cutting boards after handling uncooked foods.
  • Consume perishable and ready-to-eat foods as soon as possible.

Recommendations for persons at high risk, such as pregnant women and persons with weakened immune systems, in addition to the recommendations listed above:

  • Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot.
  • Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.
  • Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pastuerized milk.
  • Do not eat refrigerated p�t�s or meat spreads. Canned or shelf-stable p�t�s and meat spreads may be eaten.
  • Do not eat refrigerated smoked seafood, unless it is contained in acooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.

How do you know if you have listeriosis?

There is no routine screening test for susceptibility to listeriosis during pregnancy, as there is for rubella and some other congenital infections. If you have symptoms such as fever or stiff neck, consult your doctor. A blood or spinal fluid test (to cultivate the bacteria) will show if you have listeriosis. During pregnancy, a blood test is the most reliable way to find out if your symptoms are due to listeriosis.

What should you do if you've eaten a food recalled because of Listeria contamination?

The risk of an individual person developing Listeria infection after consumption of a contaminated product is very small. If you have eaten a contaminated product and do not have any symptoms, we do not recommend that you have any tests or treatment, even if you are in a high-risk group. However, if you are in a high-risk group, have eaten the contaminated product, and within 2 months become ill with fever or signs of serious illness, you should contact your physician and inform him or her about this exposure.

Can listeriosis be treated?

When infection occurs during pregnancy, antibiotics given promptly to the pregnant woman can often prevent infection of the foetus or newborn.

Babies with listeriosis receive the same antibiotics as adults, although a combination of antibiotics is often used until physicians are certain of the diagnosis. Even with prompt treatment, some infections result in death. This is particularly likely in the elderly and in persons with other serious medical problems.

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