#failed hypospadias repairs

[hypospadiasclinics]

My talk at the Hypospadias International Society (HIS)meeting

I had the great privilege to take part in the HIS meeting held in Brazil a few months ago. I couldn’t go there physically due to some family commitments. So, I attended the virtual meeting for 3 days. In the meeting, I delivered a talk on 2-stage repair for complex failed hypospadias cases with the use of oral mucosal graft. I was among the very few doctors from India to attend this meeting and deliver a talk at this prestigious meeting.

Hypospadias is one of the most common congenital anomalies. Unfortunately, there is not much awareness in the general public or even among many doctors about this problem. There are several reasons for this:

Hypospadias is an external anomaly and is not usually life-threatening. So, most people think that it is a minor problem.

Many doctors also don’t realise that hypospadias surgery is a technically demanding operation and has to be only done by the best surgeon.

Most people have little awareness about the far-reaching complications of hypospadias, which not only affects urination but can potentially disrupt the normal adult life of the person and the family.

The social and psychological stigma associated with hypospadias. Being a genital problem, most parents are not ready to share the information with family and friends and take their help to search for the best doctor for hypospadias surgery.

Once the child grows older, he becomes shy and doesn’t discuss the problem with the parents anymore.

Most parents and many doctors think that hypospadias is a minor problem and seek a solution from the local doctors; if the surgery is successful, it is ok. But more often than not, the operation may result in failure, and only then do the parents start looking for an expert. This results in the child undergoing multiple operations, including more complex reoperations, which could have been avoided if an expert surgeon had been involved from the beginning.

Thus, hypospadias remains a common and neglected problem. In addition, many surgeons of many specialities perform hypospadias surgery, and there are hundreds of techniques for hypospadias repair. This makes things more complicated for parents to choose the best surgeon and for family physicians to refer these cases to the best surgeon for hypospadias!

The purpose of the Hypospadias International Society (HIS) was to disseminate proper knowledge about hypospadias correction techniques among its members. Many enthusiastic surgeons from across the globe participate in its annual meetings. The latest meeting in Brazil was attended by over 100 hypospadialogists. Various techniques of hypospadias repair, including primary and complex failed hypospadias repairs, were discussed by experts. The pros and cons of various techniques were debated by experts in a scientific atmosphere. The long-term follow-up and results of hypospadias repairs were also discussed. 

My talk in the HIS meeting was about the most complex cases of hypospadias, which come after multiple failed operations elsewhere. These cases are very complex and require the expertise of the best hypospadias surgeon. Typically, a 2-stage (sometimes 3-stage) repair is performed utilising the skin taken from inside the oral cavity (mouth) as a graft to prepare the deficient urinary tube (urethra). We have done more than 100 such cases over the past 8 years in Hyderabad, with over 90% success of such complex operations. Our patients come from all over India, including Andhra Pradesh, Maharashtra, Karnataka, Tamil Nadu, Kerala, Orissa, West Bengal, Bihar and UP. We also performed complex redo hypospadias repairs on international patients who underwent their initial failed hypospadias operations in other countries.

My talk about the technique and results of complex hypospadias reconstructions at the HIS meeting was highly appreciated. I received positive messages from many surgeons across the world congratulating us for our work and the good results. However, an ideal situation is where no child requires such complex reconstructions for failed hypospadias. This is possible if the initial hypospadias surgery is performed by experts only. When choosing the best hypospadias surgeon for their child, parents should spend some time identifying the best surgeon with the best results in hypospadias repair. Remember, even the best surgeon can have complications (like the best driver can have an accident), but the complications will be a small percentage, usually minor and easily treatable. I discussed a few tips for parents in my earlier blog about how to choose the best hypospadias surgeon for their child. That blog may be referred to by those interested in knowing more about this.

[hypospadiasclinic]

It's commonly understood that the best age for hypospadias repair surgery is between 6-18 months for optimal results. However, success rates can vary based on factors such as the type and severity of hypospadias, the patient’s physiological conditions, the surgeon’s expertise, and post-operative care.

So, is it possible for an adult with a history of multiple failed hypospadias surgeries to have success with a redo surgery in adulthood?

Yes, there are certainly chances of success, although it's not 100% guaranteed. Here are the key factors that can influence the outcome:

Experienced Hypospadias Surgeon: It's crucial to find a surgeon who specialises in hypospadias repair and can evaluate the probable reasons for past failures to plan an effective surgery.

Surgeon’s Expertise in Redo Surgeries: Redo hypospadias surgeries in adults require different techniques compared to surgeries in children. An experienced surgeon with a track record of successful redo surgeries is essential.

Severity and Type of Hypospadias: The degree of hypospadias and the individual’s tissue health play significant roles. Adult tissues are different from those of children, and the position of the urethra must be carefully considered.

Physical and Psychological Preparedness: The individual’s overall physical health, mental preparedness, and positive attitude can greatly impact the success of the surgery. Effective communication and coordination with the surgeon are vital.

Medical History and Current Health: The patient’s complete medical history, including previous surgical techniques used, and current health conditions are crucial. This helps the surgeon tailor the surgical approach for the best possible outcome.

While challenges exist, with the right surgeon and careful planning, successful hypospadias repair in adulthood is achievable. Consulting a specialized urologist will provide a better understanding of the specific factors at play and the potential for a successful outcome.

[medicalcareinfo]

Explore the symptoms, reasons, and how to find the right surgeon before getting a second opinion for your child’s failed hypospadias repair. Click now!

[drchiraggupta]

Signs You Might Need Andrology Surgery: Understanding When It's Necessary

Andrology surgery, a specialized field within urology, focuses on diagnosing and treating conditions affecting the male reproductive system. While many issues can be addressed through non-invasive treatments or medications, there are instances where surgery becomes necessary.

Understanding the signs indicating the need for andrology surgery is crucial for timely intervention and effective resolution of underlying problems.

Erectile Dysfunction: Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for sexual intercourse. While lifestyle changes, medications, or therapy may resolve mild cases, severe or persistent ED might require surgical intervention. Procedures like penile implants or vascular surgery can restore erectile function, especially when other treatments have failed.

Peyronie's Disease: Peyronie's disease is characterized by the development of fibrous scar tissue inside the penis, causing curvature, pain, and difficulty with erections. In cases where symptoms significantly impact sexual function or cause discomfort, surgical options such as plaque excision, grafting, or penile implants may be recommended to correct the curvature and restore normal penile function.

Male Infertility: Andrology surgery can play a vital role in addressing certain causes of male infertility, such as varicocele or obstructive azoospermia. Varicocele repair, a surgical procedure to correct enlarged veins in the scrotum, may improve sperm quality and fertility outcomes. Similarly, surgeries to remove obstructions in the reproductive tract can allow for the retrieval of sperm for assisted reproductive techniques like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Testicular Disorders: Conditions affecting the testicles, such as testicular torsion or testicular cancer, may require urgent surgical intervention. Testicular torsion occurs when the spermatic cord twists, cutting off blood flow to the testicle, necessitating immediate surgery to restore blood flow and prevent tissue damage. In cases of testicular cancer, surgical removal of the affected testicle (orchiectomy) may be necessary as part of cancer treatment.

Penile Conditions: Certain penile conditions, such as congenital abnormalities (e.g., hypospadias), penile cancer, or severe phimosis (inability to retract the foreskin), may require surgical correction. Surgical techniques ranging from tissue reconstruction to partial or total penectomy (penis removal) may be performed depending on the nature and severity of the condition.

Conclusion

While not all male reproductive issues require surgical intervention, understanding the signs that may indicate the need for andrology surgery is essential for seeking appropriate medical care. Consulting with a qualified andrology specialist can help diagnose underlying conditions and determine the most suitable treatment approach, whether surgical or non-surgical, to address your specific needs and restore optimal reproductive health. Early intervention can often lead to better outcomes and improved quality of life.

[aighospitalsblog]

KIDNEY STONE TREATMENT IN HYDERABAD

The Department of Urology at AIG Hospitals offers a comprehensive urology care and treatment for common urological problems like prostate diseases, urinary stones, infections, malignancies, and strictures of the urethra. The department consists of experienced consultants who have expertise in handling all type of cases and is supported by advanced technology & world-class infrastructure to deliver an exemplary service.

Minimally invasive surgery

At AIG hospitals we are doing all advanced minimally invasive surgeries including laparoscopic and retroperitoneoscopic surgeries regularly.

Surgeries offered-

Lap/retroperitoneoscopic -simple nephrectomy

Partial nephrectomy

Radical prostatectomy

Radical cystectomy

Adrenalectomy

Ureterolithtomy

Pyelolithtomy

Renal transplantation

At AIG one of the most experienced best kidney transplant hospital in Hyderabad team including the transplant surgeons and nephrologists are there with exposure of more than 3000 kidney transplants.

All types of complex kidney transplant procedures like multiple vessels, 2nd and 3rd transplants are performed.

Pediatric Urology

All urological diseases and congenital malformation related to genitourinary organs are dealt, with the best of care and surgical expertise.

Surgeries offered

Lap pyeloplasty

Open pyeloplasty

Reimplant surgery

Valve fulguration

Vesicostomy

Hypospadias repair

Mitrofanoff procedure

Orchiopexy

All key hole and endoscopic surgeries for stones.

Reconstructive urology

All kind of urethral reconstruction like end -2 anastomotic, graft and flap urethroplasties are regulary performed with very good results.

Pelvic fracture urethral distraction defects are also managed well with excellent outcome.

Major ureteral reconstruction like ileal replacement and yang montie procedure, failed pyeloplasty, augmentation ileocystoplasty etc are also performed regularly as many referred cases come to us we are giving affordable kidney transplant cost in Hyderabad.

Uro-oncology

All type of uro oncological cancers are treated here with comprehensive care including the medical and radiation oncologist.

Surgeries for kidney, bladder, prostate, adrenal, testes and penile cancers are performed with latest technologies with minimally invasive approach

Urogynaecology

Urological ailments of females like UTI, urinary incontinence, ureterovaginal/vesicovaginal fistula are routinely treated in the department.

[fortismemorialinstitute]

Reconstructive surgery is commonly known for cosmetic procedures. World over, there has been a steady awareness and demand for breast enlargement, nose job, face lift etc. While utility of such treatment is debatable, there is another offshoot, called reconstructive urology, which is progressively seen a steady growth.

Several congenital ailments leave lifelong handicaps. One such is hypospadias, where the location of the male urethral opening is abnormal. This leaves a boy failing to void himself normally. This occurs in 1 in 300 live births and due to lack of specialized centres, undergo repeated surgeries Two eminent surgeons, Culp and McRoberts had poignantly emphasised “It is the inalienable right of every boy to be a pointer instead of a sitter by the time he starts school and to write his name legibly in the snow.” With modern techniques, most of these boys undergo a single stage repair, reducing morbidity and mental trauma

[indiaivfsurrogacy-blog]

Common Cause of Infertility in Males

Common Cause of Infertility in Males

https://drrichikasahayshukla.com/

Male fertility is a complex process. To get your partner pregnant, the following must occur:

You must produce healthy sperm.Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.

Sperm have to be carried into the semen.Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.

There needs to be enough sperm in the semen.If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner’s egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.

Sperm must be functional and able to move.If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.

Medical causes

Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:

Varicocele.A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm. Treating the varicocele can improve sperm numbers and function, and may potentially improve outcomes when using assisted reproductive techniques such as in vitro fertilization.

Infection.Some infections can interfere with sperm production or sperm health, or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, including chlamydia and gonorrhea; inflammation of the prostate (prostatitis); and inflamed testicles due to mumps (mumps orchitis). Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.

Ejaculation issues.Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra. Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. Often in these cases sperm can still be retrieved for use in assisted reproductive techniques.

Antibodies that attack sperm.Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.

Tumors.Cancers and nonmalignant tumors can affect the male reproductive organs directly or can affect the glands that release hormones related to reproduction, such as the pituitary gland. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.

Undescended testicles.In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.

Hormone imbalances.Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.

Sperm duct defects.The tubes that carry sperm (sperm ducts) can be damaged by illness or injury. Some men experience blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one or both of the tubes that carry sperm out of the testicles. Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether.

Chromosome defects.Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener syndrome.

Problems with sexual intercourse.These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.

Certain medications.Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.

Prior surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles.

Environmental causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

Industrial chemicals.Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.

Heavy metal exposure.Exposure to lead or other heavy metals also may cause infertility.

Radiation or X-rays.Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.

Overheating the testicles.Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and slightly reduce sperm production. The type of underwear you wear is unlikely to make a significant difference in male fertility.

Health, lifestyle and other causes

Illegal drug use.Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.

Alcohol use.Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.

Occupation.Certain occupations can increase your risk of infertility, including those associated with extended use of computers or video display monitors, shift work, and work-related stress.

Tobacco smoking.Men who smoke may have a lower sperm count than do those who don’t smoke. Secondhand smoke also may affect male fertility.

Emotional stress.Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.

Weight.Obesity can cause hormone changes that reduce male fertility.

Prolonged bicycling.Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles. In some cases, bicycle seat pressure on the area behind the testicles (perineum) can cause numbness in the penis and erectile dysfunction.

More About Male infertility

Surgical sperm retrieval (TESA/PESA/MESA)

Microsurgeries in Males

[indiaivfsurrogacy-blog]

Common Cause Of Infertility in Males

Common Cause of Infertility in Males

https://drrichikasahayshukla.com/

Male fertility is a complex process. To get your partner pregnant, the following must occur:

You must produce healthy sperm.Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.

Sperm have to be carried into the semen.Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.

There needs to be enough sperm in the semen.If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner’s egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.

Sperm must be functional and able to move.If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.

Medical causes

Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:

Varicocele.A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm. Treating the varicocele can improve sperm numbers and function, and may potentially improve outcomes when using assisted reproductive techniques such as in vitro fertilization.

Infection.Some infections can interfere with sperm production or sperm health, or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, including chlamydia and gonorrhea; inflammation of the prostate (prostatitis); and inflamed testicles due to mumps (mumps orchitis). Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.

Ejaculation issues.Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra. Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. Often in these cases sperm can still be retrieved for use in assisted reproductive techniques.

Antibodies that attack sperm.Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.

Tumors.Cancers and nonmalignant tumors can affect the male reproductive organs directly or can affect the glands that release hormones related to reproduction, such as the pituitary gland. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.

Undescended testicles.In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.

Hormone imbalances.Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.

Sperm duct defects.The tubes that carry sperm (sperm ducts) can be damaged by illness or injury. Some men experience blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one or both of the tubes that carry sperm out of the testicles. Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether.

Chromosome defects.Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener syndrome.

Problems with sexual intercourse.These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.

Certain medications.Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.

Prior surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles.

Environmental causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

Industrial chemicals.Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.

Heavy metal exposure.Exposure to lead or other heavy metals also may cause infertility.

Radiation or X-rays.Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.

Overheating the testicles.Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and slightly reduce sperm production. The type of underwear you wear is unlikely to make a significant difference in male fertility.

Health, lifestyle and other causes

Illegal drug use.Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.

Alcohol use.Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.

Occupation.Certain occupations can increase your risk of infertility, including those associated with extended use of computers or video display monitors, shift work, and work-related stress.

Tobacco smoking.Men who smoke may have a lower sperm count than do those who don’t smoke. Secondhand smoke also may affect male fertility.

Emotional stress.Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.

Weight.Obesity can cause hormone changes that reduce male fertility.

Prolonged bicycling.Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles. In some cases, bicycle seat pressure on the area behind the testicles (perineum) can cause numbness in the penis and erectile dysfunction.

More About Male infertility

Surgical sperm retrieval (TESA/PESA/MESA)

Microsurgeries in Males

[indiaivfsurrogacy-blog]

Common Cause of Infertility in Males https://drrichikasahayshukla.com/ Male fertility is a complex process. To get your partner pregnant, the following must occur: You must produce healthy sperm.Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production. Sperm have to be carried into the semen.Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. There needs to be enough sperm in the semen.If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner’s egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate. Sperm must be functional and able to move.If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg. Medical causes Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include: Varicocele.A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm. Treating the varicocele can improve sperm numbers and function, and may potentially improve outcomes when using assisted reproductive techniques such as in vitro fertilization. Infection.Some infections can interfere with sperm production or sperm health, or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, including chlamydia and gonorrhea; inflammation of the prostate (prostatitis); and inflamed testicles due to mumps (mumps orchitis). Although some infections can result in permanent testicular damage, most often sperm can still be retrieved. Ejaculation issues.Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra. Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. Often in these cases sperm can still be retrieved for use in assisted reproductive techniques. Antibodies that attack sperm.Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them. Tumors.Cancers and nonmalignant tumors can affect the male reproductive organs directly or can affect the glands that release hormones related to reproduction, such as the pituitary gland. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility. Undescended testicles.In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition. Hormone imbalances.Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes. Sperm duct defects.The tubes that carry sperm (sperm ducts) can be damaged by illness or injury. Some men experience blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one or both of the tubes that carry sperm out of the testicles. Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether. Chromosome defects.Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener syndrome. Problems with sexual intercourse.These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex. Certain medications.Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility. Prior surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles. Environmental causes Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include: Industrial chemicals.Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts. Heavy metal exposure.Exposure to lead or other heavy metals also may cause infertility. Radiation or X-rays.Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced. Overheating the testicles.Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and slightly reduce sperm production. The type of underwear you wear is unlikely to make a significant difference in male fertility. Health, lifestyle and other causes Illegal drug use.Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well. Alcohol use.Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems. Occupation.Certain occupations can increase your risk of infertility, including those associated with extended use of computers or video display monitors, shift work, and work-related stress. Tobacco smoking.Men who smoke may have a lower sperm count than do those who don’t smoke. Secondhand smoke also may affect male fertility. Emotional stress.Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count. Weight.Obesity can cause hormone changes that reduce male fertility. Prolonged bicycling.Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles. In some cases, bicycle seat pressure on the area behind the testicles (perineum) can cause numbness in the penis and erectile dysfunction.