|
|
If one of the testicles has undergone torsion (the technical term for twisting), it could be damaged since it is starved of blood.
Signs of torsion are an excruciating pain and swelling of the testicle. Sadly, it is often misdiagnosed as a testis infection, and left untreated. This causes the testis on that side to shrivel up and die (atrophy). The best way to make the diagnosis of torsion is with a Doppler ultrasound; and emergency surgery is needed rightaway, to untwist and fix the testis. The other testis must also always be fixed surgically to prevent it from undergoing torsion. Unfortunately, after testicular torsion, sperm antibodies are often produced and these may decrease sperm production in the other testis.
The commonest reason for azoospermia in India used to be smallpox --- the virus attacks and damages the epididymis, causing ductal obstruction. Tuberculosis also damages the epididymis, causing azoospermia. However, making a specific diagnosis of tuberculous epididymitis can be very difficult, because it is often a silent and indolent disease. Gonorrhea, chlamydia, syphilis and other STDs can also play havoc with the male genital tract, causing irreparable damage to its epithelium (internal lining).
Mumps can also cause orchitis (inflammation of the testis) --- especially when it affects young men. This can cause severe damage to the testes, resulting in testicular failure.
What about other genital tract infections? Many doctors will do a semen culture, to look for a treatable cause of infertility, if the semen sample shows many pus cells. If the test is positive treatment with antibiotics is instituted. Male reproductive tract infections (such as prostatitis) are often chronic, and may require many weeks of antibiotic treatment. It is therefore important to recheck the semen culture after therapy, to ensure that treatment has been adequate. However, the relation between the presence of bacteria in the semen and male infertility is still unclear. Do the bacteria really cause the infertility? Does treating the infection help to improve fertility? More questions than answers, once again!
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
