Testicular Problems and Infertility

Testicular failure is one condition that may affect sperm health and lead to male infertility. There are different forms of testicular failure that may affect the male reproductive system and a variety of causes that may contribute to testicular failure. All of these factors may result in different conditions affecting sperm health. However, there are several infertility treatment options available to help relieve the symptoms of testicular failure and increase a couple’s odds of getting pregnant.

What is Testicular Failure?

Testicular failure is a general term describing a condition in which the testicles do not properly produce sperm or hormones. However, there are a number of underlying male fertility problems that may be diagnosed as the cause of testicular failure. The following are some conditions that may be affecting male fertility and contributing to testicular failure:

• Chromosomal abnormalities

• Testicular trauma

• Testicular torsion (twisting)

• Diseases or infections such as mumps, orchitis or testicular cancer

• Undescended testicles at birth

• Problems involving sexual maturation

• Certain drugs or medications such as steroids or marijuana

• Lifestyle factors

Lifestyle factors may affect testicular functioning and prevent the testicles from maintaining normal functions. Activities such as riding a motorcycle, for example, can increase the risk of testicular or scrotum injury.

When testicular failure results in the inability to produce proper levels of male hormones, the condition will likely lead to a diagnosis of hypogonadism.

Testicular Failure Symptoms

Signs and symptoms of testicular failure may include the following:

• Low or lack of sex drive

• Infertility

• Delayed puberty

• Decrease in height

• Enlarged breasts (gynecomastia)

• Lack of muscle mass

• Hair loss (usually in the underarms or pubic areas)

• Infrequent need to shave

• Small testicles

• Presence of a tumor or mass near the testes

In addition, during examination, decreases in bone density or the presence of bone fractures may be noted as well as low levels of testosterone hormones accompanied by high levels of FSH and LH.

Testicular Failure and Sperm Health

Testicular failure is associated with three main fertility problems that may affect sperm health. These male fertility problems include the following:

• Azoospermia: this condition results from an absence of the cells necessary to help sperm divide and is also known as sertoli cell-only syndrome

• Maturation Problems: this refers to a condition in which sperm production begins normally, but is interrupted at some point during development. The resulting sperm that is present in the ejaculate will thus not be fully developed

• Hypospermatogeneses: this refers to a condition in which few or no sperm are present in the ejaculate as a result of low sperm production

Testicular Failure Diagnosis

Diagnosing testicular failure may involve a variety of male fertility testing procedures. Congenital testicular failure will typically be indicated by the presence of "ambiguous" genitalia at birth.

• Fertility tests for the diagnosis of testicular failure may include the following:

• Bood tests to evaluate levels of testosterone hormones, gonadotrophine, FSH and LH

• Physical exam for signs of testicular atrophy or tumors

• Semen analysis

Testicle Problems

• Epididymitis

• Hydrocele

• Testicular Cancer

• Torsion

• Varicocele

Epididymitis

What is it?

An inflammation of the epididymis, the tube that transports sperm from the testicle towards the penis. If the swelling affects the testicle as well as the epididymis, the condition is known as epididymo-orchitis.

What are the main symptoms?

• Severe pain in the scrotum

• A swollen area that may feel hot to the touch

• Fever

What's the risk?

It's unusual, although it's more common in childhood and has a peak occurrence in adolescence.

What causes it?

In adults the condition may follow a viral or bacterial infection. Bacteria can sometimes find their way to the epididymis as a consequence of infection with the common bacteria that cause urinary infections or by other organisms such as those of chlamydia or gonorrhoea. Epididymitis can sometimes follow a vasectomy.

How can I prevent it?

The risk of epididymitis being caused as a result of a sexually transmitted infection (STI) can be reduced by always practising safer sex (i.e. using a condom during intercourse) and having regular check-ups for STIs at a GUM (genito-urinary medicine) clinic.

Should I see a doctor?

Yes. A urine test can diagnose the condition. Your doctor will make the diagnosis and exclude other potentially important conditions.

How can I help myself?

Follow your doctor's orders and be patient – epididymitis can take several months to clear up completely.

What's the outlook?

Good, although sometimes the scrotum remains somewhat enlarged.

Hydrocele

What is it?

A swelling in the scrotum, caused by a harmless build-up of fluid within the sacs surrounding the testicles.

What are the main symptoms?

A soft and usually painless swelling of the scrotum. Sometimes the swelling can be as large as a grapefruit.

What's the risk?

Low.

What causes it?

A build-up of fluid in the scrotum, sometimes caused by an injury to the testicles or following infection or inflammation.

How can I prevent it? 

It's not easy to prevent, except by protecting the testicles during sport or potentially risky work.

Should I see a doctor?

Yes. It's important to rule out any more serious conditions.

The doctor will examine the testicles. He or she may also shine a light through the scrotum – if the light passes through, it's probably a hydrocele.

How can I help myself?

There's not much you can do.

What's the outlook?

Most serious cases can be permanently treated.

Testicular Cancer

What is it?

A relatively rare cancer that usually affects one testicle.

What are the main symptoms?

The key symptoms to look out for are:

• A lump in either testicle

• Any enlargement of the testicle

• A feeling of heaviness in the scrotum

• A dull ache in the abdomen or groin

• A sudden collection of fluid in the scrotum

• Enlargement or tenderness of the breasts

It's important to remember that testicular cancer may not cause any discomfort or pain, especially in the early stages. The most common symptom is a small painless lump.

Any of these symptoms can also have benign (i.e. non-cancerous) causes, but they should always be checked by a doctor.

As some of these symptoms aren't always obvious, it's important to check your testicles regularly.

What's the risk?

Testicular cancer is the most common cancer affecting men aged 20–35 but the lifetime risk of developing the disease is still only 1 in 400. That compares with 1 in 12 for lung cancer and for prostate cancer. However, the incidence of testicular cancer is increasing – in fact, it's doubled in the past 20 years.

The risks are greater (1 in 44) for men who were born with undescended testicles. Men with a brother or father who had a testicular tumour have a 6–10 times higher risk of developing this cancer.

What causes it?

The causes aren't yet fully understood. However, the fact that men who develop testicular cancer are more likely to have had undescended testicles, and to be affected by fertility problems, suggests some sort of common cause.

One plausible theory, not yet fully proven, is that testicular tissues are damaged while male foetuses are still developing, possibly as a result of their mothers' exposure to environmental pollutants which are chemically similar to the female hormone oestrogen. It may be that male foetuses are being over-exposed to oestrogen and that, as a result, some develop a range of problems with their reproductive systems.

Some studies have also linked testicular cancer to a sedentary lifestyle in boys, although further research is needed to confirm this.

How can I prevent it?

You can't.

Should I see a doctor?

If you have any of the symptoms listed above you should see your doctor as soon as possible.

Your doctor will examine your testicles and, if he or she suspects a problem, you'll probably be referred to a specialist doctor (normally a urologist). Your testicles will be examined again and you may be asked to have an ultrasound (a painless procedure) and a blood test.

How can I help myself?

• Inform yourself about your condition and its treatment. Talk to your doctor; contact cancer organisations; read material on the Internet (although with care – not all of it is accurate).

• Accept that it's inevitable that you'll feel anxious and scared. However, it's also important to remember that testicular cancer is one of the easiest cancers to treat successfully.

• Consider ways in which you can reduce your stress, such as counselling, meditation, yoga and relaxation exercises.

• If it feels right, join a cancer support group. Your hospital or a cancer organisation can give you details of groups that might be suitable for you.

What's the outlook?

Generally very good indeed. If diagnosed early, 96% of patients can be cured completely. Even when the cancer has spread, up to 80% of men can still be cured. 

Torsion

What is it?

Each testicle is suspended within the scrotum by the spermatic cord. This can become twisted, cutting off the blood supply to a testicle.

What are the main symptoms?

• Sudden, very severe pain in a testicle

• Swelling

• Nausea and vomiting

• Fever

What's the risk?

Low. It's most common in teenage boys.

What causes it?

Many cases have no known or obvious cause, although it can be linked to physical activity. Some men, who have naturally more mobile testicles, are at higher risk.

How can I prevent it?

You can't.

Should I see a doctor?

Definitely. In fact, torsion is a medical emergency – aside from the pain, if the spermatic cord is twisted for more than a few hours a testicle can die due a lack of blood supply, and will then have to be removed.

How can I help myself?

There's not much you can do.

What's the outlook?

Good, if treatment is carried out promptly.

Varicocele

What is it?

Essentially a varicose vein within the testicle.

What are the main symptoms?

• Varicoceles are often painless and almost always located on the left testicle.

• There can be a swelling that is often described as feeling like a warm tangle of worms. This is usually more noticeable when you stand up.

• There may be a "dragging feeling" in the testicle.

• Fertility problems. It's thought that the accumulation of blood overheats the testicle and affects sperm production, although not all men with a varicocele are infertile.

What's the risk?

Approximately 10–15% of men develop a varicocele.

What causes it?

A damaged valve in the vein draining blood from the testicle.

How can I prevent it?

You can't.

Should I see a doctor?

Yes. It's important to rule out any more serious conditions.

Varicoceles can usually be diagnosed through manual examination. A doctor may also shine a light through the testicle – a varicocele will block out the light. Small varicoceles can sometimes be diagnosed by ultrasound.

How can I help myself?

There's not much you can do.

What's the outlook?

Good, but varicoceles can sometimes recur. The treatment of varicoceles can result in a significant increase in fertility: improvements in semen quality occur in 50–90% of men.

Treatment

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