Testicular failure is the one cause of infertility that medicine can’t do a whole lot about. It occurs when the cells of the testicle are unable to produce or nourish sperm to maturation. There are several reasons this can happen. Injury can cause tissue within the testicle to die. Various genetic disorders can cause prevent the development of key cell types or prevent cells from expressing proteins needed for the creation of sperm.
Men generally have a “XY” chromosomal makeup (women are “XX”). However, occasionally boys are born with an extra X chromosome in their genetic makeup – “XXY”, or “47,XXY”. This condition is known as Klinefelter Syndrome, and it has been shown to drastically reduce the man’s fertility.
Poor descent of the testicle is one of the most common birth defects in baby boys affecting 3% of full-term babies and up to 30% of premies. Often the testicle will descend on its own during the first year of life (usually during the 1st 3 months), however sometimes surgery is required. In these cases, fertility is at risk as keeping the testicle in the body longer overheats the cells responsible for producing sperm and permanently cooking the ball. Boys with crytorchidism are also more likely to have other structural issues which can cause blockages leading to azoospermia.
Cancer is incredibly hard on the body. Treatment of cancer, radiation and chemotherapy is equally hard. Because cancer is a rapidly dividing cell, cancer therapies target cells that rapidly divide. This is why patients undergoing chemo loss hair and experience nausea. Unfortunately, sperm cells and the cells in the testicle that create sperm cells fall in the category of rapidly dividing cell and therefore can be wiped out during cancer treatment. If you have cancer, it is possible to donate a semen sample before undergoing treatment to freeze and preserve your fertility.
“Protect the family jewels” has an element of truth to it. Injury to the testicle can destroy tissue needed for sperm production. A cheap shot below the belt isn’t likely to do it but if you somehow injure yourself and the pain doesn’t subside it is a good idea to go to the ER. Sometimes blood flow to the testicle can get cut off and cause irreversible damage. Infections can also cause severe damage. Often these can be treated with medication. Take home point: if it hurts or it’s weird and it doesn’t go away. Good idea to see a doctor, even if its embarrassing. Your balls will thank you.
Sertoli cell-only syndrome
There are two main types of cells involved with the maturation of sperm. Sertoli cells act as mothers to the baby sperm. They feed and take care of them. Leydig cells act more like fathers and provide things that baby sperm need including testosterone. In sertoli cell-only syndrome, there either aren’t enough leydig cells or there is something wrong with them.