-LH, and FSH deficiency.
- Hyperprolactinemia due to pituitary adenoma or a side effect(s) of some medications.
Measurement of these hormones (LH, FSH, prolactine, and testosterone) will help in the diagnosis, for example:
Depending on these levels the treating physician, might determine the cause.
-Idiopathic causes for testicular problems.
-Chromosomal causes such as, klinefelter’s Syndrome (47XXY).
-Undescended testis or (cryptochidism) that may cause harm to testicular tissue.
-Congenital absence of both testes.
-Testicular varicocele: This is usually diagnosed through a physical examination, and using ultrasound, in this case tortuous veins around the epididymis, this might affect sperm production, and quality, but varicocele effect is still under debate, and there is controversy among researchers, and doctors as to whether it has a major effect or not.
-Major trauma to the testes.
-Severe testicular infection.
-Hazardous chemical or physical exposure.
-Medications such as cyclosporine, allopurinol, colchicines, sulfasalazine, spiranolactone.
-Drugs such as marijuana and alcohol especially if there is an addiction, will affect sperm quality, and slow its motility.
-Some chemicals used in factories like nematocid DBCP, lead, and mercury affects sperm production.
-Chemotherapy that is used in the treatment of cancer patients.
All the above mentioned points affect sperm production or even might cause spermatogenesis arrest.
It is well known that smoking has effects on sperm production, motility, and morphology some researchers found that smokers who have varicocele have less ability for sperm production five times less as compared to nonsmokers.
-Heat has a major role in sperm production, so men should avoid wearing tight underwear for long periods, as it may cause low or reduced sperm count.
-Jobs that require sitting for long times, may affect sperm count.
-Chronic medical illnesses, such as chronic renal failure, or chronic liver failure.
-Immunological disorders: It may cause sperm antibodies that will kill the sperm.
-Congenital causes: Vas aplasia, malformation of caudal corpus epididymis.
-Congenital obstruction of seminal vesicles.
-Congenital obstruction associated with bronchial dilatation of the lungs.
-Severe infections may cause epididymal obstruction: Some of the Microorganisms that may also cause infections are staph, gonorrhea tuberculosis, trachoma, anaerobes and Chlamydia.
-Vasectomy: A procedure done for male contraception in this procedure a cut in seminal ducts is done which will cause male infertility.
-Inappropriate time for intercourse (not at time of ovulation).
-Erectile dysfunction: It could be due to psychological, neurological or vascular disorders or as a side effect for some medication.
-Using certain ointments or creams at the time of intercourse, some of which may kill the sperm.
-Hypospadias: This means abnormal position of urethral meatus.
-Congenital Penile Defects.
-Retrograde ejaculation: In these patients the semen flows to the bladder at the time of ejaculation instead of out through external opening this happens when there is a problem in bladder neck due to:
-Disorder of the sperm and its ability to fertilize.
-Immotile cilia syndrome.
-Necrospermia (dead sperm).
-Increase viscosity of the semen above the normal levels.
-Some factors that may suppress the sperm such as deficiency of certain enzyme, which is important in sperm motility (protein- carboxyl methylase PCM).
-Presence of pus in the semen.
-Decrease the amount of the substances needed for sperm motility or decrease their use by the sperm (Adenosine triphosphate A.T.P).
-Sperm membrane malformation.
-Disorders in calcium metabolism.
-Lack of the substances in the semen that are needed for sperm motility such as bicarbonate or abnormal levels of prostaglandins.