Urogenital tract infections in men as a cause of infertility

In about 35% of couples suffering with infertility the cause of problems with getting pregnant is the male factor (Agarwal, Mulgund, Hamada, Chyatte, 2015). The male semen may have incorrect parameters for various reasons. A frequent cause is urogenital infection. Unfortunately symptoms are often minimal or nonexistent and men do not go to the doctor. These infections may result in decreased production of sperm, reduced mobility or changes in sperm morphology (oligo-asteno-teratozoospermia syndrom). Episodes of acute or chronic orchitis or epididymitis may result in permanent damage to the testis or to obstruction in the efferent ejaculatory ducts. Azoospermia (i.e. lack of spermatozoa in ejaculate) on semen analysis can be a consequence of infection-induced obstruction. The content of the ejaculate is then the seminal fluid itself, which is produced in the prostate (not in the testes). Single sperm in semen may be present (cryptozoospermia). Urinary tract infections in men can cause inflammation in their partners. This can be chronic inflammation of the cervix and endometrium, alterations in reproductive tract secretions, induction of immune mediators that interfere with gamete or embryo physiology, and structural disorders such as intrauterine synechiae, changes of the oviduct or surrounding peritoneum. On the other hand genital tract infections are a major cause of antisperm antibody formation in men. Genital tract infections and antisperm antibody formation in men can lead to immune-mediated infertility in women. Infection is also a main cause of infertility (Weidner, Pilatz, Diemer, Schuppe, Rusz, Wagenlehner, 2013; WHO, 1987). In any case of infertility, infections should be considered. It is important to identify infectious factor beacause only then is it possible to treat causal.