(iv) Urethritis: There could also be bladder or urethral infection that moves to the epididymis. gonorrhoea, Chlamydia, Escherichia coli was reported to be the main cause of epididymitis in older men, but other types of bacteria including mycobacteria and ureaplasma may also cause this condition. (iii) Infections: Inflammation results from sexually transmitted infections e.g. Inflammation of the epididymis may result in further complications such as scrotal swelling, pain, penile discharge and blood in urine. (ii) Epididymitis: This is the inflammation of the epididymis, a structure in the male reproductive system that joins the testes and the vas deferens. These include (i) ejaculatory duct obstruction: This is a common cause of male infertility and infections have been reported to be present in at least 20–50% of these men ( 17). There are several causes of inflammation in the male reproductive tract. When there is an infection to the reproductive tract, one important function of the innate immune system is to recruit more phagocytic cells and effector molecules to the site of the infection through the release of a battery of cytokines and other inflammatory mediators that have profound effects on subsequent events.Ĭauses of inflammation in the male reproductive tract: Infection remains the commonest cause of infertility in Africa particularly in sub-Saharan Africa ( 15– 16). These include environmental factors such as diet and toxic elements ( 10– 11), genetic aberrations ( 12– 13), infection and inflammation ( 14) etc. Apart from known hormonal disturbances ( 9), other physical and psychological problems may also contribute to male infertility. Male factor infertility is seen as an alteration in sperm concentration and/or motility or morphology in at least one sample of two sperm analyses, collected between 1 and 4 weeks ( 8). (2009) reported that male factor contributes averagely to half of the cases of infertility in couples ( 7). Male factors have been reported to contribute between 30–55% ( 3– 6) to global cases of infertility. This may occur as a result of environmental influences or may be due to diseases that directly or indirectly affect spermatogenesis, leading to infertility in men. The process of spermatogenesis is highly organized proliferation and differentiation of the male germ cells and the intratesticular and extratesticular mechanisms of regulation of spermatogenesis can be disturbed at every level ( 2). DNA methylation and histone modification have been implicated in the regulation of this process ( 1). Spermatogenesis is highly dependent upon optimal conditions for the process to occur correctly, and is essential for sexual reproduction.
It consists of various stages beginning with the formation of germ cells (spermatogonia) in the germinal epithelium followed by their progressive development into primary and secondary spermatocytes, and finally mature spermatozoa. The process of spermatogenesis takes place within the coiled seminiferous tubules, and continues from puberty to old age. Spermatogenesis is the process by which a complex, interdependent population of germ cells produces spermatozoa by mitosis and meiosis. In addition, the review was further strengthened by discussing how inflammation affects both fertility and assisted reproductive technologies (ART).
This article reviewed the suggested mechanisms and contribution of inflammation to male infertility. Oxidative stress, especially in sperm, is harmful because it damages sperm DNA and causes apoptosis in sperm. The inflammatory reactions within the male genital tract are inevitably connected with oxidative stress. Epidemiological studies regarding male infertility have revealed that more and more infertile men suffer from acute or chronic inflammation of the genitourinary tract, which often occurs without any symptoms. Moreover, inflammation is also associated with oxidative stress and the latter is well known to impair sperm function. However, when the levels of these cytokines are higher than normal, as seen in conditions of inflammation, they become very harmful to sperm production. The presence of pro–inflammatory cytokines, tumor necrosis factor-alpha (TNF–α), interleukin–1 alpha (IL–1 α) and interleukin 1 beta (IL–1 β) cytokines in the male reproductive tract (testis, epididymis and sperm) may have certain physiological functions. This process, called spermatogenesis is very complex and involves the synchronization of numerous factors. Fertility in the male is dependent on the proper production of sperm cells.
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