So testosterone itself, it turns out that testosterone is critical for sperm development in the testicle. And so this is where a common mistake is made both on a patient as well as multiple physician sides of things and understanding how to treat male subfertility. Because if you believe what I just said that testosterone is important for normal sperm production and man comes into your office with low testosterone, then you would think the most natural thing to do would be to put them on testosterone replacement therapy. Unfortunately, it has exactly the wrong effect.
So prolactin is another interesting hormone from the pituitary gland that if it is elevated, it can actually shut down the whole system. So prolactin elevation usually affects the other hormones in the pituitary gland, again that FSH hormone to essentially stop production. So the problem is not down in the testicle, the spur machinery is there, but there’s a problem up here in terms of if sending the proper signals down to the testicle. So prolactin elevations often can be treated with medication. Sometimes if there’s a prolactin secreting tumor involved in the elevated prolactin, a patient may even need surgery to remove that tumor. So again another common hormone I will draw on my men with potential subfertility.
And then finally estradiol. Essentially higher estradiol levels feedback on the pituitary gland to shut down those pituitary hormones much like testosterone does but to the point where the sperm production may be affected by that pituitary shutdown. So one of the treatments that I offered to patients as if their estradiol levels are too high for me, if I put them on medication to lower those levels and drive the equation back to higher testosterone levels, then we may be able to improve their sperm counts.
So heredity thinks that’s our third age now. There are a number of genetic abnormalities associated with male subfertility. Some are 100% if a man has that abnormality we won’t be able to find sperm on him, even with a microsurgical procedure where we actually go into the reproductive tract looking for sperm. So it’s important for me to get these studies on men that have extremely low sperm counts. Now extremely low, some people would put it less than 5 million and I think that’s a relatively good number, it’s pretty rare to find a man with a genetic abnormality if his sperm counts are above five million. But if they are low, then here the genes that we can see responsible for potential males subfertility factor.
There’s a chromosomal abnormality called Klinefelter’s syndrome or man actually has an extra X-chromosome. So he looks just like a guy, walks just like a guy, talks just like a guy, but he has some hormonal abnormalities as well as having poor development of his testicular tissue and therefore poor sperm development as well. We can still find sperm on those men, especially if we find them early, and especially if we find them before they start testosterone replacement therapy, which almost all of them need because their testosterone levels are going to be low.
Now if you look at the Y-chromosome itself, the Y-chromosome itself has a region called the AZF region which stands for azoospermian factor. AZF region is subject categorized into an A, B, and C region. And so when we do a molecular analysis of men’s chromosomes (so this is a blood test), we look for that what we call Y microdeletion because if they’re missing one category, one part of one of those chromosomal regions, that may be the reason for their fertility.