• The hypothalamus communicates with the pituitary with the hormone Gonaditropin Releasing Hormone (GnRH).
• The pituitary communicates with the testes the hormones Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH).
• The testes are being stimulated to produce sperm and the male hormone testosterone as well as other proteins and hormones that are needed for normal sperm development and function.

Abnormal:

• Conditions that affect glands other than the testes such as the thyroid, pituitary, or adrenal may lead to abnormal sperm production;
• Chronic medical conditions and the medications used to treat these conditions;
• Infections;
• Exposure to environmental toxins (heavy metals or other industrial exposures);
• Conditions that interfere with normal transport of the sperm from the testes to the penis or normal ejaculation;
• Anatomic (obstruction or abnormal external genitals);
• Neurologic (nerv injuries or conditions such as diabetes);
• Alcohol, smoking;
• Antibodies or abnormalitieas of sperm function might prevent the sperm from penetrating the egg and causing fertilization.

Tests: The semen analisys is used for evaluation of ability of sperm to fertilize the egg. The basic semen analisys includes the following parameters: volume, consistency, pH, sperm concentration and motility, analisys of morphological characteristics of spermatozoa using Kruger’s strict criteria. If an abnormality is found, the following is usually done:

• A complete history and physical examination;
• Hormonal studies;
• More advanced evaluation of sperm and sperm function may be required.

Treatment:

• Treatment of other medical conditions, the use of antibiotics for infections, or elimination of toxic exposures may resolve the problem.
• Abnormalities of sperm number and motility are sometimes amenable to hormonal or surgical therapies.
• The development of Assisted Reproductive Technologies provides the oppurtunuty for the couple to conceive when other forms of therapy are not indicated or have been successful. In the last 12 years Intracytoplasmic Sperm Injection becomes the basic treatment of male factor infertility.
• When no sperm is available or if the couple does not want to use advanced Assisted Reproductive Technologies, then donor insemination is an option.