Table 1 Possible acquired causes of male reproductive impairment

Hypothalamic-pituitary axis

 Compressive effect (Pituitary or brain tumors)

 Ablative effect (CNS surgery or radiotherapy)

 Infiltrative effect (fungal infections, sarcoidosis, hemochromatosis)

 Suppressive effect (exogenous AAS)

Quantitative alterations of spermatogenesis

 Varicocele

 Previous chemotherapy or radiotherapy

 Testicular failure (torsion, orchitis, orchiectomy)

 Comorbidities (liver and kidney disease)

Qualitative alterations of spermatogenesis

 Oxidative stress

 DNA damage

Ductal obstructions

 Surgery (vasectomy, hernia repair, pelvic surgery)

 Neurological disorders (Multiple Sclerosis, Spinal Cord Injury, neural tube defects)

 Erectile or ejaculatory dysfunction