**12. Inflammation and infertility**

Inflammation is a complexed process of response to tissue damage and injury. It starts with the aggregation of leukocytes and more plasma molecules to infection site. Several factors may be responsible for inflammation in reproductive tract of male. (i) Blockage of ejaculatory duct (ii) epididymitis that causing pain, swelling in scrotal area, penile leakage and presence of blood in urine (iii) sexual transmitted diseases by several agents like *E. coli* (iv) Urethritis (v) testicular torsion is another pathology affects the fertility in male. It occurs due to abnormality in supportive tissue of testis and causing the testis to pervert inside the scrotum which result in severe swelling and pain [70]. During the process of inflammation, the quality of semen is reduced due to abnormal function of accessory glands, sperm transport hindrance and spermatogenesis dysregulation [71, 72]. Cytokines which are either secreted by activated cells or secreted after receiving stimulus might assist help in normal function of reproductive system [73, 74]. Testicular macrophage is the chief source of cytokine in male but Leydig and Sertoli cells are also depicted to secrete cytokines. Two types of changes are seen due to inflammation in male genitalia; an increase in secretion of seminal fluid leads to redness, local heat and depletion in velocity of seminal flow. Cytokines (TNF-α, IL-6, and IL-1) induce the oxidative damages that impair the quality of semen and have bad impact on fertility of male. Raised level of few cytokines in male semen also disrupts the quality, density and morphology of sperm. The increased level of TNF-α is linked with low sperm count, motility and morphology of sperm. In semen raised level of TNF-α induced apoptosis due to proliferation and differentiation of B-cell, T- cell and NK cells. At the site of inflammation, the blood vessels are dilated permitting the leukocytes in high concentration to migrate out of blood and bind with vascular

endothelium. Accumulation of local fluid due to increased permeability causes pain and swelling. So different types of disorders either due to hormonal imbalance, physical or physiological problems lead to infertility in male [7].
