A couple who are unable to have a child even after repeatedly trying for more than 12 months is diagnosed with infertility. Infertility may be due to male/female or both can be factors. According to a systematic review and population-based study by W.H.O, approximately 48 million couples are affected globally with infertility. Nearly 40 to 50% of fertility issues are due to the alarming rise of infertility in men.
It is a general social stigma and a misperception in certain regions of the world to penalize the woman for not being able to conceive. But, the fact remains that male fertility factors such as semen ejaculation problems, low levels of sperm numbers, abnormal sperm anatomy, and motility contribute significantly to infertility. And dealing with infertility is distressing with tremendous social and psychological implications.
To enhance the pregnancy chances and improve fertility, it is crucial to address these infertility causing factors in both men and women by accurate diagnosis and treatment.
What is Male Infertility?
W.H.O defines Infertility as “the disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse”. Male infertility is when the couple is not able to bear a child due to the conditions of the male reproductive system.
In the male reproductive system, the testicles produce sperms. The generated sperm cells are stored in the epididymis and released out of the urethra through the ejaculatory ducts, and vas deferens during ejaculation. Hormones like testosterone, FSH (Follicle Stimulating Hormone), and LH (Luteinizing Hormone) drive the male reproductive system.
The sperm mixes with the seminal fluid (released from the seminal vesicles and prostate gland) before being ejaculated. Any imbalance in the hormones or structural and developmental deformities in a man’s reproductive tract, the whole process varies, causing conditions leading to infertility.
Here, even the sperm characteristics is a key aspect. The sperm characteristics like
- Sperm motility ( the ability of the sperm to naturally swim in the seminal fluid),
- Sperm anatomy like shape, size, with intact sperm head (acrosome), and a long active tail
- Sperm count (minimum sperm numbers enough to increase conception chances) can be affected by slight changes in the reproductive system.
Male Infertility: Most Common Causes
Fertility in men is when proper structural development of the reproductive tract during puberty can generate healthy sperm. And for adequate production of sperms, the body must produce enough testosterone, and other stimulating hormones. Every organ of the reproductive system must coordinate, work, and transport the sperms along with the seminal fluid. Over and above the sperm morphology and function has to be exceptional to penetrate and fertilise the ovum. Some of the common causes of male infertility are categorized into biological, lifestyle, and environmental factors.
Medical conditions of the reproductive tract, possible infections, inherited genes are a few of the factors that impact sperm production and integrity.
- Varicocele: This is one of the reversible conditions causing male infertility where the testicles enlarge due to the swelling and abnormal blood flow in the veins that drain the testicles. A common cause for infertility in men that can invariably reduce sperm quantity and quality.
- Sperm disorders: Sperm disorders include the conditions leading to low or absence of sperms (oligospermia or azoospermia), abnormal sperm structure and less motile sperms (asthenozoospermia). Ideally, the sperms are generated at low temperatures. Genitals, when subjected to high temperature, can disrupt the sperm production process leading to defective sperms.
- Obstructive ducts: Blockages within the reproductive tracts including the testicles, tubules of the testicles, epididymis, vas deferens, ejaculatory ducts or the urethra can cause obstructive azoospermia. This can hamper the sperm production and transportation system. These blockages may be caused due to prior infections, inherited conditions like cystic fibrosis, accidental injuries, or trauma.
- Infections: Major infections of the reproductive tract include gonorrhoea or HIV that cause inflammation and damage to the testicles, epididymis, or block the reproductive ducts due to scarring. These conditions interfere with sperm production process and can impact sperm health.
- Retrograde ejaculation: Retrograde ejaculation is a reverse ejaculation process where the semen enters the bladder during orgasm instead of moving out of the penis. Health problems such as diabetes, certain medications, surgical treatments of the reproductive tract, or spinal injuries are associated with this condition.
- Immunologic infertility: Factors of the immune system work to defend our body from invading pathogens. But sometimes, the anti-sperm antibodies are the same immunological factors that mistakenly identify the sperms as a foe and begin to eliminate them.
- Undescended testicles: This is an infertility condition that occurs during foetal development. Here, one or both the testicles do not descend or move down into a sac-like structure called the scrotum ( the sac that carries the testicles).
- Hormonal variations: Conditions of the hormonal systems like the pituitary glands, thyroid, and adrenal glands, or hormone-releasing organs of the reproductive system like testicles are possible causes of infertility in men. Hyperandrogenism or testosterone deficiency is a common fertility condition observed in men.
- Genetics: Genetic syndromes associated with infertility in men are either inherited or acquired. These can have chromosomal defects like Klinefelter’s syndrome (condition having an additional X chromosome) where the reproductive organs develop abnormally or have genetic deformities like cystic fibrosis and Kallmann’s syndrome.
- Other medical conditions: Cancers of the reproductive organs, cancer treatment and specific medications during treatment, celiac disease (gluten sensitivity), previous surgeries like vasectomy, prostate surgeries, etc. can impair sperm production process and affect male fertility.
- Erectile Dysfunction: A less firm erection, painful intercourse, defective urethral opening (hypospadias) can also interfere with fertility.
Environmental and Occupational factors
- Exposure to certain environmental and occupational elements such as toxins, pesticides, heavy metals, painting materials, lead, and other noxious chemicals contributes to sperm production impairment and production of defective sperms.
- The exposure of the genitals to high temperatures, hot saunas, tight clothing, radiation exposure like X-rays, too much working on laptops and computers also may reduce sperm production and quality.
Some of the lifestyle factors that can decrease fertility in men include
- Use of anabolic steroids, drugs that shrink the testicles and reduce sperm production.
- Abusive use of alcohol
- Smoking and secondhand exposure to tobacco smoke
Male Infertility: Noticeable signs and symptoms
The notable sign of male infertility is when the couple cannot have a child. The following are a few signs that may indicate infertility in men:
- Pain, swelling, or lump in the testicular region
- Unusual testicular shrinkage
- Small and firm testicles
- Reduced facial and body hair growth
- Abnormal growth of breasts (gynecomastia)
- Sperm counts less than 15 million sperms per milliliter (mL) of semen.
- Problems with erectile function
- No or dry ejaculate
- Mood swings
- Reduced libido or sex drive
Male Infertility: When to see a doctor?
Visit the doctor when you are unable to conceive a child even after regular unprotected intercourse. This is the first indication that requires medical help and assessment. Other indications include:
- Erectile problems
- Ejaculation issues
- Low sex drive
- Pain during intercourse
- Swelling, lump, or pain near the testicles
- Small, shrunk, or firm testicles
- Had a previous surgery of the reproductive tract or an infection
Male Infertility: Treatment
Thorough physical and medical examinations and semen analysis tests and finding out the underlying cause of infertility help choose the correct course of fertility treatment in men. Treatment options for male infertility range from hormonal interventions to fertility enhancement procedures of assisted reproduction.
Hormone medications and therapies can treat hormone disorders of the hypothalamus, pituitary, thyroid, and adrenal glands.
Antibiotics are the best and effective method to treat and cure viral and bacterial infections.
Surgical corrections and repair
Twisted, swollen veins of the scrotum, blocked reproductive ducts are majorly repaired through surgery. Varicocele can also be corrected surgically.
Surgical aspiration of sperms
Obstructive azoospermia, retrograde ejaculation, and cases where enough sperms cannot be retrieved through normal ejaculation, sperms can be recovered surgically. Surgical methods like Testicular Sperm Aspiration (TESA), Percutaneous Epididymal Sperm Aspiration (PESA), and microsurgical testicular sperm extraction (micro TESE) can conveniently retrieve sperms directly from the testicles, testicular tissue, or the epididymis.
Almost 1 in 7 couples deal with infertility worldwide, and more than one-third of them are caused due to male fertility issues. Evaluating the underlying infertility cause can help provide a treatment solution and in turn, help in successful conception.