Male fertility- everything you need to know

All about Male infertility

Sometimes, the male partner is the cause of a couple’s infertility. Infertility is defined as the inability of a couple to become pregnant after 1 year of unprotected sexual intercourse (using no birth control methods). Data shows that the male factor could be the reason for 30- 40% of the couples experiencing infertility.40% of the cases are due to the female factor. 20- 30% are due to a combination of causes in both partners. Rapid advances in medical science however means that with help, most couples can become parents. 

Causes of Male Infertility: There are many reasons for male infertility which include:

Hormonal disorders: Infertility can result from disorders of the testicles themselves or an abnormality that is affecting the pituitary and hypothalamus glands in the brain

Genetic & familial disorders: Genetic disorders of the testes such as klinefelters syndrome (male is born with two X and one Y chromosome instead of one X and one Y), microdeletion of chromosomes amongst many others cause abnormal development of the testicles.

Injury or heat damage:

Injury to male organs causes sperm damage

Direct: Testicular or Pelvic Trauma is deleterious to sperm production.Indirect: Heat, radiation, chemotherapy, radiotherapy, environmental toxins, tobacco, alcohol,

smoking, drugs, marijuana, a blockage in the ejaculatory duct.

Previous surgery: Inguinal, scrotal, retroperitoneal, bladder neck, vasectomy, hydrocele.

Varicocele: In this, veins of the scrotum get enlarged and tortuous, much like varicose veins in the legs.

Undescended testes: Physiologically, it is important for testes to have a temperature that is a few degrees lower than body core temperature in order for sperm production to occur normally. This is why nature has placed the testes outside the body – the higher internal core body temperature is harmful to sperm production.

Lifestyle issues: Alcohol, drugs, Tobacco smoking and Emotional stress are affect fertility. Alcohol or drug dependency can cause reduced fertility. Steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and decrease sperm production. Men who smoke may have a lower sperm count than those who do not smoke. Passive smoking may affect male fertility. Stress may interfere with certain hormones that are needed to produce sperm.

Sexual issues: Problems with sexual intercourse (often treatable) or technique may affect fertility. Difficulties with erection of the penis, premature ejaculation, painful intercourse (dyspareunia), or psychological or relationship problems can contribute to infertility.          

Retrograde ejaculation: Semen enters the bladder during ejaculation rather than emerging out through the penis. Various conditions can cause retrograde ejaculation, including diabetes, bladder, prostate or urethral surgery, certain neurological diseases and the use of certain medications. 

Environmental: Exposure to toxins, heavy metals, excessive heat and. certain prescription medicines can affect sperm quality.

Medical conditions: Various medical conditions that can cause infertility include Diabetes, Pituitary gland diseases, Hypothalamus disorders, Multiple sclerosis, Cushing’s syndrome, Hypogonadism etc.

Misplaced urinary opening (hypospadias): A birth defect can cause the urinary (urethral) opening to be abnormally located on the underside of the penis. If not corrected, this condition may prevent sperm from reaching the woman’s cervix.

Infections: Sexually transmitted diseases (STDs), such as chlamydia and gonorrhea, are most often associated with male infertility. These infections cause scarring and block sperm passage. If mumps which is a viral infection usually affecting young children, occurs after puberty, inflammation of the testicles can impair sperm production. Inflammation of the prostate (prostatitis), urethra or epididymis may also alter sperm motility. 

Idiopathic (cause not known) 

Evaluation of Male Infertility: Some infertile couples have more than one cause of their infertility. For a man to be fertile, the testicles must produce enough healthy sperm and the sperm must be ejaculated effectively into the vagina. 

Tests for male infertility are 

  • Semen analysis: This is gold standard for diagnosing male infertility. Physical characteristics of semen, the number of sperm present, any abnormalities in the shape and structure (morphology) and movement (motility) of the sperm are evaluated. The lab will also check your semen for signs such as infections or blood.

Male fertility tests

  • Depending on initial findings, your doctor may recommend additional, more specialized tests that help identify the cause of your infertility. 
  • Scrotal ultrasound: Ultrasound, which uses high-frequency sound waves to produce images of structures within your body, can help your doctor look for evidence of a varicocele or obstruction of the epididymis. 
  • Hormone testing 
  • Genetic tests: These tests are advised if your doctor suspects your fertility problems to be caused by an inherited sex chromosome abnormality. 
  • Testicular biopsy: This test involves removing samples from the testicle with a needle. It is used if semen analysis shows no sperm at all. The results of testicular biopsy will tell if sperm production is normal. 
  • Anti-sperm antibody tests: These tests are used to check for immune cells or antibodies that attack the sperm and can affect their ability to function. 
  • Treatment of male infertility: Treatment has to be carefully selected keeping in mind the age, the health of female partner, preference, medical history and the exact cause of infertility. The following modalities of treatment are available. 
  • Medical Treatment 
  • This consists of the administration of certain drugs to improve semen quality.
  • Surgical Treatment: Obstructions in the sperm pathway, varicoceles, undescended testes etc. can be treated surgically.
  • Assisted Reproductive Techniques: Rapid advancements in the field have enabled individuals with a variety of disorders to successfully become proud parents, a situation relatively uncommon in the past. The various options available are: 

1.In Vitro Fertilization (IVF): IVF is the most common assisted reproductive technology method and is the treatment of choice if both fallopian tubes are blocked. IVF is also widely used for male infertility or unexplained infertility. 

2.Intrauterine Insemination (IUI): During this procedure, partner’s washed sperm is placed directly into the uterus near the time of ovulation. IUI is often performed in the case of a low sperm count, abnormalities of ejaculation (retrograde ejaculation, impotence, spinal cord injury), when the cervix prevents sperm from entering the uterus, with donor sperm or when the male partner has very low to nil sperm production. 

3.Intracytoplasmic Sperm Injection (ICSI): The introduction of Intracytoplasmic Sperm Injection (ICSI) has uplifted the management of male infertility. In this procedure, a single sperm is injected directly into an egg; this procedure is most commonly used to manage male infertility problems. Following egg retrieval, the sperm is injected into the egg. About 70 percent of eggs get fertilized. Fertilization Is confirmed 18-24 hours after retrieval. ICSI Is a highly successful procedure used to help couples who have previously failed to achieve conception with standard IVF. 

4.Semen Cryopreservation: Semen cryopreservation (the freezing of sperm) is a way to store sperm for future use. Men who need to undergo certain medical procedures (e.g. cancer chemotherapy, radiotherapy) that may leave them sterile may wish to consider semen cryopreservation. Semen cryopreservation is also used before IVF to acquire multiple semen samples in men.

5.Donor Sperm: Donor sperm are recommended when sperm is not produced from the semen, often due to genetic causes, chemotherapy, radiation therapy or vasectomy. These are also an option for single women, couples with genetic disorders, and couples in which the woman is Rh-sensitized and the man is Rh-positive.