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MALE INFERTILITY – Overview

If you are facing male infertility you are not alone. One in every eight couples face problems in getting pregnant or sustaining a pregnancy. Approximately one-third of infertility is attributed to the male partner.
Infertility in men is the failure to conceive a child even after twelve months of unprotected and frequent sexual intercourse. Many factors contribute to male infertility, such as anatomical, genetic, and environmental causes. In many cases, the underlying cause of infertility in male cannot be determined. You need to consider undergoing formal assessments and tests for better clinical diagnosis.

Male Infertility Symptoms

You may experience one or more of the following symptoms:

  • Reduced sexual desire due to stress or other lifestyle habits
  • Difficulty in maintaining an erection (erectile dysfunction)
  • Pain or swelling in the testicle area
  • Difficulty in ejaculation
  • Decreased facial and body hair, and abnormal breast growth or hormonal abnormality

Visit your doctor to get yourself evaluated for these symptoms. Sometimes there are no apparent signs and symptoms of male infertility. You may not experience any issues with sexual activity, erection or ejaculation, and the only symptom you will have is the inability to conceive a child.

Male Infertility Problems/Causes

Fertility in Men is a result of a complex combination of factors. The following markers help us evaluate fertility or infertility in men.

Production of healthy sperms: This involves the growth and formation of the male reproductive organs during puberty. At least one of the testicles must be functioning optimally and the body must be producing testosterone and other hormones to trigger and maintain sperm production.

Carrying of sperm into the semen: Once sperm cells are produced in the testicles, tubes transport them until they mix with semen and are ejaculated out of the penis. This must not be obstructed in any way.

A good amount of sperm in the semen: The sperm count is considered low if enough sperms are not present in the semen. It decreases the chances that one of the sperm will fertilize the partner’s egg. Fewer than 15 million sperm per millilitre of semen or lesser than 39 million per ejaculate is considered as low sperm count.

Sperm must be healthy and functional: Healthy sperms move with great speed. If the sperms are not healthy or not able to move, it may not be able to reach or penetrate your partner’s egg. Hence the motility of the sperm is a very important factor in determining male fertility.

Sperm disorders can be hereditary or can be the result of bad lifestyle choices. Drug usage, smoking, alcohol consumption, obesity, emotional stress, and depression can result in sperm related disorders. Also, any congenital disability or damage to the reproductive system may result in low sperm count.

Varicoceles

Varicoceles are swollen veins of the scrotum that causes infertility. This occurs due to the blockage of blood flow to the scrotum, leading to difficulty in temperature regulation. The warm temperature does not favor the production of sperms resulting in low sperm count.
Varicocele can be treated, which helps to improve sperm number and function, and this may also improve the potential outcome of assisted reproductive techniques such as IVF.

Immunity related infertility

Though it is not a common cause of infertility, sometimes your body creates antibodies that attack your own sperms. These antibodies affect the functionality of sperms, which makes it difficult for them to fertilize the egg.

Ejaculation Issues

During orgasm, if semen enters the bladder instead of going out through the penis, it is called retrograde ejaculation. Various health problems can cause retrograde ejaculation, such as surgery, medication, spinal injuries, or diabetes. Generally, in retrograde ejaculation sperm count is normal and can be retrieved and used for assisted reproduction techniques.

Blockage of sperm transporting tubules

Some defects can block the tubes that carry sperms. This blockage can occur due to repeated infections, injury due to surgery, swelling, or it can be an inherited condition. This blockage can prevent the sperm from leaving the body for fertilization.

Hormonal Imbalance

Any hormonal abnormality affecting the hypothalamus, pituitary, or adrenal glands can cause infertility. The inability to produce an adequate amount of testosterone can lead to a reduced number of healthy sperms.

Chromosomal Defects

An inherited disorder can result in abnormal development of male reproductive organs. Some of the genetic syndromes causing infertility in men are Klinefelter’s syndrome, Kallmann’s syndrome or cystic fibrosis.

Medications

Certain medications can impair the function, structure, and production of sperms and interfere with male fertility. Long term use of steroids, cancer medication (chemotherapy), antifungal medications, and medications advised for arthritis and depression can cause infertility.

Environmental Causes

Overexposure to industrial chemicals, heavy metals, or radiation may contribute to your reduced sperm count. Increased scrotal temperature due to tight underpants can also be the reason for infertility.

Lifestyle Choices

Tobacco, Chewning, Smoking or drinking alcohol can lead to erectile dysfunction or decreased sperm production. Usage of drugs like marijuana or cocaine can reduce the quality and production of your sperms. Emotional stress and depression can lead to sexual dysfunction. Excessive weight or obesity can also be the reason for male infertility.

Male Infertility Diagnosis

The diagnosis of infertility in men can be a complicated process. Getting yourself evaluated from a physician, specialized in male fertility can help you with better diagnosis. The method of diagnosis starts with medical history, lifestyle, and physical examination.

History and Physical examination

Your health care provider will take a detailed history of your health and any previous surgeries. You will be asked about any childhood diseases, current health problems, any medications you are taking, which might be causing infertility. You will also be assessed for exposure to any environmental or lifestyle-related causes leading to infertility. You will be asked if you are facing any difficulties with sexual functioning.
Physical examination includes examining your reproductive organs. Here you will be assessed for varicocele or other physical abnormalities.

Semen analysis

This is a routine lab test in which semen is collected in a sterile tube, and the sample is studied. The quality of the sperm is analyzed by studying sperm volume, sperm count, movement, concentration, and structure. Low sperms or no sperms indicate blockage of the ejaculatory duct, which can be corrected through surgery.

Testicular biopsy

This test is done when your semen analysis shows low sperm count or no sperms. A needle biopsy is taken to check for the presence of healthy sperms. This helps to diagnose if there is any blockage, and these sperms can be used in the process of assisted reproduction.

Hormone Evaluation

Testosterone and other hormones are responsible for the production of healthy sperms. Hormone evaluation also helps the doctor to rule out if you are suffering from any other underlying health problem.

Male Infertility Treatment

Treatment of male infertility mainly depends on the possible causes. Many issues can be treated with medication and surgery. This helps in reversing the cause of infertility and achieving conception naturally.

Nonsurgical procedures

Infertility of male caused due to abnormalities of hormones, immunity, retrograde ejaculation, or genital tract infection can be corrected by using medications. If the drugs don’t seem to help, you can opt for assisted reproductive techniques (ART’s) to achieve conception.

Surgical procedures

Condition like varicocele can be treated by minor outpatient surgery called varicocelectomy. Any blockage causing azoospermia can also be corrected using minor surgeries.

Treatment options for unknown causes of infertility

Sometimes the cause of infertility may not be known or is non-specific. During such conditions, an experienced doctor can help you to decide which treatment can work for you.
With the latest developments, Assisted Reproductive Treatment (ART) offers powerful treatment options. These treatments have made it possible to attain pregnancy even when men have low sperm count.

Intrauterine insemination (IUI)

In this method, sperms are directly injected into the female partner’s uterus during ovulation. This method often works for low sperm count or in conditions like retrograde ejaculation.

In Vitro Fertilization (IVF)

In this procedure, sperms are mixed with eggs of the female partner in a Petri dish in a lab. This allows retrieval of matured eggs and their fertilization. After 3 to 5 days, fertilized eggs are placed back in the uterus. IVF can be the best treatment option in men with severe oligospermia.

Intracytoplasmic Sperm Injection (ICSI)

It is a form of IVF used in the treatment of severe male infertility. In this, a single healthy sperm is injected into an egg through a tiny needle. The fertilized egg is then transferred to the female partner’s uterus.

Final Words

You may find it challenging to accept male infertility. As mentioned above in many cases, male infertility can be treated. Consulting a skilled infertility doctor and getting evaluated can help you to overcome infertility. Right diagnosis and treatment can make it possible to achieve pregnancy and take home a healthy baby.

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