Male Infertility

Infertility is known to affect one in six couples. And one in three couples faces difficulty in conceiving due to male fertility problems. It is needless to say that male fertility is as important as female fertility for a couple to conceive and have children. When is a male termed infertility, what are its causes, and what can you do about it.MomJunction deals with male infertility in detail and tells you about the various treatment options to come out of it.

Defining Male Infertility

Experts define male infertility as the inability of a man to impregnate a woman even after one year of unprotected sexual activity. It mostly depends on the quality and quantity of his sperm.

Causes Of Male Infertility

Male infertility occurs if the number of sperms ejaculated is low, or if they are of poor quality. Without healthy sperms, the chance of conceiving is almost none. Hormones can affect fertility by bringing down sperm motility (movement) and count. A man’s lifestyle, physical problems, and psychological or behavioral health concerns can all influence the health of his fertility (3). Let’s see some of the most influential factors:

Lifestyle factors

· Smoking

· Use of recreational drugs

· Alcoholism

· Testosterone deficiency

· Anabolic steroid use

· Intense physical workouts such as cycling and horse-riding

· Lack of vitamin C, iron, and zinc in their diet

· Wearing tight underwears

· Exposure to environmental toxins

· Malnutrition and anemia

· Stress

Hormonal disorders

· Hyperprolactinemia (elevated prolactin reduces sperm production)

· Hypothyroidism (low thyroid levels result in poor semen quality)

· Congenital adrenal hyperplasia (suppressed pituitary that causes lower sperm cell motility)

· Hypogonadotropic hypopituitarism (low pituitary gland arrests sperm development)

· Panhypopituitarism (the failure of pituitary gland decreases libido)

Physical, psychological and behavioral problems

· Varicocele (enlargement of spermatic veins causing abnormal sperm)

· Damaged sperm ducts

· Torsion (supportive tissue abnormality affecting the testes)

· Infection and disease (such as mumps, tuberculosis, typhoid, smallpox, influenza) can cause low sperm count and low sperm motility

· Klinefelter’s syndrome (a genetic disorder that decreases the testosterone levels)

· Retrograde ejaculation (semen ejaculates into the bladder causing low sperm count)

· Erectile dysfunction (inability to have an erection firm enough for sexual intercourse)

· Premature ejaculation (inability to control ejaculation shortly after sexual penetration)

· Ejaculatory incompetence (inability to ejaculate during intercour

Factors That Increase The Risk Of Male Infertility

The risk factors include :

Overweight
Prior infections
Genital exposure to high temperatures
A family history of fertility disorders
Mumps after puberty
Prior vasectomy or pelvic or abdominal surgery
Tumors or other chronic illnesses
Taking certain prescription medications or undergoing medical procedures

How does one know if these factors or the previously mentioned causes have led to infertility? In most cases, the inability to conceive is the only sign of infertility. However, in some cases, the underlying hormonal or physical problems show a few other signs.

Signs Of Male Infertility

Some possible signs and symptoms could be.

Difficulty in erection or ejaculation, ejaculating low fluids and low sexual desire
Pain, lump or swelling in the testicle region
Abnormal breast growth
Decreased body or facial hair
Reduced muscle mass
Recurrent respiratory infections
Lower sperm count
If you are unable to conceive and/or facing any of the above issues, then see a healthcare provider for diagnosis of the problem.

How Is Male Infertility Diagnosed?

Both the partners may have to get the diagnosis done. The initial diagnosis includes an analysis of the medical history, physical examination, and common lab tests, and probably a few semen tests .

Medical history analysis includes:

A complete review of past conditions, medications, and surgeries
Knowing about the family history of infertility or birth defects
A review of social history and exposure to occupational hazards to understand if they had an impact on fertility
A review of sexual habits and practices
Physical examination evaluates the genitals including the penis, testes, scrotum, and prostate.

Laboratory tests include:

Urinalysis to detect the presence of infections.
Semen analysis to evaluate the motility (movement), shape (morphology), and maturity of the sperm, the volume and liquidity of ejaculation, and the actual sperm count. The sperm counts mostly fluctuate from one analysis to the other. Therefore, multiple semen evaluations are done over a period to get accurate results.
Hormonal tests to evaluate the levels of testosterone and follicle stimulating hormone (FSH) to understand the overall hormonal balance and state of sperm production. Sometimes, the initial hormonal testing indicates the need for other hormonal tests such as serum luteinizing hormone and prolactin.
If the above diagnostic tests are unable to determine the condition, further testing is done to identify the cause of infertility.
Scrotal ultrasound uses high-frequency sound waves to detect obstructions or problems in the testicles and other supporting structures.
Transrectal ultrasound is done by inserting a tiny and lubricated wand into the rectum to check the prostate and tubal blockages (ejaculatory ducts and seminal vesicles) that they might carry.
Post-ejaculation urinalysis helps detect the sperm in the urine indicating retrograde ejaculation, where the sperm travels backward into the bladder.
Seminal fructose test checks if seminal vesicles are producing fructose in the semen. The fructose sugar provides energy to the sperm.
Semen leukocyte analysis checks for white blood cells in the semen.
Anti-sperm antibodies test looks for the presence of antibodies that could cause infertility.
Sperm penetration assay (SPA) identifies the ability of the sperm to fertilize.
Kruger and the World Health Organization (WHO) morphology detects the sperm morphology and motility closely.
Testicular biopsy checks for the impairment or a blockage in sperm production.
Vasography detects the structure of the ducts and finds obstructions.
Genetic testing identifies mutations in gene regions of Y chromosome and diagnoses various inherited or congenital syndromes.
The treatment depends on the cause of infertility.

Treatment For Male Infertility

Male infertility is treatable with medications and other options. In some cases, where the treatments do not work, the couple may have to go for sperm donors or adopt a child.

Medications and devices:

Gonadotropin injections are suggested for hypogonadism to improve fertility. They trigger sexual glands to produce testosterone and sperm.

Pseudoephedrine medications work in treating retrograde ejaculation. They close the opening of the bladder thereby helping the sperm to ejaculate through the penis (10).

Sildenafil (Viagra) helps treat the ejection issue.

In the case of problems with erection, your doctor might suggest you try a vacuum pump. You need to place the pump over the penis and pump the air out to create a vacuum. It causes the blood to shift into the penis, thus erecting it. A constriction band is placed at the base to maintain the erection.

Surgery

Variocele (swollen veins in the scrotum) is corrected through surgery to improve the quality of your sperm.

Obstructive azoospermia is surgically treated by removing the blockage.

Vasectomy (surgery that stops sperm from going into the semen) can also be reversed.

Assisted reproductive technologies (ARTs)

If the above treatments have not worked, your doctor would suggest ARTs. These are powerful and high-technology based options that offer an extra boost to the sperm to move into an egg. The sperm is collected from ejaculated semen or through a needle from the testicle. It is then processed and released into eggs through several methods.

Intrauterine inseminations (IUI): The sperm (yours or the donor’s) is directly injected into the uterus during ovulation. Your partner would be given medications to trigger ovaries for increasing the number of eggs. This option is recommended if there is a problem with erection, and having sex is difficult.

In-vitro fertilization (IVF): The sperm is combined with the partner’s eggs in a test tube. They are made to fertilize and form embryos. The embryos are then placed in the uterus.

Intracytoplasmic sperm injection (ICSI): A single sperm is injected into an egg through a small needle, and made to fertilize. The fertilized embryo is then transferred into the uterus. It is usually recommended when the sperm count is low or the sperm is abnormally shaped.

What Can You Do At Home?

You might take a few steps at home to improve your chances of conceiving.

Have unprotected sex during ovulation when there is a high chance of fertilization. It happens in the middle of the menstrual cycle.

Do not use lubricants as they will impair sperm function and motility. Avoid products such as Astroglide, K-Y jelly lotions and saliva.

You may also try some natural means to improve your fertility.

Are There Any Complications Associated With Male Infertility?

Yes, male infertility increases the risk of: