Male Factors of Infertility
Male factors of infertility are found in approximately 50 percent of couples seeking care for infertility. Male infertility occurs due to low sperm production, abnormal sperm function, or blockages in the ducts that delivery the sperm from the testis where they are manufactured. Infections affecting the testis and the epididymis which is the reservoir for capacitation, illnesses, injuries, chronic health problems, lifestyle choices, and other factors may contribute to male infertility.
Semen analysis and general assessment of the man’s health and lifestyle practices help the doctor to analyse the causes.
Whenever the couple seeks fertility guidance the male factor too is assessed. Many times there are no symptoms but there can be semen abnormalities that need to be evaluated. Rarely there can be issues such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm responsible for male infertility.
Some facts are needed to be addressed:
Problems with sexual function, for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction)
Pain, swelling, or a lump in the testicle area
Repeated respiratory or genitourinary infections
Inability to smell
Abnormal breast growth (gynecomastia)
Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
A lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)
Obesity, diabetes, hypothyroidism
It is recommended to seek medical advice if conception has not been achieved despite regular unprotected sexual activity for a year.
One can consider as medical consultation if any of the following is present:
Erection or ejaculation problems, low sex drive, or other problems with sexual function
Pain, discomfort, a lump or swelling in the testicle area
History of testicle, prostate, or sexual problems
Groin, testicle, penis, or scrotum surgery
Partner over age 35
Male fertility is a complex process. To get your partner pregnant, the following must occur:
You must produce healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
Sperm have to be carried into the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
There needs to be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilise your partner's egg. A low sperm count is less than 15 million sperm per milliliter of semen or fewer than 40 million per ejaculate.
Sperm must have healthy motility and characteristics. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner's egg.
Medical causes can be responsible too. Problems with male fertility can be caused by a number of health issues and medical treatments:
Varicocele: A varicocele is a swelling of the veins that drain the testicle. It's the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it may be related to abnormal blood flow. Varicoceles lead to reduced sperm quantity and quality.
Infection: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
Ejaculation issues: Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate, or urethra.
Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
Tumours: Cancers and nonmalignant tumours can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation, or chemotherapy to treat tumours can affect male fertility.
Undescended testicles: In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
Hormone imbalances: Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid, and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
Defects of tubules that transport sperm: Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma, or abnormal development, such as cystic fibrosis or similar inherited conditions. Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts, or in the urethra.
Chromosome defects: Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis and Kallmann's syndrome.
Problems with sexual intercourse: These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
Celiac disease: Celiac disease is a digestive disorder caused by sensitivity to a protein found in wheat called gluten. The condition may contribute to male infertility. Fertility may improve after adopting a gluten-free diet.
Certain medications: Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some ulcer drugs, some arthritis drugs, and certain other medications can impair sperm production and decrease male fertility.
Prior surgeries: Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.
Overexposure to certain environmental elements such as heat, toxins, and chemicals can reduce sperm production or sperm function. Specific causes include:
Industrial chemicals: Extended exposure to certain chemicals, pesticides, herbicides, organic solvents, and painting materials may contribute to low sperm counts.
Heavy metal exposure: Exposure to lead or other heavy metals also may cause infertility.
Radiation or X-rays: Radiation exposure can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
Overheating the testicles: Elevated temperatures may impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count. Sitting for long periods, wearing tight clothing, or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and may slightly reduce sperm production. But, the research isn't conclusive.
Health, Lifestyle and Other Causes
Drug use: Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. The use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
Alcohol use: Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
Tobacco smoking: Men who smoke may have a lower sperm count than do those who don't smoke. Secondhand smoke also may affect male fertility.
Weight: Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.
Risk factors linked to male infertility include:
Using certain illicit drugs
Having certain past or present infections
Being exposed to toxins
Overheating the testicles
Having experienced trauma to the testicles
Having a prior vasectomy or major abdominal or pelvic surgery
Having a history of undescended testicles
Being born with a fertility disorder or having a blood relative with a fertility disorder
Having certain medical conditions, including tumors and chronic illnesses, such as sickle cell disease
Taking certain medications or undergoing medical treatments, such as surgery or radiation used for treating cancer
Complications of male infertility can include:
Stress and relationship difficulties related to the inability to have a child
Expensive and involved reproductive techniques
Increased risk of testicular cancer, melanoma, colon cancer, and prostate cancer
Male infertility isn't always preventable. However, you can try to avoid some known causes of male infertility. For example:
Limit or abstain from alcohol
Steer clear of illicit drugs
Maintain a healthy weight
Don't get a vasectomy
Avoid things that lead to prolonged heat for the testicles
Avoid exposure to pesticides, heavy metals, and other toxins
Dr. Girija Wagh