Male Factor Infertility
Male infertility is caused by deficiencies in sperm formation, concentration, or transportation. There are many cases of infertility; male infertility plays a partial role in such scenarios. Factors like injuries, chronic health illnesses, lifestyle choices cause male infertility. There are many treatments available to treat male infertility.
Symptoms
Apart from inability to conceive there are many symptoms that indicate male infertility.
- Lower sperm count
- Frequent respiratory infections
- Problems with sexual function like reduced sexual desire, difficulty in ejaculation, erectile dysfunction
- Abnormal breast growth
- Decreased facial or body hair due to hormonal imbalance
- Pain or swelling in the testicles
When a couple is unable to conceive after a year of trying and if the male partner experiences problems like erection or ejaculation difficulty, pain or discomfort in the testicles, history of groin, testicle or prostate surgery and age over 35, the couple should consult a doctor as these may indicate male infertility.
Causes
Male fertility is a complicated process. In normal conditions, the following must happen:
- Production of healthy sperm involves growth and formation of the male reproductive organs. These reproductive organs produce, store and transport sperm. Sperm and testosterone are made in testicles.
- Testicles are sac of skin below the penis. After production of sperm, it is transported through tubes to mix it with semen. During ejaculation, the semen travels through the urethra and out of the penis.
- In order for fertilization, there should be adequate amount of sperm in the semen. Normally there should be at least 15 million sperm per millilitre of semen or 39 million sperm per ejaculation.
- Apart from the sperm count sperm quality is also measured.
- Sperm must be functional and able to move. If the movement (motility) or function of the sperm is abnormal, the sperm may not be able to reach or penetrate the partner’s egg.
Medical Causes
Problems with male fertility can be caused by a number of health issues and medical treatments:
- Hormonal imbalance: Infertility can be caused by abnormality that affects the testicles and other hormone systems like hypothalamus, pituitary, thyroid glands. Hormonal imbalance can cause low testosterone levels.
- Infection: some infections like inflammation of the epididymis or testicles, STIs like HIV, gonorrhoea interrupt the sperm production.
- Retrograde ejaculation: this is a condition in which the semen goes backwards in the body. The semen enters the bladder during ejaculation instead of emerging out of the penis. Retrograde ejaculation can be caused by surgery, medications or health problems of the nervous system. Signs are cloudy urine after ejaculation and less fluid or “dry” ejaculation.
- Varicocele: this is the most common cause of male infertility. Varicoceles are swollen veins that damage the sperm growth by blocking blood drainage.
- Immunologic Infertility: in some cases, the body produces antibodies that attack the sperm as these might mistakenly identify sperm as harmful invaders and kill the sperm.
- Undescended testicles: during foetal development one or both testicles might fail to develop from the abdomen into a sack.
- Obstruction: Sometimes the tubes through which sperm travel can be blocked. Repeated infections, surgery (such as vasectomy), swelling or developmental defects can cause blockage.
- Medications: medications and treatments like chemotherapy, testosterone replacement therapy, anabolic steroid use, etc. can impair sperm production resulting in decreased male infertility.
- Prior surgeries: surgeries like vasectomy, testicular surgeries, prostate surgeries, and large abdomen surgeries can affect sperm production and ejaculation.
- Chromosome defects: Sperm carry half of the DNA to the egg. Changes in the number and structure of chromosomes can affect fertility. For example, the male Y chromosome may be missing parts.
- Problems with sexual intercourse: common problems with sexual intercourse include erectile dysfunction, premature ejaculation, painful intercourse, anatomical abnormalities like urethral opening beneath the penis.
Environmental Causes
Apart from medical causes, exposure to certain environmental elements like heat, toxin and chemicals can also affect the sperm production and quality. Too much exposure to industrial chemicals like pesticides, organic solvents, painting materials and exposure to lead or other havy metals can lead to decreased sperm count.
Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced. High temperatures can impair sperm production and function. One must avoid sitting for long periods, wearing tight clothes as these factors may contribute to rise in the temperature in the scrotum and can reduce sperm count.
Risk Factors
Factors and lifestyle choice which contribute to male infertility are smoking, alcohol or drug consumption, excessive body weight, having infections, injury or damage to testicles, history of vasectomy or other abdominal surgery, congenital fertility disorder, habits causing heat in the testicles, medical conditions like tumours or chronic illnesses, medical treatments such as surgery and radiation.
Prevention
In some cases male infertility cannot be prevented however one can make choices like quitting smoking and alcohol consumption, abstain from drug consumption, maintaining healthy body weight, reduce stress and avoid exposure to pesticides and other toxins.
Diagnosis
Causes of male fertility can be hard to diagnose. The problems are most often with sperm production or delivery. It might take a number of tests to determine the cause of infertility. In some cases, a cause is never identified. Diagnosing male infertility problems usually involves:
- Physical examination and medical history: the doctor will examine the genitals and enquire about any inherited conditions or chronic health problems, and surgeries.
- Semen analysis: Semen analysis is a routine lab test. It helps show the level of sperm production and whether sperm are functioning well. Semen sample is collected and sent to a lab to ascertain the number of sperm and abnormalities in the shape and motility of the sperm.
- Scrotal Ultrasound: the doctor may order a scrotal ultrasound. This helps the doctor to determine if there is a varicocele or any other abnormality in testicles and other reproductive organs.
- Transrectal ultrasound: A small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate and look for blockages of the tubes that carry semen.
- Testicular Biopsy: This test can be done with general or local anesthesia. A small cut is made in the scrotum. A small piece of tissue from each testicle is extracted and studied under a microscope.
- Hormonal Profile: blood tests are done to determine if there is any hormonal imbalance. Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production.
- Genetic testing: genetic testing can be ordered to diagnose congenital and inherited syndromes. Blood test can reveal signs of genetic abnormality.
- Post-ejaculation urinalysis: when the doctor suspects case a retrograde ejaculation, post- ejaculation urine testing is done to identify presence of sperm in urine.
- Specialized sperm function tests: tests that determine capability of sperm survival after ejaculation, penetration in the egg, etc. are done.
Treatment
The doctor might recommend the female partner also be checked and prescribe specific treatments. In some cases the couple might be advised to opt for assistive reproductive techniques. Treatments for male infertility include:
- Treatment for infections: the doctor might prescribe antibiotic medication to treat infection of the reproductive tract.
- Surgery: Varicocele can be corrected with the help of surgery and any blockage can be cleared by doing surgery. A vasectomy is considered to be a type of blockage. Vasectomies can be reversed in most of the cases; couples can achieve pregnancy after vasectomy reversal.
- Treatments for sexual intercourse problems: medications and counselling can help reduce the cause of sexual intercourse problems like erectile dysfunction and premature ejaculation, etc.
- Hormone treatments and medications: infertility caused by hormonal imbalance can be treated with hormone replacement medicines.
- Assistive reproductive technology: ART required obtaining sperm through ejaculation or surgical extraction. Sperm is then injected in the uterus of the female partner in intra-uterine insemination or the sperm is used for IVF and procedure.
