Despite the increasing trends in male infertility, it is an often neglected aspect of infertility. According to the National Library of Medicine, a man causes about 20% of infertility cases alone and accounts for roughly 40% when he contributes to the cause of infertility.
Male infertility is the inability of a man of reproductive age to get a woman pregnant after one year of having regular, unprotected sex. The overall impact of infertility on men can be overwhelming. To some, it crushes their ego, while others live in constant denial, refusing to seek a way forward. While there are many causes of infertility in men, this article will focus on the primary reasons for male infertility and how it can be diagnosed and treated.
Causes of Male Infertility
The causes of male infertility can be grouped into these three main categories, namely:
- Unexplained male infertility
- Factors affecting sperm production
- Factors affecting sperm transportation
Unexplained Male Infertility (UMI)
Unexplained male infertility accounts for 6%–27% of reports in the study populations. The treatment, mainly being expectant, includes fertility-focused or timed intercourse on peak fertility days to enhance chances for conception. Several studies have reported that after the first year, the rate of spontaneous pregnancy doubled during the next two years in couples, who were trying to conceive.
Factors Affecting Sperm Production
A defect in any of the processes that produce sperm will lead to deficiencies in sperm parameters ranging from the absence of sperm cells to abnormally formed sperm or sperm that cannot move well. These factors include:
- Genetic defects
- Injury to the testicle(s)
- Engorged veins in the scrotum (Varicocele)
- Hormonal imbalance
- Undescended testicles
- Environmental factors and lifestyle
Factors Affecting Sperm Transportation
After the sperm from the semen exits the penis through the urethra, it goes through the womb to the woman’s fallopian tube, where fertilization occurs. Any defect or obstruction in these transport channels can lead to male infertility. These defects could be:
- Congenital defects
- Obstruction from surgeries
- Obstruction from infection or diseases
- Sexual dysfunctions like ejaculating before the desired time, inability to ejaculate at all, or infrequent sexual intercourse
Signs and Symptoms of Male Infertility
Aside from being unable to conceive a child, other signs and symptoms you may notice include:
- Breast enlargement and production of breast milk
- Early onset of puberty (at 9 years of age or earlier)
- Smell impairment (associated with Kallmann syndrome)
- An undescended testicle
- Loss of facial or body hair
- Recurrent genital and respiratory infections
- Sexual dysfunctions
A combination of your medical, reproductive, and sexual histories will provide your physician with pointers to what may be causing your infertility. After that, your male reproductive organs will be physically examined.
Semen fluid analysis
It involves the use of sperm parameters to analyze what the problem could be. Samples are collected in a clear, sterile mini-bottle either in the hospital, laboratory or even at home if the distance is close to the evaluating centre. “Semen fluid analysis is the defining feature in the evaluation of male infertility.” At least 3 days of abstinence are recommended, and samples must be evaluated at least twice with a week-long interval in between to arrive at a more accurate analysis. According to WHO, semen should be analysed as follows;
- Semen volume is the amount of ejaculation that is measured in the sterile bottle, and it should be equal to or more than 1.5 millilitres.
- Sperm count is the total number of sperm cells counted in the ejaculate, and it should be equal to or more than 39 million cells per ejaculate (or 15 million cells per millilitre).
- Sperm vitality analyzes the number of sperm cells that are alive. At least 58% should be alive.
- Sperm motility is the ability of sperm to move. This is the feature that enables them to move from the vagina through the womb to fertilize the egg in the fallopian tube. At least 40% of sperm cells are expected to be motile.
- Sperm morphology examines the appearance of the cells. At least 4% should appear normal to foster fertility.
Depending on the result of the analysis, you may be asked to do other tests such as transrectal or scrotal ultrasound, a hormonal assay, a genetic test, etc.
What are the possible treatment options for male infertility?
The treatment of male infertility varies, ranging from the treatment of known causes to the treatment of unknown or unexplained causes. Usually, your partner will also be evaluated and treated if any causes are found. Some common treatment options include:
- Watchful waiting for natural conception
- Lifestyle Modification to improve sperm parameters
- Use of fertility Supplement
- Hormonal therapy
- Surgical treatment
- Assisted Reproductive Technology (Timed intercourse, In-vitro fertilization, Intracytoplasmic Sperm Injection Etc)
Male infertility is probably the most dreadful diagnosis you would want to hear from your doctor, especially if you are yet to start or complete your family cycle. This can impact your physical health and mental, social, financial, and total well-being. Once you are ready to undergo your treatment, a multidisciplinary team including a urologist, an endocrinologist, a psychotherapist, and an IVF specialist will be employed for you. The goal is for your clinician to identify these causes on time so that you can receive adequate treatment. This would lead to a reduction of the stigma associated with male infertility. It also helps if you join a support group close to you to help you through your journey.