Male infertility refers to a man’s reduced ability to cause pregnancy in a fertile female after one year of regular, unprotected sex. It is the cause of infertility in up to 50% of couples who cannot conceive.
SYMPTOMS
Often, the only sign of male infertility is the inability to conceive. However, some men may also notice:
- Sexual dysfunction, such as trouble with erection or ejaculation, reduced libido, or low semen volume
- Pain, swelling or lumps in the testicular area
- Recurrent respiratory infections, which can indicate broader health issues
- Loss of smell, abnormal breast growth (gynecomastia), or reduced body/facial hair are signs of hormonal or chromosomal abnormalities
CAUSES OF MALE INFERTILITY
Male fertility depends on healthy sperm production, proper hormone balance, unobstructed sperm transport, and normal sexual function. Problems in any of these areas can lead to infertility.
Medical Causes
- Varicocele: Enlarged veins in the scrotum that compromise sperm quality and production
- Infections: Including epididymitis or orchitis caused by bacterial infection, or sexually transmitted infections that can damage reproductive structures or cause scarring
- Ejaculation issues: Such as retrograde ejaculation, where semen flows into the bladder instead of outward
- An autoimmune response that produces anti-sperm antibodies: Immune reactions that attack sperm
- Tumours: Cancers or benign tumours may affect reproductive organs or hormone-producing glands
- Undescended testicles: A developmental issue increasing infertility risk as it prevents proper sperm production (spermatogenesis) through maintaining a temperature lower than the core body temperature
- Hormone imbalances: Disorders affecting testosterone or hormones from the hypothalamus and pituitary gland
- Prior vasectomy or surgeries, and chronic illnesses
- Blockages: Obstructions in the sperm transport system from surgery, infection, trauma, or birth defects
- Chromosome defects: Such as Klinefelter syndrome and other genetic conditions
Environmental and Lifestyle Factors
- Exposure to heat, toxins, heavy metals, or radiation, which may impair sperm production
- Drug or medication use, including anabolic steroids or chemotherapy
- Smoking, alcohol misuse, and recreational drugs, which can reduce sperm count and function.
- Obesity and poor overall health, which may alter hormones and impair fertility.
HOW FERTILITY IS TESTED
Diagnosis typically includes:
- Physical exam and health history review, including development and sexual history.
- Semen analysis to check sperm count, movement, and shape.
- Hormone testing to assess levels of testosterone and other key hormones.
- Genetic testing when sperm count is very low.
- Additional tests, such as imaging or a testicular biopsy, to find blockages or production issues.
TREATMENT OPTIONS
Treatment for male infertility depends on the underlying cause, how long the couple has been trying to conceive, and both partners’ reproductive health. Even when a specific cause isn’t identified, several effective treatments and procedures exist to improve the chances of pregnancy.
Surgical Treatments
Surgery can correct physical problems that interfere with sperm production or delivery:
- Varicocele repair (varicocelectomy): Fixes enlarged veins in the scrotum, which can improve sperm quality.
- Vasectomy reversal: Reconnects the vas deferens after a vasectomy.
- Sperm retrieval procedures: In cases where no sperm are present in the semen, sperm can be directly extracted from the testes or epididymis for use in assisted reproductive technology (ART).
Treating Infections
If a reproductive infection is diagnosed, antibiotics may cure the infection. While this doesn’t always restore fertility, it can improve the reproductive environment.
Sexual Function Treatments
Medications or counselling can address erectile dysfunction, premature ejaculation, or other sexual health issues that affect fertility.
Hormone Therapy and Medications
Hormonal imbalances that affect sperm production may be treated with hormone replacement or specialised medications to correct low or high hormone levels. For example, hormone therapy can help when the hypothalamus or pituitary gland, the source of some hormones that affect fertility, isn’t functioning properly.
Assisted Reproductive Technology (ART)
ART includes procedures that help fertilisation outside the body or assist sperm in reaching and fertilising an egg:
- Intracytoplasmic Sperm Injection (ICSI): A single sperm is injected directly into an egg in the lab.
- In Vitro Fertilisation (IVF): Eggs are retrieved and fertilised outside the body, then embryos are transferred into the uterus.
- Other ART methods, including intrauterine insemination (IUI) to improve fertilisation and pregnancy outcomes, are used based on individual cases.
Lifestyle and Supportive Measures
Although not direct treatments, lifestyle changes can improve fertility outcomes and complement medical therapy:
- Maintaining a healthy weight and good nutrition.
- Reducing alcohol use and quitting smoking.
- Regular exercise and stress management.
- Having intercourse frequently during the partner’s fertile window.
When Treatments Don’t Work
In some cases, male infertility cannot be fully treated. Options in such situations may include:
- Use of donor sperm for insemination procedures.
- Adoption or other family-building approaches.
SUMMARY
This article by the Mayo Clinic gives further insight into Male infertility, which has many potential causes, spanning physical, hormonal, genetic, environmental, and lifestyle factors. While the primary symptom is difficulty conceiving, men may experience sexual or testicular symptoms pointing to underlying issues. Diagnosis and management involve detailed evaluation and tailored treatments depending on the cause.
