Cases of infertility are on a surge in males, especially with the sedentary lifestyle. This article throws light on the causes of male infertility.
Conception is nothing but getting pregnant. For conception to occur, several steps are involved, which includes the following:
The process of conception is dependent on several factors, which is shown below:
Male infertility is a disorder of the reproductive system which produces impregnation failure in the affected individual. Couples who have been having unprotected intercourse frequently for over a year and are not able to conceive are supposed to have fertility issues. These can be present either in one of them or may involve both.
In about 35 to 52 percent of childless couples, the male partner is the cause of infertility. This percentage is increasing in number nowadays because of the changes in the lifestyle of most males.
Alcohol consumption, the increased smoking rate among young people, physical inactivity, excessive workplace stress, irregular and unhealthy diet, change of sleep pattern (poor sleep), etc., are the main cause of life-threatening diseases like diabetes, hypertension, high cholesterol, heart attacks, cerebrovascular attack (brain stroke), and most importantly 'infertility.'
The fertility of a male depends on several factors, which include:
Healthy sperm production by at least one of the testicles of a man. This is aided by testosterone and other hormones produced by the body.
Sperm should be able to enter the semen. This transportation is done with the help of delicate tubes. The sperm which enters the semen should be ejaculated.
The number of sperms in the semen should be adequate. If the sperm count is less than 15 million in one millimeter of semen, it is considered low. The probability of fertilizing an egg becomes difficult in these cases.
The sperm must be motile enough to penetrate the egg and fertilize it.
Any disruption in the characteristics of sperm can bring about fertility issues in the male.
The causes of male infertility are as follows:
A. Lifestyle Factors:
Smoking - Tobacco smoke can cause a reduction in sperm count. Not only active smokers but also those exposed to passive smoke have a risk of developing fertility problems.
Obesity - Being overweight can also produce infertility as it impairs sperm function and also brings about hormonal imbalances.
Alcoholism - Testosterone levels are reduced with alcohol consumption. It also reduces the production of sperms. In addition, the impact of alcohol on the liver can produce liver dysfunction, which also has an effect on fertility.
Drugs - Individuals who take anabolic steroids to strengthen and increase muscle growth are more prone to fertility problems. This is because shrinkage of testicles and reduction in sperm production occurs with the intake of anabolic steroids. Although not permanently, drugs like Cocaine and Marijuana can decrease the quality and count of your sperm.
B. Environmental Factors:
Radiation Exposure - There can be a temporary reduction in sperm production when exposed to radiation. However, high doses can bring about a permanent reduction.
Chemical Exposure - A decrease in sperm count is noted in individuals who are constantly exposed to organic solvents, chemicals, herbicides, materials used for painting, and pesticides.
Testicular Overheating - Although there is not sufficient evidence to support it, it has been attributed that increased temperature of the testicles can negatively impact the production and function of sperms. Also, it has been said that prolonged sitting, working in systems or laptops for excessively long periods, using hot tubs or saunas often, and wearing tight clothes can contribute to the rise in temperature of the testicles. Studies are still needed to bring about a conclusion.
Exposure to Heavy Metals - Infertility can also occur due to exposure to heavy metals like lead, etc.
C. Medical Conditions:
Primary Pathologies -
a. Undescended Testicles (Cryptorchidism):
It is a condition in which the testicles have not descended down into the scrotum, the bag that usually holds the testicles. Instead, these are still held up in the abdomen. Infertility is likely to occur in these patients.
The quality and count of sperms are compromised in varicocele, a reversible cause of infertility characterized by a swelling in the veins draining the testicle.
It is characterized by reduced quality of sperms which can also affect the conception process resulting in infertility.
d. Tubular Defects:
Transportation of sperm occurs through a number of tubules, namely the tubes present within and those that drain the testicle, tubes in the epididymis, vas deferens, or urethra, and tubules present adjacent to the ejaculatory ducts. Blockage in any of these tubules due to injury, surgery, infections, or developmental issues can cause fertility problems.
e. Antisperm Antibodies:
These are antibodies synthesized by the body's own immune system against the sperms. As a result of this immune action, the sperm are mistakenly eliminated.
Scarring by some infections can also produce problems with fertility. This is because as a result of scarring, there occurs a blockage affecting sperm transportation. The infections responsible are epididymitis (inflammation of the epididymis) and orchitis (testicular inflammation). In some cases, sexually transmitted infections like gonorrhea and HIV can also cause scarring. It is reversible damage in most cases, while some infections may bring about irreversible damage.
g. Hormonal Imbalance:
Hormonal imbalance caused by a testicular disorder, or dysfunctions of the endocrine organs like the pituitary, thyroid, hypothalamus, or adrenal glands can also result in infertility.
h. Chromosomal Abnormalities:
Infertility is a characteristic of individuals having genetic disorders with chromosomal aberrations like Klinefelter's syndrome, Kallmann's syndrome, and cystic fibrosis. In the case of Klinefelter's syndrome, there is an extra X chromosome (usually male has XY chromosomes, whereas in this syndrome there are XXY chromosomes) that produces abnormalities in the male sexual organs.
i. Coital Factors:
Hypospadias (a urethral opening is present below the penis), erectile dysfunction, pain during intercourse, relationship problems, premature ejaculation, etc., are contributing factors to infertility as far as sexual intercourse is concerned.
j. Retrograde Ejaculation:
In this condition, the semen which has to come out of the penis during ejaculation enters the urinary bladder. It is an important cause of azoospermia. Surgical procedures involving the bladder, urethra, and prostate glands, certain medications, trauma to the spinal cord, and diabetes are important causative conditions.
k. Previous Surgery:
Infertility can occur as a result of surgeries of the testis, prostate, scrotum, and urethra, vasectomy, and surgeries done to treat rectal and testicular cancers.
2. Systemic Pathologies -
Intake of anabolic steroids, certain medicines taken for arthritis, gastric ulcer, etc., chemotherapy, and testosterone-replacement therapy can impair sperm production resulting in infertility.
Cancer, in general, or tumors of the male reproductive organs, and cancer treatment can have an impact on fertility.
b. Other Medical Conditions:
Patients with diabetes and hypertension are more prone to develop infertility.
c. Celiac Disease:
Celiac disease, a digestive dysfunction caused by gluten sensitivity, can also produce fertility issues. Opting for a gluten-free diet can help in reversing the condition.
The following risk factors increase the chances of developing male infertility:
Exposure to radiation or toxins.
Trauma to the testicles.
Using illegal drugs.
Previous surgeries of the pelvic organs.
Testicles frequently exposed to overheating.
Chronic medical conditions like diabetes, hypertension, cancers, etc.
Diagnosis of male infertility is made with the help of the below tests:
1. Medical History:
A detailed medical history of the patient about the presence of any hereditary or genetic disorders, chronic medical conditions, trauma, or surgeries is collected. These help in identifying the causes of infertility.
2. Physical Examination:
The physician examines the male genital organs to look for abnormalities.
3. Semen Analysis:
Semen is the ejaculatory fluid that contains the sperm. The semen is analyzed for the sperm count, morphology of the sperm, and the ability of the sperm to swim across the vagina to reach the egg in the uterus. The semen is obtained by asking the patient to masturbate in a special container. Some patients do not masturbate owing to their religious beliefs. In these patients, a specialized condom is used to collect the semen. To establish an accurate sperm count, multiple semen analysis has to be done.
In addition to the above, the following tests are employed to diagnose the cause of infertility:
1. Transrectal Ultrasound:
In this test, a wand inserted into the rectum diagnoses the prostate abnormalities and duct blockages.
2. Post-Ejaculation Urinalysis:
This test detects the presence of semen in urine. It is useful in the diagnosis of retrograde ejaculation, in which the semen enters the urinary bladder during ejaculation instead of passing out through the urethra.
3. Scrotal Ultrasound:
The presence of abnormalities in the testicles or other structures and varicocele are detected with the help of scrotal ultrasound.
4. Testicular Biopsy:
It helps in analyzing sperm production. If the sperm count in the testicles is normal, then the cause of reduced sperm production may be a blockage in the ducts or decreased motility of the sperm.
5. Hormonal Tests:
Testosterone and other hormones responsible for sexual function are analyzed to look for any imbalances.
6. Genetic Testing:
Genetic testing is employed to look out for genetic disorders that are causing very feeble sperm production.
7. Sperm Function Tests:
These tests determine the survival capacity of the sperms, the ability to penetrate the egg, and problems occurring during its attachment with the egg.
Treatment for male infertility is aimed at treating the cause. In many cases, causative treatment is beneficial in sorting fertility issues.
The following are the different treatment modalities involved:
Infertility caused by an infection is treated with the help of antibiotics. However, the chances of reversing infertility by treating the infection are less.
Surgical correction of a blocked vas deferens by bypassing the obstructed area (vasoepididymostomy) and varicocele is of help. Also, a previous vasectomy can be reversed to regain fertility. Sperm retrieval techniques can be helpful in patients where there is normal sperm production but an absence of sperm in the ejaculate.
Treatment for Coital Factors:
Erectile dysfunction, premature ejaculation, and other relationship problems can be treated with the help of medications or psychological counseling, depending on the root cause.
In conditions where there are abnormal levels of hormones, based on the level of hormones, hormone replacement medications or medications to reduce the hormone levels are prescribed.
Assisted Reproductive Technology (ART):
a. Intracytoplasmic Sperm Injection -
In this procedure, sperm is injected directly into the egg. With the help of this procedure, nine out of ten males with infertility problems can be benefitted.
b. In Vitro Fertilization (IVF) -
The ovaries are stimulated to produce multiple eggs, which are collected, fertilized with the sperm in the culture dish, and two to three developed embryos are placed inside the uterus of the female with the help of a small catheter.
The following factors can boost your chances of impregnating a woman:
Avoid smoking and alcohol.
Maintain ideal body weight.
Eat a balanced and nutritious diet.
Have frequent sexual intercourses around the days of ovulation (release of an egg from the ovary).
Avoid using lubricants that hamper sperm motility.
Maintain a healthy sexual relationship with your partner.
Below are the complications that can occur with male infertility:
The most important implication of the fertility problem is the inability to have a child.
Relationship problems might accompany infertility.
The artificial techniques involved in achieving pregnancy are expensive.
Inability to release the semen increases the risk of developing testicular cancer, prostate cancer, colon cancer, etc.
Male infertility can be prevented by following the below steps:
Abstain from unhealthy habits like smoking, alcohol, and drugs.
Keep your body weight in control.
Avoid getting involved in activities that cause overheating of the testicles.
Limit exposure to pesticides, toxins, radiations, and chemicals.
Avoid getting a vasectomy procedure.
Patients who are about to get cancer treatment should opt for sperm banking.
Infertility is becoming a rising concern among men. With technological advancements in the medical field, the chances of impregnating are increasing. Around 90 % of individuals with male infertility are capable of having their own child. Always remember both men and women should be examined for fertility issues. Reaching out to a healthcare professional is advised when a year of unprotected sexual intercourse cannot result in pregnancy.
The clinical features of infertility in males involve difficulty with ejaculation or small volumes of ejaculated semen, reduced libido or erectile dysfunction, pain, swelling or a lump in the testicular area, gynecomastia, and decreased body and facial hair.
Some of the ways to increase fertility in males are:
- D-aspartic acid supplements.
- Regular exercise.
- Vitamin C.
- Minimizing stress.
- Sufficient vitamin D.
- Tribulus terrestris (medicinal herb).
- Zinc supplementation.
- Withania somnifera (fenugreek).
- Maca root.
Infertility due to varicocele can be reversed by surgery; infectious etiology can be treated with antibiotics, hormone therapy, and assisted reproductive technology can be used to reverse infertility.
Males contribute 50 % of all infertility cases globally out of 60 to 80 million couples suffering from infertility issues. Infertility affects every one in six couples, portraying a statistic of male infertility at 10 % of all adult male US population.
The following tests and examinations can diagnose male fertility:
- Laboratory sperm and semen analysis.
- Physical examination to detect any scrotal abnormalities.
- Evaluating hormone levels.
- Genetic testing.
- Testing for the presence of anti-sperm antibodies.
Home test kits are available to check the quality and fertility of sperm at home, giving complete privacy to the user. However, the efficiency and accuracy of the kits are still not evaluated. A home test kit usually detects the presence and motility of the sperm in a semen sample. Still, it does not give a complete picture of a person’s fertility which warrants a laboratory study.
Normally semen is thick and white. Several factors may change the color and consistency of semen, giving it a translucent color and watery consistency. Watery semen may indicate low sperm count and possible fertility problems. Ejaculating thin, clear semen might be an isolated event or transient condition with no underlying health issue.
To improve low sperm count, one needs to identify the underlying condition and treat them with the following:
- Surgical repair of abnormalities.
- Lifestyle modifications.
- Alternative medications.
Intake of certain food items can improve the rate of sperm production like dark chocolate, eggs, goji berries, bananas, garlic, spinach, asparagus, walnut, oysters, ashwagandha, pumpkin seeds, carrots, lentils, olive oil, tomatoes, and berries.
The four major reasons for male infertility are:
- Detective sperm production
- Hormonal problems.
- Autoimmunity against sperm.
- Blockage of the pathway of semen.
Male infertility requires professional help, who then decides the course of treatment based on the underlying cause. The physician might opt for
- Surgical elimination of scrotal abnormalities.
- Treating infections.
- Treating erectile dysfunction and premature ejaculation.
- Hormone treatment.
- Assisted reproductive technology (ART).
Some medicines that may improve sperm count are estrogen receptor blockers like Clomiphene citrate, human chorionic gonadotropin injections, and supplementation therapies like vitamin C, D-aspartic acid, tribulus terrestris, zinc, fenugreek, and maca root.
Some natural ways to improve male fertility are:
- Eat antioxidant-rich foods.
- Have frequent sex.
- Limit soy intake.
- Maintain a healthy weight.
- Treat medical conditions.
- Avoid toxic chemicals.
- Eat more greens.
One of the non-pharmacological ways to improve sperm count is to exercise daily, as exercise reduces fat and decreases the amount of testosterone converting to estrogen. Weight resistance or cardiovascular exercises are the most recommended exercises to increase sperm count.
Male sperm quality starts decreasing around 40 to 45 years of age, decreasing male fertility.
Last reviewed at:
27 Jan 2023 - 9 min read
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