Infertility in men

About Infertility in Men

 

Infertility in a couple is not always the incapability of a female to contribute to conception. In many of the cases of infertile couples, infertility in men or male infertility plays a strong role. However, we usually come across situations where the woman alone is blamed for the incapability without the man being subjected to any kind of fertility test.

In India approximately 15 – 20 % couples are infertile of which 50 % is due to infertility in men. This leads us to the conclusion that almost 7.5 to 10 % men in the reproductive age are incapable of contributing to conception. This is a fact unknown to many.

Infertility is different from Impotence
There is a significant difference between infertility and impotence. These are two different conditions. The normal misconception amongst people to consider infertility the same as impotence discourages many men from undergoing a fertility test.

Impotence is a condition wherein the male is unable to attain or sustain erections for satisfactory sexual intercourse. This is completely unrelated to infertility in men. An impotent man can be fertile and pregnancy is possible for such a couple by the insemination of the man’s semen.

Infertility however is a condition wherein a man is unable to produce children. This can be caused due to the man’s semen being infertile or sub-fertile. Men with this defect can have completely satisfactory sexual relations with their partner but cannot achieve conception.

Causes of Infertility in Men

Detecting infertility in men is a complex case. In order for a male to contribute to conception he needs to produce healthy sperms that can fertilize his partners eggs and for this to happen –

  • The man needs to produce healthy sperms for which at least one of his testicles should be functioning correctly to produce testosterone and other reproductive hormones.
  • The sperms need to be carried into the semen and ejaculated out of the penis
  • The semen needs to carry enough sperms. In case the sperm count is low; the odds of the sperm to fertilize your partner’s egg will reduce.  A low sperm count means less than 20 million sperm per millilitre of semen.
  • The movement/ motility and the shape/ morphology of the sperm need to be right. If not then the sperms will not be able to reach or penetrate your partner’s eggs.

The cause of infertility could be hidden anywhere among these crucial developments.

Varicocele –
This is amongst the most common cause of infertility in men. A varicocele is the swelling of the veins that that drain the testicle. This causes the scrotum to enlarge and decreases sperm motility and volume. This obstructs normal cooling of the testicle and also leads to lower sperm quality.

Infection –
The male reproductive system can encounter certain infections that interfere with sperm production, sperm health, scarring that can block the passage of the sperm. These infections are Sexually Transmitted Diseases (STDs) like chlamydia and gonorrhea, inflammation of the prostate inflamed testicles due to mumps and other urinary tract or reproductive organ infections.

Retrograde ejaculation –
In this defect the semen enters the bladder instead of coming out of the tip of the penis during ejaculation. This condition can be an effect of diseases like diabetes, multiple sclerosis, spinal injuries, and surgery of the bladder, prostate or urethra. Also certain medications can lead to retrograde ejaculation.

Lack of ejaculation –
In this condition the male reproductive system cannot ejaculate semen even if the sperm production is normal.

Antibodies attacking sperms –
This is common for men who have undergone vasectomy. Anti-sperm antibodies that are immune system cells mistakenly identify sperm as harmful invaders and attempt to eliminate them.

Tumours –
Diseases like cancer and non malignant tumours affect the male reproductive organs directly. They can harm the glands that release hormones related to reproduction. Also the treatment given to cure tumours can lead to male infertility.

Undescended Testicles –
This happens during the fetal development stage. One or both the testicles fail to descend from the abdomen into the sac containing the testicles

Hormonal Imbalance –
Since hormones have a great control over the reproductive systems any disorder affecting the testicles or the glands in the brain that produce testosterone and other hormones that control the testicles, can also be the cause of male infertility.

Sperm duct defects –
Damage to the sperm ducts that carry the sperms can also be a potent cause of male infertility.  Men can also be born with blockages in the part of the testicle that stores sperm or in the tubes that carry sperm out of the testicles.

Certain Medications –
There are many medications that produce side effects that harm the male reproductive system like Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antibiotics, some ulcer medications etc.

Other causes of infertility in men

  • Exposure to radiation or X-rays
  • Overheating the testicles
  • Injury
  • Prolonged bicycling
  • Illegal drug use, Alcohol abuse and Tobacco smoking
  • Emotional stress

Treatment for Infertility in men or male infertility issues –

Medical treatment –Doctors prescribe certain drugs that improve seminal quality like Clomiphene citrate, mesterolone, tamoxifen, gonadotropin injections, antibiotics, steroids and a whole lot of other medicines etc.

Surgical treatment –
Defects like Obstructions in the sperm conduction pathway, varicoceles, undescended testes etc can be treated surgically. Also the latest microsurgical techniques help greatly.  Patients who have undergone vasectomy previously can get it reversed through microsurgery.

Assisted reproduction –
However there are cases where neither medicine nor surgery can help the patient restore fertility. For such cases a process is carried out in the reproductive laboratory to improve semen quality and facilitate the penetration of the sperm into the ovum. This process involves procedures like sperm washing/capacitation, intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), in vitro fertilisation (IVF) and micro-manipulation (ICSI).

However there have been cases wherein all the above mentioned treatments have been unsuccessful. For such couples are suggested the option of AID (donor insemination) or adoption.

Read our pregnancy articles to know more about infertility in men and women and many other issues related to pregnancy.