What is infertility?
A number of factors affect fertility, including hormone levels, sperm quality, and structural issues that may impede sperm fertilization. You should discuss your testing options with your doctor before embarking on the path to parenthood.
A semen analysis is an easy, quick, and cost-effective way to get started. Even healthy, fertile men are experiencing a decline in sperm quality. Sperm count has declined globally over the last decade and low sperm count has increased. Over 40 years ago, a similar trend was observed.
Which males are more likely to have male infertility problems?
It is possible for men of any age or background to suffer from male infertility. Male infertility can, however, be caused by a variety of factors. Male infertility may be caused by the following factors:
- Age: The fertility of men can decline as they age. A decrease in sperm quality and quantity may occur, as well as an increase in the likelihood of genetic abnormalities.
- Varicocele: An enlarged scrotum vein is known as a varicocele, and it affects sperm production and quality. Younger males are more likely to suffer from this condition.
- Medical conditions: Male infertility can be exacerbated by certain medical conditions. In addition, these disorders include hormonal disorders (such as hypogonadism), infections of the testicles (such as orchitis), and chronic illnesses (such as diabetes).
- Genetic factors: Infertility in men can be caused by certain genetic conditions. Klinefelter syndrome, microdeletions of the Y chromosome, and chromosomal abnormalities are some examples.
- Lifestyle factors: Male fertility can be affected by unhealthy lifestyle choices. The quality and quantity of sperm can be affected by factors such as smoking, excessive alcohol consumption, drug abuse, obesity, and environmental toxins.
- Occupational hazards: Chemicals, toxins, heat, and radiation can adversely affect the production and function of sperm when exposed to certain occupational hazards.
- Prior surgeries or injuries: It is possible for male fertility to be affected by surgery or injuries to the reproductive organs, such as testicular surgery or trauma.
- Medications and treatments: There are certain medications that may impair sperm production, such as chemotherapy drugs or anabolic steroids taken over an extended period of time. Male fertility can also be affected by treatment for cancer, such as radiation or surgery.
There are no specific risk factors associated with male infertility. Both partners should undergo a comprehensive evaluation if they are having difficulty conceiving in order to determine the cause of infertility and determine the appropriate treatment.
Men’s infertility: what causes it?
Sperm-related issues:
- The production of sperm is less than usual when a man has a low sperm count (oligospermia).
- A problem producing sperm or a blockage in the reproductive tract can cause azoospermia (no sperm in the semen).
- It may be difficult for sperm with abnormal shapes and structures to reach and fertilize an egg.
- It can be difficult for the sperm to swim to the egg when they have reduced movement or immobility.
- An abnormal genetic condition can affect the function or production of sperm.
Hormonal imbalances:
- Low testosterone levels: Fertility is affected by testosterone levels, which are essential for sperm production.
- Elevated levels of prolactin: Sperm production can be interfered with by high levels of prolactin.
Reproductive tract issues:
- Varicocele: Expansion of the veins in the scrotum can affect sperm quality and production.
- Blockages: Sperm cannot be ejaculated if the tubes carrying sperm (vas deferens) are blocked.
- Ejaculatory disorders: Infertility can be caused by retrograde ejaculation (semen entering the bladder) and premature ejaculation.
Testicular factors:
- Undescended testicles: Sperm production can be affected when the testicles do not descend into the scrotum from the abdomen.
- Testicular injury or trauma: Testicles can be damaged, impairing sperm production.
- Testicular cancer: Treatments for certain types of testicular cancer can affect fertility.
Lifestyle and environmental factors:
- Substance abuse: Smoking cigarettes, using illicit drugs, and drinking excessively can have negative effects on fertility.
- Obesity: Excess weight can negatively affect sperm production and hormone levels.
- Exposure to toxins: Pesticides, chemicals, and radiation can harm sperm quality and production.
- Certain medications: Medications, such as chemotherapy drugs or long-term steroids, can affect fertility.
Genetic factors:
- Genetic abnormalities: Many genetic disorders can cause infertility, including Klinefelter syndrome, Y-chromosome microdeletions, and cystic fibrosis gene mutations.
Male infertility can have multiple contributing factors, which is why it may not be possible to pinpoint the exact cause in many cases. Identifying the specific causes and developing an appropriate treatment plan requires consulting a fertility specialist.
Signs & Symptoms
Changes in sexual function:
- Erectile dysfunction refers to difficulty achieving or maintaining an erection.
- Ejaculatory disorders such as premature ejaculation.
- Libido or sexual desire is reduced.
- An infection or underlying condition may cause swelling, lumps, or pain in the testicles.
- A testicle that has not descended into the scrotum is said to have undescended testicles.
Hormonal issues:
- Hair growth on the face or body is reduced.
- Breast tissue development (gynecomastia).
- An insufficient amount of energy or chronic fatigue.
- A decrease in muscle mass or strength.
A healthcare provider or a fertility specialist can conduct a thorough evaluation and provide appropriate guidance if you or your partner suspect you may be experiencing fertility issues.
What are the common male infertility tests performed?
Common male infertility tests include:
- Semen analysis: Male fertility is evaluated primarily through this test. Semen is analyzed for sperm count, motility (movement), morphology (shape), and other factors. Sperm quality and the likelihood of successful fertilization can be assessed through the analysis.
- Hormone testing: Hormone levels can be measured with blood tests, including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin. Fertility and sperm production can be affected by hormonal imbalances.
- Genetic testing: There are genetic tests available that can identify specific genetic abnormalities or chromosomal disorders that may affect fertility. There are many genetic tests that can be performed, such as tests for karyotypes or Y-chromosome microdeletions.
- Scrotal ultrasound: Testicles and epididymis, as well as the vas deferens, can be examined through ultrasound imaging of the scrotum. Sperm production and transport can be affected by abnormalities or blockages.
- Post-ejaculation urinalysis: In retrograde ejaculation, semen flows back to the bladder instead of being ejaculated through the penis, and this test detects if sperm is present in the urine after ejaculation.
- Testicular biopsy: A small sample of testicular tissue is obtained through a biopsy procedure to determine sperm production, identify blockages, and assess sperm levels for assisted reproduction.
- Genetic counseling: When genetic testing reveals potential genetic concerns or if there is a family history of genetic disorders, genetic counseling may be recommended. Genetic testing assists in assessing the risk of passing on genetic conditions to future generations.
Treatments for Male Infertility
Male infertility treatment involves lifestyle changes, medication, surgeries, or assisted reproductive techniques, depending on the underlying cause. The following are some common treatment options:
Lifestyle changes:
- You should avoid tobacco, alcohol, and illicit drugs in order to improve the quality and quantity of your sperm.
- Weight maintenance: Obesity can affect hormone levels and sperm production, so maintaining a healthy weight is important.
- By reducing exposure to toxins, such as pesticides and chemicals, sperm health can be protected.
Medications:
- The use of hormone replacement therapy or medications can help restore hormone levels and improve sperm production in cases of infertility caused by hormonal imbalances.
- Infertility can be treated with antibiotics or antifungal medications if an infection is causing it.
Surgical interventions:
- Sperm production and quality can be improved by surgically correcting varicoceles, which involves tying off or blocking enlarged veins.
- Infertility can sometimes be treated with vasectomy reversal surgery if the surgery is the cause.
- Surgery can be used to remove sperm tubes that have been blocked.
Assisted reproductive techniques:
- In intrauterine insemination (IUI), sperm is collected, processed, and directly injected into the woman’s uterus during ovulation.
- The process of in vitro fertilization (IVF) involves fertilizing eggs with sperm in a laboratory setting and implanting the embryos.
- When there is severe male infertility, intracytoplasmic sperm injection (ICSI) is performed to assist in fertilization by injecting a single sperm directly into the egg.
- Assistive reproduction can be performed by using donor sperm in cases of severe male infertility.
Percutaneous Epididymal sperm Aspiration (PESA)
- PESA is a procedure that can be performed under local anesthesia without a microsurgical skill set. The procedure involves placing a butterfly needle into the head of the epididymis after the administration of local anesthetic. Negative pressure is applied until a milky white fluid is visualized. The tubing is then clamped and the system is flushed with sperm media into a collection tube. The procedure can be repeated until sufficient yield is obtained. The percutaneous approach obviates the need to perform a skin incision, therefore, avoiding the associated morbidity such as infection and pain.PESA sperm yield is lower than MESA although usually sperm numbers are adequate for ICSI.
Testicular Sperm Aspiration (TESA)
- procedure in which a sample of sperm cells and tissue are removed from the testicle through a small needle attached to a syringe. The sperm is separated from the tissue and looked at under a microscope in the laboratory. It may then be used right away to fertilize eggs or frozen for future infertility treatment. Testicular sperm aspiration may be useful for men who have fertility problems caused by a blockage that keeps sperm from being ejaculated. This could be caused by previous vasectomy, certain genetic conditions, ejaculation problems, infection, or other conditions. It may also be useful for men who want to have children after having treatment that may cause infertility, such as certain cancer treatments. Testicular sperm aspiration is a type of sperm retrieval method. also called TESA.
Testicular Sperm Extraction (TESE ):
- TESE involves making a small incision in the testis and examining the tubules for the presence of sperm. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. TESE is usually performed in the operating room with sedation but can be performed in the office with local anesthesia alone. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. MicroTESE has replaced this as the optimal form of retrieval for men with no sperm in their ejaculate (azoospermia) from a problem with production.
FAQs
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Is infertility a common problem?
Infertility affects 10 to 15 percent of married couples worldwide. This means that both partners are equally responsible for infertility. Male factor: 30% Female factor: 30% Both factors: 30% Unexplained infertility: 10%. Therefore, both male and female partners should be investigated and treated simultaneously.
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How Does Life Style Affect Male Fertility?
Lifestyle factors & risk factors:
- Infertility can be caused by emotional stress and depression.
- The effects of chemotherapy and radiation on sperm production and motility have been shown to be severe.
- Anabolic steroids, alcohol, drugs, and smoking can impair sperm motility and reduce sperm count.
- Male infertility may be caused by occupational exposure to excessive heat and pesticides.
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For male fertility, what is the minimum amount of semen required?
Fertility requirements for males:
- The volume of sperm: more than half an ml
- Sperm concentration: more than 20 million/ml
- Total sperm count: more than 15 million/ml per ejaculate
- Motility: More than 32% (Grade 3 and grade 4) (forward progression).
- Morphology: more than 4% normal sperms
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What Diseases Can Cause Male Factor Infertility?
Many diseases can cause male infertility, including kidney disease and testicular cancer. Infections and fevers, as well as systemic conditions and metabolic disorders, can affect sperm development. Sexually transmitted diseases can also cause obstructions and scarring of the reproductive tract, while genetic conditions, such as cystic fibrosis, can lead to sperm shortages due to missing vas deferens. As any number of illnesses can play a role in this, it is important that both you and your partner share with your doctor information about your family history and personal medical history.
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When it comes to male infertility, what’s most important to remember?
If you are having fertility problems, neither you nor your partner should be held responsible. About one-third of infertility cases are attributed to male factors, while another one-third are attributed to female factors. One-third of infertile couples experience infertility due to multiple factors, or, in 20 percent of cases, there is no explanation. Currently, physicians have the technology and surgical tools to address many of those issues (in men, few or no sperm is the biggest problem; in women, ovulation disorders and blocked tubes are the most common problems.)