Male Infertility

What is Male Infertility?

Male infertility is a common condition affecting many men globally. It is defined as the inability of a male to cause pregnancy in a fertile female after one year of regular, unprotected intercourse. Male infertility can result from a variety of causes, including medical, environmental, and lifestyle factors. Understanding these causes, the diagnostic processes, and the treatment options is crucial for managing this condition effectively.

What are Other Common Names for Male Infertility?

Some other common names for male infertility include:

• Sterility: this means the complete inability to reproduce
• Infertility: this generally refers to the inability to conceive despite regular, unprotected sexual intercourse
• Subfertility: this indicates a reduced ability to reproduce but not necessarily an inability to do so
• Hypogonadism: this refers to a deficiency in the function of the gonads or testes, which can result in a decreased production of sperm
• Andropause: also called male menopause, refers to the decline in testosterone production and other hormones that can occur in older men and may contribute to infertility.

Impact of Male Infertility on Your Health

Male infertility can impact a man's health in a few different ways.

• 
  Sperm Production: Infertility in men is often linked to problems with sperm production. This can include low sperm count, low sperm motility, and abnormal sperm shape. Various factors, such as hormonal imbalances, genetic disorders, environmental toxins, and lifestyle factors, such as smoking and excessive alcohol consumption, can cause these problems.
• Hormonal Imbalance: Infertility can also be caused by hormonal imbalances such as low testosterone levels. Testosterone plays an important role in sperm production, so that low levels can lead to reduced sperm production.
• Testicular damage: Certain medical conditions or injuries can cause damage to the testicles, which can affect sperm production. Other surgical procedures can also impact sperm production, like varicocele surgery.
• Emotional and psychological impact: Infertility can also affect a man's emotional and psychological well-being. It can lead to feelings of depression, anxiety, and low self-esteem. This can affect the overall health of the person and can make it difficult for him to cope with the physical and emotional challenges of infertility.

Some cases of infertility can be reversible, such as in cases of varicocele or infection, but in other cases, the issue may be more persistent or even irreversible. 

Consulting a healthcare provider, like a gynaecologist, urologist or reproductive endocrinologist, to understand the causes and potential treatment options can help alleviate the impact of male infertility on a man's anatomy and health.

Risk Factors for Male Infertility

Certain factors increase the risk of male infertility:

• Age: Sperm quality declines with age.
• Medical History: Conditions like diabetes, infections, and genetic disorders.
• Lifestyle Factors: Smoking, excessive alcohol consumption, drug use, and obesity.
• Environmental Exposure: Pesticides, radiation, and heavy metals.
• Occupational Hazards: Jobs involving prolonged sitting, heat exposure, or toxic substances.

Causes of Male Infertility

• Medical Causes:
• Varicocele: Enlarged veins in the scrotum that can impair sperm production.
• Infections: STIs, mumps, and epididymitis.
• Hormonal Imbalances: Disorders affecting the hypothalamus, pituitary gland, or testes.
• Retrograde Ejaculation: Semen enters the bladder instead of exiting through the penis.
• Antibodies: Immune cells attacking sperm.
• Tumours: Cancer or non-malignant tumours affecting reproductive organs.
• Undescended Testicles: Testes that did not move into the scrotum properly during foetal development.
• Environmental Causes:
• Overheating: Frequent use of saunas or hot tubs.
• Radiation and X-rays: Can reduce sperm production.
• Chemicals: Exposure to pesticides, solvents, and heavy metals.
• Lifestyle Causes:
• Drug Use: Anabolic steroids, marijuana, cocaine.
• Alcohol and Smoking: Affect sperm count and quality.
• Obesity: Can alter hormone levels and impair fertility.

Classifications of Male Infertility

Sexual function concerns how male infertility can be classified.

Primarily, there are three main classifications of causes of male infertility, each containing numerous contributing factors:

• Medical: Clinical reasons include medication, infections, hormone imbalances, sexual intercourse difficulties, etc.
• Environmental: Our environment is filled with pollutants that can affect male fertility (chemicals, heavy metals, and radiation, to name a few).
• Lifestyle: Drugs, alcohol and tobacco are prime contributors to male infertility, obesity, stress and a sedentary lifestyle, all of which are often linked with a demanding occupation.

In some cases, the cause of male infertility may be difficult to determine and could be a combination of multiple factors.

Diagnosis of Male Infertility

Diagnosing male infertility typically involves a combination of physical examination, medical history, and laboratory tests. The process of diagnosing male infertility normally includes the following steps:

• Medical history: The healthcare professional will ask about any history of illnesses, injuries, surgeries, or other factors affecting fertility. They will also ask about the patient's sexual history and any issues related to sexual function.
• Physical examination: A healthcare professional will perform a physical exam to look for any signs of physical problems causing infertility, such as a varicocele or undescended testicles.
• Semen analysis: The most common test for male infertility is a semen analysis. It evaluates the quantity, quality, and movement of sperm in the semen and measures sperm concentration, motility, and morphology. 
• Sperm DNA fragmentation testing: This can provide an assessment of the quality of sperm
• Hormonal testing: Blood tests may be done to check levels of hormones such as testosterone, follicle-stimulating hormone (FSH), and luteinising hormone (LH), which play an important role in sperm production.
• Genetic testing: Genetic testing may be done in certain cases where there is a suspicion of a genetic disorder that causes infertility.
• Testicular ultrasound: This may be undertaken if other concerns, such as low sperm count or a testicular lump, are present
• Testicular biopsy: A testicular biopsy may be performed in cases of non-obstructive azoospermia. This procedure involves removing a small sample of tissue from the testicle and examining it for the presence and quality of sperm.
• Specialised tests: Additional tests may be ordered if certain conditions are suspected, such as anti-sperm antibody tests, sperm function tests and more.

Some men may need more than one test to identify the cause of their infertility. Also, sometimes, no definitive cause is determined, and the condition can be classified as idiopathic infertility.

Treatment of Male Infertility

The treatment for male infertility depends on the underlying cause of the condition. Here are some common treatment options for male infertility:

• Medications: Certain medications can treat underlying conditions, such as hormonal imbalances, contributing to male infertility. These medications can help increase sperm production and improve sperm quality.
• Surgery: In some cases, surgery can be used to correct physical problems causing infertility, such as a varicocele or an obstruction in the ducts that transport sperm.
• Assisted Reproductive Technology (ART): ART, such as Intrauterine insemination (IUI) and in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), can be used to help couples conceive. ICSI is often used as a component of IVF when there are semen abnormalities. 
• Surgical Sperm Retrieval: These procedures involve obtaining sperm t from the testicles. This may include a needle biopsy procedure (such as TESA) under local anaesthetic or sedation. An advanced surgical technique, MicroTESE, involves an open biopsy of the testis (or testes) for the best chance of obtaining sperm for ART. This is performed under anaesthetic. 
• Lifestyle Changes: Improving overall health by making positive changes such as quitting smoking, reducing alcohol consumption and maintaining a healthy diet and exercise can improve sperm quality and lead to better chances of natural conception.

Only some treatment options will be appropriate for some cases, and some treatments may be more effective for certain underlying causes than others. 

What can Interfere with My Sperm Quality?

What's needed for good fertility isn't just lots of sperm. It needs to be good quality also. And just to be clear, the amount of semen doesn't guarantee that it contains viable sperm....they are two different entities. 

Drugs, alcohol, stress, tobacco and diet can all interfere with sperm production and quality...but are luckily all things you can change!

So, what can be done to improve your sperm?

To start with, there are a few things you can change to help you recover your fertility levels:

• Reduce your alcohol intake – the odd glass of wine with a meal is okay
• Stop smoking (tobacco smoke or vaping and other substances)
• Check your BMI (body mass index) and try to get to an optimum weight level
• Cut down on sugar and processed foods. Aim for a diet high in antioxidants and whole foods. 
• Get lots of rest and sleep, but exercise too (walking and swimming are great things you can do with your partner)
• Switch to wearing boxer shorts if you don't already

Improve Your Chances of Conception?

There are no guarantees, but unless you have been diagnosed with certain medical conditions and put in the maximum effort, you should see an improvement. 

Improving your chances of conception can involve lifestyle changes, managing underlying medical conditions, avoiding environmental toxins, and seeking a specialist fertility assessment.

What if Male Infertility is Untreated?

Untreated male infertility can have significant emotional and psychological impacts, including stress, anxiety, depression, and strained relationships. It can also lead to prolonged efforts and expenses related to fertility treatments.