Fertility in men

A man’s fertility generally relies on the quantity and quality of his sperm. If the number of sperm a man ejaculates is low or if the sperms are of poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy.

The common causes of infertility in men are classified as:

1. Sperm production problems
2. Blockage of sperm movement
3. Sexual problems (erection and ejaculation)
4. Hormonal problems and
5. sperm antibodies.

About two-thirds of infertile men have a problem in producing sperm in their testes. Sperm transportation problems are also found in about one in every five infertile men, including men who have had a vasectomy, but now wish to have more children. Blockages in the tubes leading sperm away from the testes to the penis can also cause a complete lack of sperm in the ejaculated semen.

• One in 100 infertile couples faces sexual problems like erectile dysfunction and premature ejaculation which can affect semen from entering the woman’s vagina and prevent fertilization.
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• One in 100 infertile men suffer from low levels of hormones produced in the pituitary gland, which in turn act on the testes. In rare cases ( one in 16 infertile men), sperm antibodies are found to reduce fertility.

There are limited possibilities in preventing infertility due to genetic factors. On the other hand, men facing other infertility issues can boost their fertility by adhering to the following things.

• Avoiding sexually transmitted diseases
• Avoiding illicit drugs
• Avoiding radiation when possible
• Avoiding exposure to toxic substances
• Avoiding heavy or frequent use of alcohol
• Observing good personal hygiene and health practices
• Avoiding long, hot baths, hot tubs or saunas
• Wearing loose-fitting underwear
• Intake of foods like pomegranates, tomatoes, walnuts, lentils, pumpkin seeds, water and dark chocolate can improve fertility and sperm count in men.

Causes of infertility in men

Smoking: Regular use of recreational or other drugs, chronic alcohol abuse, use of anabolic steroids, highly intensive physical exercises, dietary deficiencies, anemia, malnutrition, tight underwear and excessive use of hot water baths, saunas can hamper male fertility. Excessive stress and exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive substances, mercury, heavy metals, excessive stress etc. can also be stumbling blocks in the path of a male to achieve fertility.

Effective tackling these issues can improve a man’s fertility potential. Moreover, fertility is an indicator of a man’s overall health. Men who live a healthy lifestyle are more likely to produce a healthy sperm. Male infertility can also be caused by hormonal problems. Sperm production is regulated by the hypothalamus-pituitary endocrine system. So any disorder that affects this system can turn detrimental to a man’s fertility. This can result either in excessive or reduced production of hormones from the hypothalamus and pituitary glands.

Subfertility: This is a situation when a man cannot get a woman pregnant after one year of regular sex without birth control. According to experts, Oligoasthenoteratozoospermia (OAT) is the most common cause of male subfertility. Ignoring the symptoms and signs of infertility, ignorance about the condition itself and the general resistance to treatment lead to OAT. Hence, it is advisable to clarify that there is no existing male factor contributing to infertility, before trying any invasive procedures for plausible female problems like endometriosis and fibroids.

Varicocele: An abnormality of the vein in scrotum, which results in low sperm production and poor quality of sperm. If diagnosed and treated properly, it can be cured completely. Even issues with the duct tube (vas deference) that carries the sperm from the testis to the penis like complete absence or blockage can be overcome with other treatment modalities. Even previous infections like mumps, tuberculosis, typhoid or sexually transmitted diseases can cause either a blockage or complete damage to the testis.

Genetic issues: Klinefelter‘s syndrome, Y chromosome micro deletion can cause a significant reduction in sperm production.

Sexual problems: Severe sexual problems, which could be psychological or physical in nature, like erectile dysfunction, premature ejaculation, ejaculatory, loss of libido or sexual interest etc., can also cause male infertility. These issues can be corrected with expert counselling and certain medications.

Unfortunately, in over 70% of the cases, male infertility cannot be diagnosed and during such instances, empirical treatment methods like antioxidants are administered to the patients.

Semen Analysis

In semen analysis, the count, motility and morphology are considered. Motility and morphology are in fact far more important than sperm count. Semen test suffers from drawbacks like the parameters being varied from sample to sample, technician to technician and from lab to lab. At some instances, the sample with good parameters have failed to give an accurate picture (if the male is fertile or not), pregnancies have found to be possible even with very poor samples, and one male being infertile to one woman and fertile to another.

Advanced treatments must be resorted if in case the semen analysis shows consistently a low count, bad morphology, poor motility (more than 50% of immotile sperms) and Follicle Stimulating Hormone of more than 8 (early sign of impending testicular failure). In such situations, we may conclude that to the male factor should be focused upon for treatment.

However, for most of the males with unexplained factors, the prognosis cannot be predicted.