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Male infertility is a frequent issue that reduces a male’s ability to help his female partner to conceive a child due to insufficient sperm production, abnormal sperm function, or obstructions that prevent sperm delivery.
If both partners engage in recurrent unprotected intercourse for more than a year and the female partner is unable to get pregnant with a child, then either one or two of the partners may be experiencing infertility problem.
Male infertility is a condition that can be stressful, but there are several therapies available. Male infertility may be caused by illnesses, accidents, chronic health issues, lifestyle choices, and other circumstances.
Symptoms
The inability to conceive a child is the primary sign of male infertility. Signs and symptoms can occasionally be caused by an underlying issues. The following signs and symptoms may include:
- Sexual disorder: difficulty in ejaculation, low sperm count, reduced sexual desire, or erectile dysfunction.
- Testicular pain, swelling, or lump
- Recurrent respiratory infection
- Lack of sense of smell
- Gynecomastia
- Decreased in sperm count (less than 39 million per ejaculation)
- Abnormality in chromosomes or hormones
Causes
Different factors could cause problems that prevent sperm cells from developing, such as temperature that affects the infertility at the scrotum. Male infertility could be caused by biological or environmental factors that may include:
- Health issues: Several health issues and concerns affect the male infertility, such as:
- Azoospermia: Infertility could be caused by the body’s inability to produce sperm cells.
- Oligospermia: The production of sperm is low or the maturity is poor, which will affect the life span of the sperm cell to live to fertilize the egg cell.
- Varicocele: the veins at the scrotum are swollen. This condition results the scrotum to heat up which affects the maturity and count of the sperm.
- Retrograde ejaculation: When an orgasm occurs, semen enters the bladder rather than coming out the tip of the penis. This occurs when your bladder’s nerves and muscles fail to contract during an orgasm (climax).
- Sexual intercourse problem: Erectile dysfunction, premature ejaculation, painful sex, physical anomalies like hypospadias, which is the presence of a urethral hole beneath the penis, and sex-interfering psychological or interpersonal issues are a few examples of these.
- Undescended testicles: One or both testicles in certain male fail to descend from the abdomen into the testicular sac during fetal development. Men who have experienced this illness are more prone to experience infertility.
- Infection: Some illnesses may affect sperm health or production, or they may lead to damage that prevents sperm from passing through. Some sexually transmitted infections, such as gonorrhea or HIV, as well as inflammation of the testicles or epididymis are included.
- Immunologic infertility: Immune system cells called anti-sperm antibodies wrongly view sperm as dangerous invaders and make an effort to get rid of them. Most typically, injuries, operations, or infections result in the production of antibodies. They stop sperm from functioning normally and from transferring.
- Hormonal imbalances: The pituitary gland releases hormones that instruct the testicles to produce sperm. Poor sperm development is a result of very low hormone levels. Testicular problems or abnormalities affecting other hormonal systems, such as the hypothalamus, pituitary, thyroid, and adrenal glands, can cause infertility. Male hypogonadism, a condition which occurs due to low testosterone levels, and other hormonal factors may have a variety of underlying reasons.
- Cancer treatment: Surgery, radiation, or chemotherapy used to treat tumors can occasionally have an impact on male fertility. Male reproductive organs can be directly affected by cancers and benign tumors.
- Defects of tubules that transport sperm: Tubules that carry sperm have defects. Sperm travels through several tubes. They may become blocked as a result of unintentional harm from surgery, previous infections, trauma, or abnormal development, like in cystic fibrosis or other genetic diseases.
- Genetic disease: Male reproductive organs grow abnormally as a result of inherited diseases such Klinefelter’s syndrome, Kallmann’s syndrome and cystic fibrosis.
- Certain medications: Sperm production can be hampered and male fertility can be reduced by testosterone replacement therapy, long-term anabolic steroid usage, cancer drugs (chemotherapy), some therapies for ulcers, some drugs for arthritis, and other pharmaceuticals.
- Previous surgery: Vasectomy, scrotal or testicular surgery, prostate surgery, large abdominal surgery for testicular or rectal cancer, among other procedures, can all prevent sperm during ejaculation.
- Environmental causes: The production or function of sperm can be decreased by extended exposure to certain environmental factors as heat, pollutants, and chemicals. Certain factors include:
- Industrial chemicals: Low sperm counts may be caused by prolonged exposure to specific chemicals, pesticides, herbicides, or organic solvents.
- Radiation exposure: Sperm production may be lowered by radiation exposure, but it frequently returns to normal afterward. Sperm production can be permanently decreased by high radiation exposures.
- Elevated temperature of testicles: High temperatures may harm sperm function and production. Regular use of saunas or hot tubs may temporarily lower your sperm count.
- Heavy metal exposure: Infertility may also result from lead or other heavy metal exposure.
- Health, lifestyle and other causes: Male infertility can also be brought on by:
- Alcohol use: Alcohol use can reduce testosterone levels, lead to erectile dysfunction, and decreased sperm counts.
- Smoking. Smoking may diminish sperm counts in men compared to non-smokers. Male fertility may also be effected by secondhand smoke.
- Drug use: The testicles can shrink and sperm production can fall when anabolic steroids used to promote muscle strength and growth are consumed. Use of cocaine or marijuana may also briefly lower the quantity and quality of the sperm.
- Weight: Obesity can affect sperm directly and indirectly by altering hormones, which decreases male fertility.
Risk factors
The following are risk factors for male infertility:
- Age: 40 years old or older
- Bad habits: Smoking tobacco, alcohol consumption, and drug abuse increases the risk of male infertility.
- Weight: Overweight or obese
- Health issues: History of infection, undescended testicles,
- Surgical history: Previous vasectomy, significant abdominal surgery, or pelvic surgery
- Others: Exposure to environmental toxins, exposure of testicles to heat, or history of trauma of the testicles. Having a family who suffers with infertility or being born with it.
Tumor or other chronic diseases such as sickle cell disease could increase the risk. Utilizing specific drugs or receiving medical care, such as cancer treatment procedures like radiation or surgery.
Diagnosis
Male fertility problems may be difficult to diagnose. It is probable that the partners need to consult a healthcare provider because many infertile couples have more than one reason of infertility.
A thorough medical history and physical examination are the first steps in the diagnosis. Blood tests and semen analysis may also be requested by the doctor.
Male infertility issues are typically diagnosed by:
- Physical Examination: Thorough medical check to establish the general health and identify any physical issues that might affect fertility. Further test will determine the cause of infertility may be necessary if the physical examination and medical history fail to reveal any factors contributing to their failure to conceive.
Doctor will check the genitals and ask questions about inherited conditions, chronic health problems, injuries, or any surgeries that could contribute to infertility.
- Semen analysis: Semen analysis is a typical laboratory test to determine the sperm count, sperm quality, and motility. If there are less sperm, the test is often repeated at least twice. Patient will be requested to masturbate into a sterile cup to collect sperm. Study is done on the semen sample.
The laboratory will also examine the semen for signs of infections. To achieve reliable findings, semen analysis procedures are typically performed repeatedly throughout time.
- Scrotal ultrasound: High-frequency sound waves are used to create pictures inside the body. This procedure will check for varicocele or other issues in the testicles and supporting tissues.
- Transrectal ultrasound: Ultrasound utilizes sound waves that are reflected off the organ to create an image. The healthcare provider can determine if organs like the ejaculatory duct or seminal vesicles are malformed or obstructed. It also allows the healthcare provider to examine the prostates that could inhibit the passage of semen.
Hormone testing: To find out how successfully the testicles produce sperm and to rule out serious health issues such as follicle-stimulating hormone (FSH) which instructs the testicles to produce sperm. High levels might indicate that the testicles are unable to produce sperm.
Infertility may also be affected by abnormalities in other hormonal or organ systems. Testosterone and other hormone levels are determined through a blood test.
- Genetic tests: There can be a genetic reason for abnormally low sperm quality. If the Y chromosome has undergone modest modifications, a blood test can detect these changes as indicators of a genetic anomaly. For the diagnosis of different congenital or hereditary disorders, genetic testing may be required.
- Post-ejaculation urinalysis: Indication of sperm at the urine could mean that the sperm are moving backward into the bladder rather that out of the penis.
- Testicular biopsy: A testicular biopsy may be necessary if a semen test reveals extremely few or no sperm. A needle will be inserted through the numbed scrotal skin to remove a sample from the testicle. If the testicular biopsy findings reveal that sperm production is normal, a blockage or another issue with sperm transport is most likely responsible for the condition.
- Specialized sperm function tests: Different kind of tests will be performed to determine how well the sperm could survive after ejaculation and how effectively they could penetrate the egg.
Treatment
The specific reason for infertility is frequently unknown. The treatment is usually based on the underlying cause of infertility. Medications and surgery are effective ways to treat many issues. This would enable conception via regular sexual intercourse.
It is recommended that both partners should be checked for infertility in order to establish the treatment options. They might also discover that using assisted reproductive methods in your case is appropriate.
Surgery
- Vasectomy reversal: The vas deferens, the scrotal tube through which the sperm travels, is reconnected by the surgeon. The surgeon delicately stitches the ends of the vas deferens back together while using a high-powered surgical microscope. This could be performed as an outpatient procedure.
- Vasoepididymostomy: This method is used to treat blockages in the vas deferens. The blockage is surgically removed, the vas deferens is split, and the tube ends are then reconnected. Obstruction in the epididymis may have developed during the original vasectomy that was carried out many years ago.
Infection or damage can also lead to blockage at the epididymis. Surgeon will address the issue by avoiding the obstruction in the epididymis. - Varicocelectomy: An outpatient procedure, can be used to treat varicoceles. By treating these enlarged veins, sperm mobility, quantity, and structure are improved.
- Transurethral Resection of the Ejaculatory Duct (TURED): Blockages in the ejaculatory duct can be surgically removed. A cystoscope is inserted into the urethra and a tiny incision is made in the ejaculatory duct. The ejaculatory duct is then made open again by resecting the obstruction with a cutting loop inserted inside the cystoscope.
Other treatments:
- Assisted reproductive technology (ART): Depending on your unique situation and preferences, ART treatments may involve getting sperm by routine ejaculation, surgical extraction, or from donors. In order to carry out in vitro fertilization or intracytoplasmic sperm injection, the sperm are then injected into the female vaginal canal.
Intrauterine Insemination (IUI): Through a tube, the infertility doctor will insert the sperm into the female partner’s uterus. IUI is frequently effective for infertility caused by low sperm count, sperm mobility issues, retrograde ejaculation, and other factors.
Intracytoplasmic sperm injection (ICSI): Manually inject one sperm into an egg. The fertilized egg is then placed in the uterus of the female partner. The therapeutic options for even the most severe cases of male factor infertility have been significantly improved.
In vitro fertilization (IVF): Injectable fertility drugs are used during IVF to stimulate the ovaries and encourage the maturation of many eggs. When the eggs are ready, a quick operation is performed to collect the eggs. IVF is the process of uniting sperm and an egg from a female partner or donor in a petri dish at a laboratory. The fertilized egg (embryo) is placed back into the uterus after 3 to 5 days of growing.
Many hormonal disorders in women, obstructed tubes in women, and idiopathic infertility can all be treated with IVF.
- Infection treatment: Although antibiotic therapy can sometimes clear up a reproductive tract infection, fertility is not always returned.
- Sexual intercourse treatment: In cases of erectile dysfunction or early ejaculation, medication or counseling can assist enhance fertility.
- Hormonal and medications: In circumstances when infertility is brought on by high or low levels of hormones or issues with how the body uses hormones, healthcare provider may advise hormone replacement or medicines.
Most of the time, an outpatient surgery can treat male infertility. These are performed while sedated by IV or general anesthesia. Although postoperative discomfort is often mild, recovery and follow-up can differ. Your doctor should conduct a physical examination following varicocele repair to check if the vein is entirely gone. Since they are simply blocked off during surgery to stop unnatural blood flow, the veins frequently remain swollen.
Male reproductive issues are sometimes untreatable, making it difficult for a man to become a father. Healthcare provider could advise that the partners could consider about utilizing donor sperm or adopting a child.
