MALE INFERTILITY

Reproduction is a normal human event for the survival of the human race. Infertility affects 25% of couples of reproductive age.
Around 50% of infertility has a male factor as a cause. Many men are in denial. They equate good erection and great sexual prowess with fertility. Many men tend to believe that infertility problems are more likely to be women’s fault.
Male fertility is on the decline markedly as a result of modern lifestyle. There is increasing evidence that the quality and the quantity of sperm that men produce has declined over the past 30 years due to many causes such as environmental pollution, stress, alcohol, smoking and increased incidence of sexually transmitted diseases. The advent of IVF and other Assisted Reproductive Techniques (ART) has helped several thousand otherwise infertile couples to have children. However, about 10% of couples will still be left with the inability to have children because IVF does not work for everyone.


Causes of Male Infertility
Infections:
It was previously thought that mumps infection is an important cause of male infertility but recent evidence suggests that it is rare for mumps to lead to sterility. Other infective causes of male infertility include STDs like gonorrhoea, Chlamydia and inflammation of the prostate gland (prostatis). Infected semen can cause infertility.

Testicular Heat:
Heat reduces sperm production. This is the reason why the testicles are outside the body in the scrotum rather than in the abdomen like the ovaries in women. Some men have frequent use of Sauna, use hot baths, jobs where long hours of sitting causes over heated testicles, wearing too tight fitting clothing, prolonged bicycling. Some obese men can become sterile because the sagging layers of fat can overheat the testicles.
Varicocele of the testes also affects sperm production and motility based on the excess heat generated by the varicoceles.

Frequent Sex:
Very frequent intercourse can lead to dramatic reduction in sperm count, and cause the man to be effectively infertile. If a man ejaculates as much as 2 to 3 times a day, they are likely to have a problem. If a man wants to be at his most fertile, he has to wait at least 2 to 3 days between each ejaculation.

Cigarette Smoking:
Cigarette smoking of over 20 per day has been shown to reduce the sperm count, sperm production and sperm motility.

Alcohol Abuse:
Excessive alcohol intake can lead to low sperm count, it can result in lower male hormone (testosterone) and cause erectile dysfunction.

Illegal Drug Use:
Anabolic steroids to stimulate muscle strength can cause testicular shrinkage and reduce sperm production. Cocaine and marijuana temporarily reduces the quantity and the qualities of sperm.

Retrograde Ejaculation:
This is a rare condition when semen is ejaculated backwards into the bladder. It is seen in severe diabetes, multiple sclerosis, spinal cord injury and surgery to the bladder or prostate.

Stress:
Emotional stress and workaholic can result in fatigue and lack of interest in sex. Increasing age can also lead to infertility because of lack of interest in sex and less frequency.

Environmental:
Environmental causes of male infertility could arise from issues such as chemicals, toxins and heat. Pesticides such as ethylene dibromide and organophosphates affect sperm production. Exposures to heavy metals such as lead also affect the quality and quantity of sperm. Excessive exposure to radiation and X-ray are harmful to the testis and sperm production.

Sexual Dysfunction:
Psychological or relationship problems that interfere with sex, erectile dysfunction, premature ejaculation, painful intercourse can all result in infertility if not well handled.

Risk Factors Linked to Male Infertility

35 years
Tobacco
Alcohol
Illegal drug use
Overweight
Underweight
STD infections
Undescended testicules
Vasectomy
Family history of fertility problem
Bicycling.

Semen Analysis
Semen analysis is always done when assessing male infertility.
The sperm is evaluated for sperm count, sperm motility, sperm shape (morphology) and other elements such as blood or white cells which can provide evidence of damage or infection.

Semen analysis is important in infertility work up, because the male partner contributes to almost 50% of all infertility problems that couples face, and yet many men refuse to think they may be the possible cause of the couples’ failure to conceive.
10-20% of men have sperm count below the WHO cut off level and about 2% of all men are completely infertile and produce no sperm at all.
Sadly, many men resist being tested and in many cases it means the women go through years of unnecessary treatment. This also means that the couple can go through a lot of unnecessary emotional turmoil and anxiety.

Azoospermia
Azoospermia is a medical term of a man not having any measureable level of sperm in his semen.
Azoospermia could be obstructive, where the sperm are produced but cannot be mixed with the rest of the ejaculatory fluid due to a physical obstruction, or non obstructive azoospermia where there is a problem of spermatogenesis.

A diagnosis of azoospermia is sometimes still made even though as many as 500,000 sperm per ml of semen may have been seen in the sample because it is extremely unlikely that a man will be able to father a child naturally with this number of sperm.
Azoospermia occurs in about 2% of the general population and many men suffering from it appear normal and healthy.

Oligospermia
Oligospermia means few spermatozoa in the semen. Oligaspermia is related to sample with less than 20 million spermatozoa per ml of ejaculated sperm.

Teratospermia
Teratospermia is characterised by presence of sperm with many abnormal shape (morphology) and it results in infertility.

Asthenospermia
Asthenospermia refers to reduced sperm motility. It decreases sperm quality and it is one of the major causes of infertility.

Aspermia
Aspermia is a complete absence of semen. It should not be confused with azoospermia which is absence of sperm cells. One of the causes of aspermia is retrograde ejaculation which can occur as a result of excessive drug use or prostate surgery.

Varicocele

Presence of varicocele (varicose vein in the testicles) is a correctible cause of low sperm count. It is the most commonly identified correctible abnormality that is associated with male infertility.
A varicocele is an abnormal dilatation of testicular veins. 15% of healthy fertile men in the general population have a detectable varicocele. In the infertile population up to 40% of men have it, so there seems to be an association with infertility.

Treatment
The treatment of male infertility is individualized and dependent on the cause and the abnormal parameters in the semen analysis.

Surgery
Varicocele can often be surgically corrected and an obstructed vas deferens repaired.

Infection
Treating infection will cure the infection but it rarely restores fertility.

Sexual intercourse Problems
Treatment of erectile dysfunction or premature ejaculation can improve fertility. Medication and psycho sexual counselling is important.
Hormonal deficiencies can easily be corrected but, they are rarely the only underlying problems in male infertility.
Assisted reproductive techniques (ART) such as Intrauterine Insemination (IUI), In-vitro fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) are usually the definitive mainstay of treatment in severe male infertility.
Donor Sperm and adoption are also viable alternative treatment options.
Many mild problems in semen analysis that has underlying lifestyle and environmental issues, can be corrected by lifestyle changes in the male e.g. stop smoking, reduce alcohol intake, etc.