Infertility is a disease of the reproductive system that makes a person unable to have children. Nearly 1 in 7 couples are infertile, which means they are unable to get pregnant after a year or longer of frequent and unprotected sex. Infertility occurs in both males and females. One-third of fertility issues lie with the male, one-third in the female, and one-third in both. To conceive a child, a healthy sperm must meet a healthy egg. The sperm must penetrate the egg and deliver genetic material to the egg. This creates a child. In male infertility, a man is unable to initiate pregnancy with a female partner. In female infertility, a woman is unable to get pregnant naturally.
Process of Male Fertility
The quantity and quality of sperm are major factors in fertility. A sperm is the male reproductive cell with a head and tail. The head contains the genetic material (23 pairs of chromosomes) while the tail functions to propel the sperm towards the egg. Millions of sperm are created daily by a process called spermatogenesis, which starts in puberty. Spermatogenesis takes about 5 weeks to complete each cycle of sperm creation. When sperm is ejaculated, it starts a journey towards the uterus. Although millions of sperm are produced in each ejaculate, typically, one sperm fertilizes one egg. Since this is a competitive process, any sperm that is too slow, damaged, or low count, would find it difficult to fertilize an egg. Thus, for a man to get a woman pregnant, several steps must happen:
- A male body must form reproductive organs with at least one functional testicle as well as produce testosterone and other hormones that facilitate sperm growth and development.
- After the sperm is produced in the testicle, they must mix with semen and be ejaculated out of the penis.
- The sperm count must be adequate. A low sperm count increases the risk of not being able to fertilize an egg. Less than 15 million sperm per milliliter of semen or fewer than 39 million sperm per ejaculate is considered low sperm count.
- Sperm should be able to move as well as be functional. The motility (movement of a sperm) determines if it is able to reach and penetrate an egg. The functionality of a sperm determines if a child is conceived or not.
Causes of Male Infertility
Several factors contribute to male infertility, including medical, environmental, health, and lifestyle choices. Some of these causes are reversible while others are not.
Poor Health and Unhealthy Lifestyle – lifestyle choices can make a difference in fertility. Alcohol use, drug use, smoking, and obesity can all lead to poor fertility. Drugs can decrease sperm production as well as the quality of sperm. Alcohol can lower testosterone, reduce sperm production, and cause erectile dysfunction.
Environmental factors – exposure to certain toxins and chemicals like radiation, x-rays, heavy metals, pesticides, solvents, and paint can lead to low sperm count. Tight clothes can lead to overheating of the testicles, which causes reduced sperm production and subsequently, infertility.
Health and medical factors – several things can lead to infertility in males, including hormone imbalance, certain medications, undescended testicles, infections, ejaculation and other related sexual problems, cancers and tumors, swelling of veins that drain the testicles, and prior surgeries, especially those involving any part of the male reproductive system.
Other general causes of infertility include:
- Low sperm production (oligospermia)
- Abnormal sperm function
- No sperm in ejaculate (azoospermia)
- Blockage that prevents sperm delivery
- Injuries to the male reproductive system
- Dilated veins around the testicles
- Illness and inherited disorders
- Chronic health problems
Symptoms of Male Infertility
One of the first signs of male infertility is the inability to conceive a child. Other signs and symptoms that can occur, depending on the cause of infertility, include:
- Low sperm count
- Reduced sexual desire
- Abnormal breast growth
- Erectile dysfunction – difficulty maintaining erection
- Decreased facial or body hair
- Signs of chromosomal or hormonal abnormality
- Pain, discomfort, lumps, or swelling in the testicle area
- Difficulty with ejaculation
- Small volume of fluid ejaculated
- Recurrent respiratory infections
- Inability to smell
Complications of Male Infertility
Dealing with infertility of any kind, for both men and women, can be challenging. Most couples who are unable to have a child can find their relationship tested in so many ways, which can put a lot of stress on the relationship. And for men who choose to get help, reproductive techniques can be expensive, emotionally draining, and time-consuming. Men who are infertile have an increased risk of prostate cancer, testicular cancer, colon cancer, and melanoma.
Diagnosis of Male Infertility
Infertility is often caused by so many factors, making it crucial that both males and females trying for a baby without success see the doctor to determine the right treatment. Diagnosing male infertility involves physical exams, taking accurate medical history, and semen analysis. Other tests for diagnosing infertility include sperm function test, testicular biopsy, ultrasound, hormone testing, urinalysis, and genetic tests.
Treatment of Male Infertility
Due to the advancements in medicine and technology, male infertility can be treated in many ways, including using hormones, medications, and surgical interventions, as well as treating infections and sexual intercourse problems.
Male infertility can also be treated with Assisted Reproductive Therapy (ART). In ART, sperm is obtained from the patient or a male donor and inserted into the female. The sperm can also be used for in vitro fertilization.
If any of these options are not viable and male infertility persists, adoption and sperm donors could be an option.
Who is at risk for Male Infertility?
Although any male could face infertility, some men are more at risk. Certain circumstances predispose a man to infertility, including:
- Scrotum, groin, testicle, or penis surgery
- Sexual problems like low sex drive, and erection and ejaculation problems
- A partner over 35 years old
- History of certain infections
- History of testicle or prostate problems like trauma to the testicle
- Undescended testicles
- Overheating of the testicles
- History of sexual problems
- History of family fertility disorder
- Alcohol use
- Illicit drug use
- Exposure to toxins
- History of abdominal or pelvic surgery
- History of past vasectomy
- Some chronic conditions like sickle cell anemia
- Some medications and medical treatments
- Radiation for cancer therapy
Preventing Male Infertility
Although some men are born with infertility, which is not preventable, there are some behaviors that increase the risk of infertility. Limiting alcohol consumption and cigarette smoking can help reduce the risk of male infertility. Avoiding illicit drugs, reducing stress, and limiting exposure to chemicals like pesticides and heavy metals can reduce the chances of being infertile. Maintaining a healthy weight and avoiding activities that can overheat or stress the testicle can also help prevent male infertility. Avoiding vasectomy surgery throughout your life will also greatly reduce the risk of male infertility in the future.