All you need to know about male factor infertility
Over the past few decades, there has been a decline in fertility rates (both men and women) worldwide. Though both men and women face issues with infertility, there is a bias in terms of considering and talking about it as a ‘woman’s issue’, more so in traditional communities. In fact, according to the WHO (World Health Organization), the male factor contributes to about 20% to 40% of infertility issues.
Simply put, male infertility is usually defined as the inability of a man to make a fertile woman pregnant within one year of frequent, unprotected sex. However, there are several misconceptions that cloud this issue. For example, many people mistakenly believe that being impotent equals to being infertile. In reality, impotence refers to a man’s inability to maintain an erection, and it is a treatable condition. Hence, it is important that we understand what male factor infertility is, what causes it and the treatment options available. Most importantly, it is important to remember that, given the advancements in fertility treatments and assisted reproduction techniques, parenthood is a dream that can become reality for most people.
Detailed View of the Male Reproductive System
The male reproductive system consists of number of sex organs, which are located outside and within the body.
Thus, the inter-connected functions of several organs, including the nerves, muscles and blood vessels are needed for normal erection, penetration and successful pregnancy.
Indicators of Normal and Abnormal Sperms
As good sperm quality is of utmost importance for a healthy pregnancy, 90% of fertility problems in men have been associated with poor sperm quality.
The spermisamale reproductive cell produced by the testicles, which is needed forfertilising a femaleegg. The sperm contains three parts:The head, which contains DNA(genetic material) andpenetrates the female egg;the mid-piece that produces energy to the cell; and the tail, whichhelps the sperm to move forward towards the egg.
Indicators of healthy sperms includethe volume (between 2 to 5 ml), sperm count (ranging from 15 to 200 million), with at least 58% viability (live), round-shaped heads with long and strong tails(of nearly 50%) and motility (ability of the sperm to move)above 40%.An abnormal sperm may be immature, abnormally shaped or unable to swim (due to head and/or tail defects, have large heads or double-tails).
The natural ability of the sperm to reach and penetrate the female egg is reduced if:
What Causes Male Factor Infertility?
The following causes may be responsible for male factor infertility. (For proper diagnosis and treatment of male factor infertility, it is best to consult a fertility specialist.)
Age: In recent times, due to social and economic pressures and lifestyle changes, men are starting their families at an older age. At later ages, due to hormonal changes, sexual dysfunction, increased body fat, and various chronic diseases such as diabetes mellitus, hypothyroidism that can affect fertility.
Sexual Dysfunction:Conditions such as premature ejaculation (when a man reaches orgasm after beginning foreplay or intercourse and the release of semen from the penis too quickly and without control) and erectile dysfunction(otherwise known as impotence; the inability to maintain an erection that is firm enough to have sexual intercourse). These conditions play a part in hindering conception. In extreme cases, the resultant stress and anxiety may even put off the man from having sex in the first place.
Medication: The long-term use of steroids, anti-epileptic drugs, antiretrovirals and several kinds of antihypertensive drugs and chemo-radiation therapies have been associated with low sperm production and/or other abnormalities that cause infertility in men.It is to be noted that the sperm parameters are generally reversible if the treatment is discontinued. If it is not possible to stop therapy process, the doctor may sometimes recommend the use of antioxidants in the form of vitamins and minerals that may increase sperm count and motility. In any case, it is very important that you consult your doctor if you are taking any medications and are also planning for a baby.
Hormonal Deficiencies: The entire reproductive system is dependent on hormones, and about 10% of all male factor infertility issues arise from hormonal imbalances.The primary hormones produced in the pituitary gland and which areinvolved in male sexual health are the follicular stimulating hormone or FSH (necessary for sperm production), and the luteinising hormone or LH (essential for production of testosterone).The FSH regulates the production of sperm. The LH impacts the testes in producing testosterone, which is responsible for the development of male characteristics such as muscle mass, strength, fat distribution, sex drive and erection. A simple blood test can help to detect any hormonal imbalances. The urologist/andrologist will determine the underlying cause and may prescribe hormonal supplements that mimic the function of naturallymade FSH and LH.
Chromosomal Abnormalities: Genetics play an important role in the production of sperms, and about 30% of male infertility issues are associated with chromosomal abnormalities and gene mutations. Genetic testing and counselling are needed for men with less than 5 million sperm count on routine semen analysis.Though chromosomal abnormalities are usually not treatable per se, the advancements in assisted reproductive techniques have helped many men to father children.
Other causes:
Lifestyle Factors and Impact on Male Infertility
Let us take a look at some lifestyle habits and environmental factors that may cause male infertility. The good news is that infertility, if causedby these factors,is usually reversible.
Infrequent sexual intercourse: This may sound like an obvious reason for enabling conception but there is more to it. Frequent, well-timed intercourse lays the foundation for the best chancesof getting pregnant. Research shows that regular sex can boost the immune system of the partners and reduce stress levels, thereby making conception easier.
Increased testicular temperature:For the healthy production of sperm, optimal testicular temperature (typically between 34 to 35ºC)is necessary. Several experimental studies have shown that exposure to heat and a continued sedentary posture may reduce semen quality. However, these effects may be reversible once the necessary changes are made to contributing circumstances. As a norm, it is good to wear loose-fitting clothes and underwear to avoid increasing the scrotal temperature.
Environmental factors:Sperm production or function may be affected by prolongedexposure to certain environmental elements (including industrial chemicals and lead).Excessive smoking and consumption of alcohol are associated with reduced sperm count and quality. Smoking produces a two-fold decrease in sperm count – one, due to the effect of nicotine, and,two, the reduction in the concentration of zinc in semen.
Obesity:Obese men tend to have higher levels of estrogen, which may lead to low sperm production(spermatogenesis) due to the suppression of FSH and LH by the brain. The increase in fat mass in men reduces plasma testosterone levels and also increases gonadal temperatures due to increased fat tissue around the testes. Reducing the weight by going on a healthy diet and increasing physical activity and exercise (to reach and maintaining a BMI of less than 25)may improve semen parameters.
Psychological stress: Stress reduces reproductive potential and causes suppression oftestosterone.Worrying about conception can slowly drive up stress levels and reduce the sex drive, so it is important to focus on the relationship and keep sex enjoyable. If necessary, the person can undergo non-pharmacological measures for stress management like behavioural therapy, counselling and support.
Improper diet: A diet that has a high concentration of foods high in saturated sugar and fat maylead to the production of high levels of bad cholesterol in the body. This induces excessive generation of highly reactive harmful chemicals called ‘free radicals’, which may damages the testicular cells and affect their ability to produce testosterone. Switching to a healthy diet that prioritises the consumption of vegetables, greens, nuts, fruits, fish, and low-fat dairy products can improve semen production and quality.
Lack of sleep:Too little sleep or irregular sleep patterns can affect a man’s fertility, says research studies. This is due to the fact that the majority of testosterone release occurs during sleep and improper sleep patterns can upset the balance.
Male Fertility Check-up: What, How and Why?
If you have any of the above risk factors and are concerned, it is good to consult a fertility specialist for right diagnosis and treatment. The following steps may be prescribed for the investigation.
Physical examination: Your doctor may want to do a general examination, such as height, weight, body mass index, fat distribution and genital examination of penis and scrotum for any abnormality.
Semen analysis: Semen analysis is the cornerstone of all laboratory evaluation. At least two samples will be collected, with a gap at least one week within 3 days of abstinence after the first collection. These samples are collected through masturbation or a special condom. If it is collected at home, it should reach the laboratory within 60 minutes for accurate results. ‘Semen concentration’refers to sperm density and it is measured in millions of sperms per millilitre of semen. The number of sperms that present in the total semen samples is called ‘sperm count’.
Hormonal test: This is a blood test undertaken to evaluate the functioning of the pituitary glands, which is responsible for the production of follicular stimulating hormone (FSH), luteinising hormone (LH), testosterone and thyroid stimulating hormone.
Scrotal ultrasound:This is a safe, non-invasive technique performed by using high-frequency sound waves to produce images inside the body.It helps to point out varicoceles, abnormalities in testicles and duct obstruction.
Trans-rectal ultrasound:This is a non-invasive, high-resolution imaging of the prostate, seminal vesicle and vas deferens.
Testicular biopsy: Thisis performed when a semen analysis shows abnormal sperms but the other tests have not pointed to any specific cause for the same. In this outpatient procedure, a small piece of tissue is take fromthe testicle and examined to find out if there are any blockages or underlying issues. In some cases, the same procedure is used to retrieve sperm to fertilise the eggs in assisted fertility procedures.
Post ejaculation urinalysis:A sample of the urine is taken following ejaculation and a physical, chemical and microscopic examination is conducted of the sample. If sperm if present in the urine, itmay reveals that the sperms are travelling backwards into the bladder (known as ‘retrograde ejaculation’).
Genetic testing:This is an essential part of the diagnosis process, and is used to identify changes in the chromosomes.
Seminal fructose test:In this test, the semen is tested for the presence of fructose, which is contributed by the seminal vesicle. The absence of fructose may indicate an obstruction of the seminal vesicle. This test is usually done along with the semen analysis.
Sperm DNA fragmentation:This is performed at laboratory using a semen sample obtained through ejaculation to check for a break or separation in one or both strands of DNA contained within the sperm.This is performed at laboratory using a semen sample obtained through ejaculation to check a break in one or both strands of DNA contained within the sperm.
Bloom Healthcare’s Approach
At Bloom Healthcare, we believe that each person is unique and provide a personalised approach. Men also feel frustrated, depressed and/or fearful when facing the possibility of infertility but often find it harder to open up and communicate about their emotions. The first step toresolving any is to approach a fertility expert and seek their guidance on diagnosis and next steps. At Bloom Healthcare, we assure you of a safe and private consultation with our team of fertility experts. They will establish a conclusive diagnosis based on test reports and advise on a suitable line of treatment. At every step, your health and well-being is our highest priority.
