What is male infertility

In couples, infertility has become a common problem. And not only women but men too suffer from infertility issues. Infertility issue in men is known as male infertility. Approximately 30 to 50% of couples are struggling with male infertility.

What is Male Infertility?

Male infertility is a health issue caused due to problems in the male reproductive system. A male faces a problem in either sperm production or sperm deposition into the female reproductive tract, lowering the chances of his female partner getting pregnant.

 Approx 13 out of 100 couples can’t get pregnant even though they’ve had frequent, unprotected sexual intercourse for a year or longer. Injuries, illness, chronic health problems, lifestyle choices and other factors may contribute to male infertility.

what causes male infertility

What Happens under Normal Conditions?

Usually, sperms are produced in the testicles that are in the scrotum, stored in a sac called the epididymis, and transported via a tube called the Vas Deferens. During ejaculation, the sperm mixes with fluid from the prostate and seminal vesicles, which form semen. This semen travels via the urethra (male urine tube) and is ejaculated out of the penis.

Male fertility depends upon your body making normal sperm and delivering them into your female partner’s vagina. These sperms travel through the female partner’s cervix into the uterus and her fallopian tubes. And when a sperm and egg meet, fertilization happens.

What Causes Male Infertility?

Making healthy mature sperm that can travel and fertilize the egg depends on several things. Problems with erection and ejaculation may mean you have infertility. And even the temperature of the scrotum may also affect fertility. Below are the leading causes of male infertility:

1. Sperm Disorder

The most common cause of male infertility is sperm disorder. It may be abnormally shaped, immature, unable to swim, or you may not have enough sperm or may not make any sperm.

Lifestyle choices play an essential role in the quality and quantity of sperm, such as smoking, drinking alcohol, and taking certain medications. It also affects sperm production, function and delivery. Medications to treat health problems like arthritis, depression, anxiety or depression, infection, cancer, etc., can lower sperm count.

 There can also be other causes of low sperm numbers such as long-term sickness such as kidney failure, childhood infection such as mumps and chromosome or hormone problems such as low testosterone.

2. Structural Problem

Sometimes the tube through which sperm travels are blocked, which stops the flow of semen. This could be because of repeated infections or inflammation from a sexually transmitted disease, swelling, surgery, genetic or congenital disability.

3. Hormonal Imbalance

Hormonal imbalances such as thyroid disorder, low testosterone levels, pituitary or adrenal disorders etc., can affect sperm production and deposition. Very low hormone levels also cause poor sperm growth.

4. Environmental Factors

Exposure to harmful chemicals or radiation affects sperm count and motility when working in high temperatures.

Factors in Male Infertility

5. Other Factors

Other factors may include erectile dysfunction or premature ejaculation, liver or kidney disease, or treatment for seizure disorders, which are examples of problems that can also cause infertility.

How is Male Infertility Diagnosed?

Diagnosis of male infertility starts with reviewing a complete history and physical examination. The problem is usually with sperm production or delivery. Following are the other tests for male infertility: –

1. Semen Analysis

Semen analysis is done to know the level of sperm production and its functioning. It tells how much sperm you make, how well they move, and their shape. Two semen analysis is done on separate days. It tells about one’s ability to conceive.

If your test shows a low number of sperm or no sperm, it does not mean you are permanently infertile. It shows that there may be a problem with the growth and delivery of sperm.

2. Testicular Biopsy

Suppose semen analysis shows a meagre number of sperm or no sperm. You may be told for a testicular biopsy. In this, a small piece of tissue is removed from each testicle and studied under a microscope. This helps find the cause of infertility and can collect sperm for use in assisted reproduction, such as IVF.

3. Transrectal Ultrasound

Your health care provider may tell you for a transrectal ultrasound. In this ultrasound, sound waves bouncing off an organ are used to get a picture of the organ. In the rectum, a probe is placed, which beams the sound waves to the nearby ejaculatory ducts. It helps doctors to see if structures such as the ejaculatory duct or seminal vesicles are blocked or poorly formed.

4. Blood Test

Your health care provider may use blood tests to check hormone levels and rule out other major health problems.

How is Male Infertility Treated?

The treatment of male infertility varies from person to person, depending on the cause of infertility. Most male infertility can be treated without surgery. There are three categories of male infertility:

  • Treatment with assisted reproductive techniques
  • Treatment with medicines
  • Treatment with Surgery

1. Treatment with Assisted Reproductive Techniques (ART)

Health care provider usually suggests this technique in case infertility treatment fails or there is no treatment.

(A) Intrauterine Insemination (IUI)

This treatment is used for patients having low sperm count, movement problems, retrograde ejaculation or any other cause of infertility. In this method, the health care provider puts much healthy sperm at the entrance of the cervix or into the female partner’s uterus. And sperm make their way to the fallopian tube.

(B) In Vitro Fertilization (IVF)

In IVF, the female egg and sperm are met in a laboratory, and after 3 to 5 days of growth, it is placed in the uterus. This is generally used where the male partner has very severe and untreatable oligospermia, low sperm count, and for women with blocked tubes or unexplained infertility.

(C) Intracytoplasmic Sperm Injection (ICSI)

 It is a treatment used for severe male infertility. A single sperm is implanted into the egg with the help of a tiny needle. And as the egg is fertilized, it is put in the female partner’s uterus.

Sperm Retrieval Process for Assisted Reproductive Techniques (ART)

Following are the different methods of sperm retrieval for ART. These methods are used to get the best quality and quantity of sperm.

(a) Testicular Sperm Extraction (TESE): – This technique is used to diagnose the cause of azoospermia (no sperm). A small portion of the tissue is removed from the testicles, and sperm cells are extracted for further procedure.

(b) Testicular Fine Needle Aspiration (TFNA): -It is sometimes used to collect sperm from the testicles.

(c) Percutaneous Epididymal Sperm Aspiration (PESA): – It is performed under general anaesthesia. The urologist attaches a needle to a syringe into the epididymis. Then they gently withdraw fluid. It is not always possible to get sperm. So, they may tell you about surgery.

(d) Microsurgical Epididymal Sperm Aspiration (MESA): -In this process, sperm are recovered from the epididymal tubes using a surgical microscope. It yields a high quantity of motile sperm, which can be frozen and thawed later for IVF treatments.

2. Treatment with Medicines

If you have a hormone disorder causing your infertility, hormone treatment may help you. Hormone imbalances can affect how sperm develop. Treatment may include antibiotics or gonadotropin therapy.

3. Treatment with Surgery

Much male infertility is treated without surgery. However, if it is required to fix the problems, your health care provider will inform you. Surgery is done to remove twisted, swollen veins in the scrotum, etc.

Frequently Asked Questions (FAQs)

You may suffer from a male infertility problem if your female partner has not become pregnant even after trying for a year without birth control. It would help if you visited the doctor to know the cause of infertility. However, other symptoms include: –

  • Erectile Dysfunction
  • Pain or significant injury in the testicles
  • Hormonal imbalance
  • Reduction in sperm counts

You must consult a fertility specialist immediately if you cannot conceive even after a year without unprotected intercourse. Consult a doctor even if you have any of the following problems:-

  • Low sperm count
  • Decrease sexual desire
  • Erection problem, difficulty in ejaculation, or small volume of ejaculate
  • Partner above 35 years of age who cannot conceive after trying for six months.
  • Swelling in the scrotum
  • Lumps or pain in the groin
  • Undergone or will be undergoing cancer treatment
  • Any history of sexual, prostrate, or testicular problems
  • Abnormal breast growth
  • Record of infertility in family ancestry.

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