Milann | The Fertility Specialist




Male Infertility: Causes, Testing, and Treatment Options

Male Infertility: Causes, Testing, and Treatment Options

Introduction to Male Infertility

What is Male Infertility?

Infertility in males refers to a health issue that reduces the chances of a man's female partner conceiving. Primarily, this is due to problems related to sperm production or delivery.

The Causes Behind Male Infertility

Medical Factors Contributing to Male Infertility

Multiple medical reasons can lead to male infertility. These may include:
  • Genetic Disorders: Conditions like Klinefelter syndrome, myotonic dystrophy, or microdeletion can adversely affect sperm production and health.
  • Varicocele: When veins that drain the testes become abnormally dilated, it increases the testicular temperature. This overheating of the testes can harm the number and form of the sperm.
  • Testicular Trauma or Inflammation: Direct harm or injuries to the tests can impair a man's fertility.
  • Oligospermia: It is a condition identified by low sperm count, or poor-quality sperm, that can interfere with conception.
  • Undescended Testes: An undescended testicle occurs when one or both of the testes fail to descend before birth. This condition is associated with decreased fertility.

Lifestyle and Environmental Factors Influencing Fertility

Various lifestyle and environmental factors can negatively impact male fertility.
  • Exposure to Harmful Pollutants and Chemicals: Environments with hazardous physical and chemical materials can potentially increase the risk of male infertility. Long-term exposure to elevated temperatures, such as in the metallurgical industry or from prolonged sitting, can also harm fertility.
  • Radiation Exposure: Elements like tight-fitting underwear, consistent use of mobile phones/laptops near the genital area, recurrent hot baths/saunas, and harmful chemicals like pesticide residue, bisphenol A, phthalates, or dioxin are reported to reduce sperm vitality and motility.
  • Microbial Dysbiosis: Changes to the human microbiome, which participates in both health and disease regulation, can be a risk factor for various non-communicable diseases. Testicular and/or gut microbiome-induced immune system activation may lead to inflammation and perturbed hormone secretion, affecting spermatogenesis and erectile function.
  • Lifestyle Factors: A well-balanced diet, regular exercise, and reducing consumption of harmful substances can contribute to healthier fertility levels. The Symptoms of Male Infertility

Common Signs Pointing Towards Male Infertility

Male infertility often occurs without obvious symptoms. However, some signs can indicate potential underlying fertility issues:
  • Ejaculation Issues: Problems with ejaculation, including infertility, a low volume of ejaculation, or difficulties in achieving or maintaining an erection.
  • Reduced Libido: A decrease in sexual desire.
  • Pain or Swelling in the Testicle Area: Testicular discomfort might involve pain, swelling, or the presence of a lump.
  • Significant Changes in Hair Growth: Hormonal imbalances might present themselves as decreased facial or body hair.
  • Abnormal Breast Growth: Known as gynecomastia, this is another potential sign of hormonal imbalances.
  • Low Sperm Count: A lower-than-normal sperm count, with fewer than 15 million sperm per millilitre of semen, or a total sperm count of less than 39 million per ejaculate, can be a sign of male infertility.
However, these symptoms do not necessarily indicate infertility, and you should always seek medical advice if you experience any of these symptoms and are trying to conceive.

When Should You Consult a Healthcare Provider?

It's recommended to consult with a healthcare provider if you and your partner have been trying to conceive for a year or more without success. Early consultation may be beneficial if there is a known issue associated with male partner fertility, such as:
  • History of genital, prostate or sexual problems.
  • Surgery on your reproductive organs or hernia repairs.
  • Being diagnosed with a hormonal or genetic disorder.
  • Family history of fertility problems, particularly affecting men.
  • Lifestyle and environmental conditions, such as frequent exposure to certain chemicals or radiation.
  • Dealing with mental health problems related to infertility.
These consultations can then lead to an appropriate and tailored fertility workup for your particular situation.

Testing for Male Infertility

Who Conducts Diagnoses for Male Infertility?

The diagnosis of male infertility is typically conducted by a urologist who specializes in male reproductive medicine. A urologist has the required training and expertise to evaluate, diagnose, and potentially treat male infertility. In some cases, consultation with an endocrinologist may also be recommended if hormonal imbalance is suspected.
It's important to communicate openly and honestly with your healthcare provider about any health concerns, changes in your health status, or difficulties with sexual function, as this information is crucial in giving an accurate diagnosis and effective treatment plan.

Essential Evaluations Required for Diagnosing Male Infertility

The evaluation of male infertility often entails a comprehensive medical history review, physical examination, and laboratory investigations.
Medical History: Generally, it covers the duration of infertility, prior fertility experience, timing of puberty, childhood urological disorders, acute or chronic medical illnesses, sexual history, medication use, and family history.
Physical Examination: A careful examination includes checking the testicles for size, consistency, and symmetry. The epididymis, vas deferens, and spermatic cords are checked for any abnormalities. The penis is also checked for any anatomical abnormalities. A rectal exam might also be carried out to check for any prostate or seminal vesicle abnormalities.
Laboratory Tests: Typically, this involves one or more semen analyses for evaluation of fertility. Other laboratory tests might be indicated based on the findings from the history and physical examination.
If abnormalities are detected in any parameters of the semen or the patient's physical examination, further evaluations may be performed by a male reproductive expert, including genetic counselling or more specialized tests when required.

Treatment Options Available for Male Infertility

Medical and Nutritional Interventions for Fertility

Medical treatment for male infertility is dependent on the root cause. Interventions might include adjusting lifestyle factors, over-the-counter (OTC) or prescribed medications, surgery, or assisted reproductive technologies (ARTs) if necessary.
Lifestyle Adjustments: Adopting a healthy lifestyle is pivotal for improving fertility, including balanced nutrition, maintaining a healthy weight, avoiding smoking, and exercising regularly.
Nutrition: Consuming a balanced diet that includes folic acid, zinc, and antioxidants—found in fruits, vegetables, whole grains, and lean proteins—can contribute to better sperm health. Vitamins such as vitamin D and co-enzyme Q10 also play an important role.
Medications: Certain medications, such as antibiotics, can treat infections in the reproductive tract that might be negatively affecting sperm production or function. Hormonal medications, including testosterone supplementation or medicines that regulate hormones, may also be prescribed to improve male fertility.

Surgical Remedies Including Varicocele Repair/Varicocelectomy

Surgical solutions could be considered in certain cases where there's a correctable cause of infertility. Varicocele repair, also known as a varicocelectomy, is one such option.
A Varicocele is a common condition characterized by dilated varicose veins in the scrotum, similar to varicose veins that occur in the leg. Varicoceles can decrease sperm production, quality, and motility, which can lead to infertility.
In men attempting to conceive who have palpable varicocele(s), below-normal semen parameters, and infertility, surgical varicocelectomy could be a viable treatment strategy. Notably, varicocelectomy is not recommended for men with non-palpable varicoceles detected solely by imaging.

Assisted Reproductive Techniques (ARTs): A Glimpse into IVF/ICSI

When other interventions have not been successful or if a couple is dealing with unexplained infertility, Assisted Reproductive Techniques (ARTs) could be a viable option. ARTs include various procedures to assist in achieving a pregnancy, such as In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI).
IVF is among the most efficient treatments for infertility. This process comprises collecting a woman's eggs from her ovaries and fertilizing them in a lab with her partner's sperm. The embryos are then implanted back into the woman's uterus.
When IVF alone doesn't work or when male fertility issues are severe, ICSI may be an effective alternative. During ICSI, a single sperm is directly injected into an egg to achieve fertilization. This process is particularly beneficial when the sperm count is very low or if the sperm cannot move effectively.
Although ARTs have improved the success rates for treating infertility, potential complications include an increased risk of multiple pregnancies, ovarian hyperstimulation syndrome, and low birth weight in babies. Therefore, it's crucial to have thorough discussions with healthcare professionals when contemplating such methods.

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