The Truth Behind Male Infertility

When we speak about infertility, what’s the first thought that comes to our mind? Do we still assume it could be a woman’s problem? But, isn’t the sperm as important as an egg when it comes to conception? Evidence suggests that, 9% of couples struggle with fertility problems worldwide, out of which male infertility accounts for 50% of the issues.¹

Despite this fact, in some communities, a woman is blamed for infertility. Discrimination, social exclusion, and abandonment are a few consequences they have to face. But, we all know that it takes two to make a baby, don’t we?^2,3      

So, as a couple, if you are being treated for infertility, knowing the right diagnosis and treatment can be helpful.⁴

“The first step toward change is awareness. The second step is acceptance”

- Nathaniel Branden

In this article, we will discuss the causes of male infertility, diagnosis and treatment options, as well as some tips to improve your sperm health.

What Is Infertility? 

Infertility is a disease that affects both males and females, wherein the reproductive system fails to reproduce (depending on the specific sexual health issue which may vary)6. Having said that, infertility in men is usually treatable except for some extremely rare cases ⁷. 

Understanding Male Infertility: Causes, Diagnosis, And Treatment

One of the main infertility symptoms is the inability to conceive after one year of unprotected sex. And, when it comes to evaluating male infertility, it usually starts with a complete look at an individual’s medical, sexual, and personal history that include:⁵

• Family history
• History of significant trauma on the pelvis
• Reproductive history
• Occupation
• Alcohol intake
• Smoking habits
• History of previous chemo/radiotherapy
• Surgical history 
• Previous exposure to toxic chemicals
• Sexually Transmitted Infections (STIs) ⁵ 

Problems with male fertility can be due to a combination of various factors such as hormonal, physical, genetics, or environmental.⁶ We will now learn about them in detail:

Causes Of Male Infertility

Hormonal Defects

The hypothalamic-pituitary-gonadal network needs to work in coordination to provide the right concentration of hormones for normal testicular function in males. This network is made up of:^6,7 

• Gonadotropin-releasing hormone (GnRH) secreted from the hypothalamus i.e. a part of your brain
• Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) produced by the pituitary gland i.e. located at the base of your brain
• Testosterone produced by the gonads

These hormones are required for optimal development and functioning of the male reproductive system. Any dysfunction in the process of hormone secretion can lead to infertility in men. Hence, a hormonal evaluation is one of the many important parameters in assessing male infertility.^6,7

Physical Reasons

Disturbed sperm production and blocked ejaculatory path have been observed to affect male fertility. ⁶ And, this could be due to the following reasons:

1. Varicocele (when veins inside the scrotum become enlarged) affects about 40% of men who are facing infertility issues.⁶ 
2. Testicular torsion (when a testicle rotates and twists the spermatic cord) can cause testicular damage due to the pressure on sperm vessels.⁶ 
3. Chronic and acute genital tract infections can also lead to infertility in men.⁶
4. Sexually Transmitted Diseases (STDs) such as chlamydia and gonorrhea can also cause male infertility problems. This is often a result of an obstruction in the epididymis (a tube that stores and carries sperm).⁶

Environmental Factors

Environmental factors such as exposure to radiation or solvents hamper sperm production and affect fertility. Occupations that need prolonged sitting or exposure to high temperatures can also negatively affect male fertility. Additionally, excessive intake of saturated fats and high glycemic index foods can also be one of the triggers for male infertility.^6,9

Genetic Factors

Research suggests that genetic factors are the reasons for 15% of male infertility cases and can be classified as chromosomal abnormalities (a disorder or alteration in chromosomes) or single-gene mutations (DNA changes in a specific gene). Absence or unusual rearrangement of genetic material at the chromosomal level can cause infertility in men.⁶

Cancer And Cancer Treatments

Men diagnosed with cancer or undergoing cancer treatments are concerned about their ability to have a child. This is because cancer therapies such as chemotherapy and radiation therapy can impair fertility.¹⁰

However, “sperm disorders” is yet another factor that causes infertility in men. Sperm disorders are the problems that affect an individual’s capability to produce healthy sperms. Furthermore, it also inhibits the growth of sperm cells, and negatively impacts the quality of sperm11.

Now let’s discuss about 2 sperm disorders: 

• Azoospermia - It is a condition in which the ejaculate (semen) doesn’t consist of sperm. This disorder could arise due to hormonal problems, issues with testis, ejaculation difficulties and reproductive tract blockage12. 
• Oligospermia - It’s a condition wherein the sperm count of an individual is very low (less than 15 million sperm in 1mL of semen)13. 

Symptoms

The most apparent symptom of infertility in men is that an individual is unable to have a child with his sexually fit partner. However, in some rare cases, an underlying condition like twisted and enlarged veins around testicles, hormonal imbalance, etc. can also cause similar symptoms (related to infertility)⁷.

Following are some warning signs to look out for⁷:

• Abnormal growth of breasts
• Inflammation or unfamiliar mass growth in the testicular area
• Decreased facial or body hair
• Abnormal sexual function, such as erectile dysfunction (difficulty in maintaining an erection), less libido (reduced sexual drive), little to no ejaculation

Diagnosis And Tests For Male Infertility

Semen analysis is a painless, non-invasive test in which a semen sample, usually obtained through masturbation, is microscopically tested to determine the quality and quantity of sperm. The following are some of the main factors that help in evaluating sperm health: 

• Quantity - At least 16 million or more sperm every milliliter (ml) of semen is required in the quantity ¹²
• Movement - The sperms need to wriggle and swim. Hence, we need strong swimmers for you to be fertile
• Structure - A healthy sperm has an oval head and strong long tail

Furthermore, here are the lower reference limits of semen parameters according to the World Health Organization (WHO) based on which sperm analysis is done:¹²

• Sperm volume = 1.4 ml to 6.2 ml
• Sperm concentration = 16 million to 208 million
• Total sperm count = 39 million to 701 million per ejaculate
• Sperm vitality = 54% to 97%
• Progressive motility = 30% to 77%
• Non-progressive motility = 1% to 32%
• Total motility = 42% to 90%
• Immotile sperm = 20% to 58%
• Normal shaped sperm = 4% to 39%

There are also some other additional tests recommended to determine specific factors affecting male fertility. They include:

Hormonal Tests

If there is any abnormality in the hormone secretion process by the hypothalamic-pituitary-gonadal network, it may lead to male infertility. In such cases, hormonal tests might be recommended for men who have a low sperm count or concentration. Serum Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), prolactin, and testosterone are the hormones that may be evaluated to determine male infertility.

DNA Integrity Test

A DNA integrity test is recommended for those who have experienced recurrent miscarriages. This test helps to assess the degree of sperm DNA fragmentation (where sperm quality is measured) in the provided sample.

Genetic Testing

There is also an increased chance for  sperm concentration to be affected as a result of  underlying genetic causes. In such instances, genetic testing might be recommended for males with severe oligozoospermia (< 5 million sperm/ml) or azoospermia (absence of spermatozoa in the ejaculate).

Post Ejaculate Urine Analysis

This test looks for sperm in urine, which can result from retrograde ejaculation. Retrograde ejaculation occurs when the sperm enters the bladder instead of exiting the penis. This test is usually recommended to men who have low semen volume (less than 1.0 ml) 5.  

Treatment Options For Male Infertility

• Surgical Treatment And Corrections

Corrective surgeries are highly recommended in case someone has had vasectomy (surgical procedure to split and separate vas deferens for sterilization purposes) in the past or has an impaired varicocele (the vein that takes deoxygenated or poor oxygen blood away from the testicle).²,³ 

• Vasectomy Reversal

If a patient has had a vasectomy, a surgery such as vasectomy reversal will help. In this surgery, the separated vas deferens (the tube that sends sperms towards urethra) is simply reconnected back to its functioning position.⁴ 

• Vasoepididymostomy

In some cases the patient may have blockage in their vas deferens due to some infection, injury or past vasectomy surgery. This blockage can be surgically removed  by cutting the vas deferens and re-connecting them at the ends, leaving the blockage out of the path.⁴ 

• Surgical Sperm Retrieval

Surgical sperm retrieval is highly effective when a patient has a vas deferens blockage or a birth condition in which their vas deferens is absent. This procedure is also preferred in the event the patient has gone through irreversible vasectomy.⁵ 

The surgical retrieval of sperm could be done in 2 ways-⁵

1. PESA: It stands for Percutaneous Epididymal Sperm Aspiration. It is the procedure in which the sperm is collected directly from the epididymis (where the sperm is stored)  with the help of a very thin needle.
2. TESE: It stands for Testicular Extraction, it is also a surgical procedure for retrieval of sperm. But in this, the sperm is collected from the biopsy (extraction of tissue sample) of a testicle tissue.

• Physical Examination 

The basic physical examination of the patient (who is experiencing infertility) includes a variety of tests -

• General Physical Examination

Under physical examination the height, weight, BMI (Body Mass Index), muscle and fat distribution along with waist circumference of the patient are measured.⁴ It is a crucial step in the initial evaluation of male infertility, especially in cases wherein the cause of infertility is unknown.⁶ 

• Genital Examination

In this, every part of the male genitalia (male reproductive system) is checked and the doctor examine following-⁶ 

1. Epididymis (where the sperm is stored) and vas deferens are checked for cysts, their overall size, etc.
2. Presence of varicocele (dilated veins inside the scrotum) 
3. Penis (male reprouctive/ sex organ) is checked for its overall anatomy, the curvature, etc.
4. Testes (male reproductive gland that produces sperm and secretes hormones) are checked for their location, size, etc

• Secondary Sex Characteristics

After the general physical health examination, other traits like secondary sex characteristics are also considered6. Under this, the gynecomastia (growth at chest of males due to imbalance of hormones), body proportions, and distribution of general hair along with pubic hair are checked.

• Digital Rectal Examination

An examination of the prostate (it is the gland that provides nourishing fluid for sperm and helps them to move) is also done by the doctor. Wherein the physician may look for the presence of nodules, soreness or pain at the prostate.

• Ultrasound or Ultrasonography

Ultrasound is mainly used for the imagining of the male genitalia, for identifying the cause of infertility caused by blockage. Other than this, the ultrasound scans can also be helpful in assisted reproduction where the steps like sperm aspiration and in-vitro fertilization are involved.⁷ 

Under this, ultrasound scans of the male reproductive system, including the scrotum, vas deferens, rectum, epididymis, seminal vesicles (glands that create fluid that turns into semen), and urethra (duct that transports pee from the bladder to the exterior of the body) are taken.

Because sperm count varies, a diagnosis based just on sperm count may be inadequate. As a result, additional testing, such as ultrasound scans, is carried out. Although ultrasound scans are not a treatment option for male infertility, they are useful in determining the root cause of reproductive problems.⁸

• Antisperm Antibody Testing

Antisperm antibodies are cells that perceive sperm cells as invaders and attack or kill them. Antisperm antibody cells can exist in both males and females, affecting the conceiving process in many couples.⁹,¹⁰

In males, the antisperm antibody could lead to following complications:¹¹

• Decreased sperm mobility
• Sperm agglutination (clumping of cell particles)
• Ability to penetrate through the cervical mucus membrane
• Ability to penetrate the egg’s outermost layer
• Affects sperm-egg interaction & initial embryonic development

The antisperm antibody test is a method that checks for the presence of antibodies.⁹ Antisperm antibody testing checks for antibodies that fight sperm in the blood or sperm. In this test, a sperm sample is taken and mixed with a chemical that only binds to affected sperm. If sperms are binded with the chemical, the presence of an antisperm antibody is detected.

Ways To Improve Your Sperm Health: Diet & Nutrition

 Nutritional intervention is an important parameter in the treatment of male infertility. It can both negatively and positively affect the quality of semen.⁹  

Improper dietary patterns such as skipping meals and insufficient intake of antioxidants have been observed in infertile men. So, it is advisable to consume a balanced diet that consists of:⁹

• Fish and seafood
• Lots of fruits and vegetables
• More nuts and seeds
• Low-fat dairy products
• Olive and canola oil

Additionally, there are also a few lifestyle changes recommended to help with infertility such as: avoiding hot baths and tight-fitting clothes, limiting alcohol intake, and managing stress.⁵

Reasons To Visit A Doctor

If you and your partner have been trying to conceive for an year (by engaging in unprotected sexual intercourse¹⁴) but have been unsuccessful, you both should consult a specialist. Also, if any of you are experiencing above mentioned symptoms, it could be a potential sign of an underlying reproductive condition.

LifeCell Wishes To Support You In Your Parenthood Journey

Dealing with infertility could be challenging, but being informed and aware of your fertility potential can help. Focus on yourself, understand the cause of male infertility and decide the next step. 

So, are you ready to give your fertility journey a positive kickstart? Then visit any nearby laboratory to test your semen or order an at-home test kit!