Up to 15 percent of couples are not able to conceive even though they've had frequent, unprotected sexual intercourse for a year or longer.
In up to half of these couples, there is some problem with the male. This problem can be in ability to generate good fertile semen or in ability to perform the act of intercourse.
Male infertility is due to low or absent sperm production, abnormal sperm function or blockages that prevent the delivery of sperm.
Symptoms of male infertility:
The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes signs and symptoms.
Although most men with male infertility do not notice symptoms other than inability to conceive a child, signs and symptoms associated with other disorders causing infertility may be present such as:
• Sexual Problems like inability to perform the act of intercourse, difficulty with ejaculation or small volumes of fluid
ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
• Pain, swelling or a lump in the testicle area
• Recurrent respiratory infections
• Inability to smell
• Abnormal breast growth (gynecomastia)
• Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
Male fertility physiology:
Male fertility is a complex process. To be fertile, initially, involves the growth and formation of the male reproductive organs during puberty. At least one of the testicles must be functioning correctly, and body must produce testosterone and other hormones to trigger and maintain sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
If the number of sperm in husband’s semen (sperm count) is low, it decreases the chances that one of the sperm will fertilize partner's egg. A low sperm count is less than 20 million sperm per milliliter of semen or fewer than 40 million per ejaculate. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate partner's egg.
Causes for male infertility:
Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:
1. Varicocele (a swelling of the veins that drain the testicle).
2. Infection. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV.
3. Ejaculation issues.Retrograde ejaculation may occur in diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra. Some men with spinal cord injuries or certain diseases can produce or generate sperms in testes but can't ejaculate semen.
4. Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
5. Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
6. Undescended testicles.In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). These males may have decreased fertility
7. Hormone imbalances.Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
8. Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including injury from surgery, infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.
9. Chromosome defects.Inherited disorders such as Klinefelter's syndrome (male is born with XXY chromosomes instead of normal XY) cystic fibrosis, Kallmann's syndrome and Kartagener's syndrome.
10. Problems with sexual intercourse: Erectile dysfunction, premature ejaculation, painful intercourse, hypospadias, or psychological /relationship problems
11. Celiac disease.A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
12. Certain medications.Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
13. Prior surgeries.Certain surgeries may prevent from having sperm in ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers.
14. Industrial chemicals. . Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
15. Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
16. Radiation or X-rays. Exposure to radiation can reduce sperm production, which can be reversible.
17. Overheating the testicles. Elevated temperatures impair sperm production and function. Frequent use of saunas or hot tubs may temporarily impair sperm count. Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and may slightly reduce sperm production.
18. Illicit drug use. Anabolic steroids taken to stimulate muscle strength, cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
19. Alcohol use. Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
20. Tobacco smoking.Men who smoke may have a lower sperm count than do those who don't smoke.
21. Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
22. Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.
Diagnosis and investigations:
1. Semen analysis.Patient has to provide a semen sample by masturbating and ejaculating into a special container at the lab. Semen should be examined within half hour of collection into that container. In laboratory the pathologist measures the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm, pus cells in the semen. Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results.
2. Scrotal ultrasound. A scrotal ultrasound can help us to see if there is a varicocele or other problems in the testicles and supporting structures.
3. Hormone testing. Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems might also contribute to infertility. A blood test measures the level of testosterone and other hormones.
Less frequently following tests may be required: Post-ejaculation urinalysis, genetic tests, Testicular biopsy, specialized sperm function tests, trans-rectal ultrasound.
Treatments for male infertility:
1. Surgery. Varicocele surgery. Microsurgery to remove the blocks in vas deferens, reversal of prior vasectomies, can be done if indicated. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
2. Treating infections. Antibiotic treatment might cure an infection of the reproductive tract, but doesn't always restore fertility.
3. Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
4. Hormone treatments and medications.. Hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones can be the treatment for some patients.
5. Assisted reproductive technology (ART).ART treatments involve IUI, IVF, ICSI, Testicular or epididymal sperm retrieval techniques to use sperms for IVF-ICSI etc are advanced treatment options in selected patients.
6. Donor semen: Donor insemination or donor semen can be used for IVF ICSI if sperm production is absent
7.Last resort can be adoption.