Male infertility is a rising cause of couples having issues conceiving. More often it goes undetected for longer as culturally India places the burden of fertility and reproduction on women. Read this article by Dr. Aakriti that clears up some misconceptions that can interfere with male fertility and overall health.

Infertility in men: Causes and treatment

Dr. Aakriti Gupta is a consultant gynaecologist and IVF specialist. She has a keen interest in spreading awareness around women’s health issues, and does so through her Instagram handle @doctor_the_healer.  She specializes in topics such as PCOS, male and female infertility and pregnancy.

Male infertility is a global health concern. According to a rough estimate, there are nearly 72.4 million couples across the world who experience fertility problems. World Health Organisation (WHO) estimates that 60-80 million couples worldwide who currently suffer from infertility and it varies across different regions in the world. In Indian couples seeking treatment, the male factor is the cause in approximately 23 percent. 

A recent report on the status of infertility in India, states that nearly 50 percent of infertility is related to the reproductive anomalies or disorders in the male. Also, over 25 percent of infertility cases, no detectable cause can be traced after routine tests, which leaves the case as unexplained infertility. According to several studies, overweight men are more likely than their peers with more normal weights to have low sperm counts or no sperm production at all, an important way to measure fertility. Genetics also play an important role in sperm development, but the extent to which heredity contributes to male infertility is not clear. 

What is sperm count? 

Normal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semen. A person is considered to have a low sperm count if you have fewer than 15 million sperm per milliliter or less than 39 million sperm total per ejaculate. Why does sperm count matter? If one is trying to conceive naturally, a healthy sperm count is often necessary. Even though it only takes one sperm and one egg to get pregnant, a greater number of healthy sperms will increase your chances of pregnancy each month. Even when you aren’t trying to conceive, your sperm count may be an important measure of overall health. One study found men with a low sperm count are more likely to have a higher percentage of body fat (bigger waistline and higher BMI) and higher blood pressure than men with higher sperm counts. They also experience a higher frequency of metabolic syndrome, or a higher chance of developing diabetes, heart disease, and stroke. For these reasons, if you’re diagnosed with a low sperm count, your physician may want to evaluate your testosterone levels, and assess your lifestyle. 

What is male infertility?

Male infertility refers to a male’s inability to result in pregnancy in a fertile female. Male factor infertility is seen as an alteration in sperm concentration and/or motility and/or morphology in at least two samples collected 1 and 4 weeks apart.

Semen analysis remains the single-most useful and fundamental investigation with a sensitivity of 89.6 percent, that it can detect 9 out of 10 men with a genuine problem of male infertility.

Overweight and sedentary lifestyle has long been linked to low sex drive and an increased risk of infertility in men. Research bears evidence to the fact that men who exercised and logged the most time doing intense workouts had better sperm quality than men who got the least amounts of exercise. Sperm abnormalities are also a critical factor in male infertility. These abnormalities

include:

  • Abnormalities in sperm count
  • Absence of sperm in seminal plasma
  • Low sperm count (oligozoospermia: <15 million sperms/mL)

Semen Parameter Table

Semen Parameter

WHO 1999 (Old)

WHO 2010 (Latest)

Volume (mL)

>2.0

1.5

Count (x106/Ml)

>20

_

15

Total sperm number/ejaculate

>40

39

Motility (%)

>50 (a+b)

32 (a+b)

Vitality (%)

>75

58

Morphology (%)2

(14)

4

Leukocytes (x10^/mL)

<1.0

<1.0

Causes of infertility in Men 

The exact reason for the decline in Semen quality is not clear, but it may be due to environmental, nutritional, socioeconomic, or other unknown causes. Aging is an important factor responsible for the decline in semen quality. 

Abnormal sperm production: Abnormal sperm production occurs due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm. 

Delivery of sperms: There can be problems in the delivery of sperms due to sexual problems such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs. 

Overexposure to environmental factors: Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, high blood pressure, and depression can also affect fertility. 

Frequent exposure to heat, such as in saunas or hot tubs, can raise body temperature and may affect sperm production. Damage is related to cancer and its treatment, including radiation or chemotherapy. Cancer treatment can impair sperm production.

Treatment for infertility in Men 

Infertility in men can be treated with lifestyle changes, medication, and/or surgery. For male patients with azoospermia (no sperm), donor sperm is often used to achieve pregnancy as an alternative when normal pregnancy is not possible. Alternatively, azoospermic males can achieve pregnancy by donor sperms.

When to see a doctor 

In case you’re trying to conceive, you can see a doctor after one year of unprotected sex that does not result in pregnancy. If the female partner is over 35, see a doctor after six months of unprotected sex that does not result in a pregnancy. If you are in a profession or have a medical condition that could negatively impact the sperm count, you should talk to a doctor as soon as possible. 

Disclaimer: This article is for informational purposes only and is not a substitute for medical advice or treatment.

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