INFERTILITY: What is male infertility?

To begin with, infertility refers to inability of a couple to achieve pregnancy after one year of unprotected sexual intercourse.

Male infertility is the inability of a man’s semen to cause pregnancy in a woman who is capable of conceiving. Male infertility contributes to approximately 30-35 per cent of all infertile cases.

1. When or how does a married man realize he is infertile?
2. Usually, the man and his partner will have been trying but failing to conceive for at least a year with regular unprotected sexual intercourse. This usually triggers a visit to the doctor who will run fertility tests.

The doctor will ask about your history; past surgeries, medications, physical exercise, smoking or recreational drug use, your sex life, past history of sexually transmitted diseases, etc.

He will then do all or some of the following tests;

• Physical exam especially of the groins and genital area
• Semen and sperm analysis
• Hormone evaluation for testosterone, FSH etc.

However, most men, especially in our African setting where infertility is still associated with women only, will realise their infertility after separating with their spouses who later conceive and have children in their next marriages.

1. What are the major causes of infertility in men?
2. Male fertility is complex. To get your partner pregnant, the following must occur:

• You must produce healthy sperm.Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
• Sperm have to be carried into the semen.Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
• There needs to be enough sperm in the semen.If the number of sperms in your semen (sperm count) is low, it decreases the odds that one will fertilize your partner’s egg. A low sperm count means fewer than 15 million sperm per milliliter of semen or less than 39 million per ejaculate.
• Sperm must be functional and able to move.If the movement (mobility) or function of your sperm is abnormal, it may not be able to reach or penetrate your partner’s egg.

Medical causes of male infertility:

Problems with male fertility can be caused by a number of health issues, including the following:

• A varicocele is a swelling of the veins that drain the testicle. It is the most common reversible cause of male infertility. Varicoceles result in reduced quality of the sperm.
• Some infections can interfere with sperm production, sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV.
• Ejaculation issues.Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra. Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm.
• Antibodies that attack sperm.Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
• Undescended testicles.In some males, during fetal development one or both testicles fail to descend from the abdomen into the scrotum. This leads to higher risks of infertility.
• Chromosome defects.Inherited disorders such as Klinefelter’s syndrome – in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) – cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.

Environmental causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

• Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
• Exposure to lead or other heavy metals also may cause infertility.
• With high exposure to radiation, sperm production can be permanently reduced.
• Overheating the testicles.Elevated temperatures impair sperm production and function. Although studies are limited and inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.

Other causes include drug abuse, alcohol, smoking, and depression.

1. Is male infertility curable?
2. Treatment of male infertility depends on the cause. Some causes may be cured while others may not be curable.
3. What is the cure or treatment?
4. Cure may involve medications as prescribed by your doctor or even surgery.
5. What if it fails, what can an infertile man do to have children of his own?

Usually if medications and surgery fail, Assisted Reproductive Technology (ART) can be used. These may include Intrauterine Insemination (IUI), In-vitro Fertilization (IVF), Intra Cytoplasmic Sperm Injection (ICSI), and cryopreservation of gametes or embryos.