These Fertility facts may help you understand the importance of a healthy lifestyle and how it can enhance your chances of conceiving and avoiding infertility.
Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. This is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity
The Sperms Role
Although it seems quite simple for a sperm to fertilize an egg, the process is quite precise. A man’s body must be able to fulfil the following criteria for natural conception to occur:
- Sustain an erection
- Produce enough healthy sperm that are the right shape and can move in the proper ways
- Produce sperm in the ejaculate to be emitted during intercourse
Problems that disrupt this chain of events reduce the chances of pregnancy.
Factors Influencing Fertility
Many factors resulting in male infertility can be diagnosed and treated, such as structural defects, problems with ejaculation and sperm, and immunologic conditions.
Problems that may reduce the health or number of sperm and affect fertility include:
- Alcohol, drug use or smoking
- Certain medications
- Environmental toxins
- Genetic conditions
- Chemotherapy / radiation
Factors relating to male fertility problems may include:
Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including:
- Hypogonadotropic hypogonadism due to various causes
- Obesity increases the risk of hypogonadotropic hypogonadism. Animal models indicate that obesity causes leptin insensitivity in the hypothalamus, leading to decreased Kiss1expression, which, in turn, alters the release of gonadotropin-releasing hormone (GnRH)
- Drugs, alcohol
- Strenuous riding (bicycle riding, horseback riding)
- Medications, including those that:
- Genetic abnormalities such as a Robertsonian translocation
Male smokers also have approximately 30% higher odds of infertility. There is increasing evidence that the harmful products of tobacco smoking kill sperm cells. Therefore, some governments require manufacturers to put warnings on packets. Smoking tobacco increases intake of cadmium, because the tobacco plant absorbs the metal. Cadmium, being chemically similar to zinc, may replace zinc in the DNA polymerase, which plays a critical role in sperm production. Zinc replaced by cadmium in DNA polymerase can be particularly damaging to the testes.
Common inherited variants in genes that encode enzymes employed in DNA mismatch repair are associated with increased risk of sperm DNA damage and male infertility. As men age there is a consistent decline in semen quality, and this decline appears to be due to DNA damage. These findings suggest that DNA damage is an important factor in male infertility.
Testicular factors refer to conditions where the testes produce semen of low quantity and/or poor quality despite adequate hormonal support and include:
- Genetic defects on the Y chromosome
- Abnormal set of chromosomes
- Neoplasm, e.g. seminoma
- Idiopathic failure
- Varicocele (14% in one study)
- Testicular cancer
- Defects in USP26 in some cases
- Acrosomal defects affecting egg penetration
- Idiopathic oligospermia – unexplained sperm deficiencies account for 30% of male infertility.
Radiation therapy to a testis decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes.
Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation:
- Vas deferens obstruction
- Lack of Vas deferens, often related to genetic markers for Cystic Fibrosis
- Infection, e.g. prostatitis
- Retrograde ejaculation
- Ejaculatory duct obstruction
The diagnosis of infertility begins with a medical history and physical exam by a physician, preferably a specialist with experience or who specializes in male infertility. Typically two separate semen analysis will be required. The provider may order blood tests to look for hormone imbalances, medical conditions, or genetic issues.
- The history should include prior testicular or penile insults:
- Sexual habits, frequency and timing of intercourse, use of lubricants, and each partner’s previous fertility experiences are important.
- Loss of libido and headaches or visual disturbances may indicate a pituitary tumor.
- The past medical or surgical history may reveal thyroid or liver disease (abnormalities of spermatogenesis), diabetic neuropathy (retrograde ejaculation), radical pelvic or retroperitoneal surgery (absent seminal emission secondary to sympathetic nerve injury), or hernia repair (damage to the vas deferens or testicular blood supply).
- A family history may reveal genetic problems.
- Usually, the patient disrobes completely and puts on a gown. The physician will perform a thorough examination of the penis, scrotum, testicles, anus and rectum.
The volume of the semen sample, approximate number of total sperm cells, sperm motility/forward progression, and % of sperm with normal morphology are measured. This is the most common type of fertility testing. Semen deficiencies are often labeled as follows:
- Oligospermia or Oligozoospermia – decreased number of spermatozoa in semen
- Aspermia – complete lack of semen
- Hypospermia – reduced seminal volume
- Azoospermia – absence of sperm cells in semen
- Teratospermia – increase in sperm with abnormal morphology
- Asthenozoospermia – reduced sperm motility
There are various combinations of these as well, e.g. Teratoasthenozoospermia, which is reduced sperm morphology and motility. Low sperm counts are often associated with decreased sperm motility and increased abnormal morphology, thus the terms “oligoasthenoteratozoospermia” or “oligospermia” can be used as a catch-all.
Common hormonal test include determination of FSH and testosterone levels. A blood sample can reveal genetic causes of infertility, e.g. Klinefelter syndrome, a Y chromosome microdeletion, or cystic fibrosis.
Some strategies suggested or proposed for avoiding male infertility include the following:
- Avoiding smoking as it damages sperm DNA
- Avoiding marijuana and alcohol use.
- Avoiding excessive heat to the testes.
- Sperm counts can be depressed by daily coital activity and sperm motility may be depressed by coital activity that takes place too infrequently (abstinence 10–14 days or more).
- When participating in contact sports, wear a Protective Cup and Jockstrap to protect the testicles. Sports suchas Baseball, Football, Cricket, Lacrosse, Hockey, Softball, Paintball, Rodeo,Motorcross, Wrestling, Soccer,
Karate or other Martial Arts or any sport where a ball, foot, arm, knee or bat can come into contact with the groin.
Treatments vary according to the underlying disease and the degree of the impairment of the male fertility. Further, in an infertility situation, the fertility of the female needs to be considered.
Pre-testicular conditions can often be addressed by medical means or interventions.
Testicular-based male infertility tends to be resistant to medication. Usual approaches include using the sperm for intrauterine insemination (IUI), in vitro fertilization (IVF), or IVF with intracytoplasmatic sperm injection (ICSI). With IVF-ICSI even with a few sperm pregnancies can be achieved.
Obstructive causes of post-testicular infertility can be overcome with either surgery or IVF-ICSI. Ejaculatory factors may be treatable by medication, or by IUI therapy or IVF.
The off-label use of Clomiphene citrate, an anti-estrogen drug designed as a fertility medicine for women, is controversial. Vitamin E helps counter oxidative stress, which is associated with sperm DNA damage and reduced sperm motility. A hormone-antioxidant combination may improve sperm count and motility. The Low dose Estrogen Testosterone Combination Therapy may improve sperm count and motility in some men. including severe oligospermia.
Getting to the bottom of fertility concerns:
The diagnosis of infertility begins with a medical history and physical exam by a physician, preferably a specialist with experience or who specializes in male infertility. Typically two separate semen analyses will be required. The provider may order blood tests to look for hormone imbalances, medical conditions, or genetic issues.
Often, there are no visible signs of male infertility. That’s why it’s important to have an open discussion with your doctor, urologist or a fertility specialist. Tell your doctor about your medical history, including past illnesses, medications, and surgeries. Also give current information about your lifestyle habits, diet, exercise, and any drug or alcohol abuse. Your doctor may order a semen analysis (SA). This is the single most important test for male fertility.
How is male infertility treated?
Some types of male infertility can be medically or surgically treated. If you are taking a medication that increases the risk of male infertility, your doctor may switch you to another medication. Also, STDs such as gonorrhea and Chlamydia can lower sperm count and mobility. Your doctor will test for STDs and provide medication if needed. In addition, when trying to get pregnant, it’s important to avoid toxins, alcohol, cigarettes, and other known hazards that may injure your sperm.
See a fertility specialist
Concerned about male fertility? The best route is a quick referral to a fertility center. A reproductive endocrinologist (RE) receives training in both female and male infertility and may be the best professional to explain your testing options. (list/links to clinics).
Male infertility and his manhood
Females often find it helpful to discuss health changes like infertility throughout their lifespan. Men, on the other hand, seem to get by just fine without talking about these things. Here are 5 reasons why:
- Men are encouraged to be strong. He can suppress his feelings about infertility because pain and weakness are not socially acceptable.
- Men are encouraged to provide for their families. He might feel like a failure for not providing you with a child.
- Men must be in control at all times. By not fathering a child he feels like he has let you, and others, down.
- A man often wants to have descendants to carry on his genes and the family name. He is disappointed that he is not fulfilling his end of this bargain.
- Men are encouraged to be highly sexual, with virile sex organs. Infertility affects his manhood and he may worry that he is less of a man because he is infertile.
As he struggles with these beliefs, wanting to stay strong, your partner may just be less likely to talk about his feelings and seek infertility support.
Men need infertility support, too
Close to 10 percent of all couples experience infertility at some point, with male infertility contributing to half of all couple’s fertility problems. While men may be less likely to openly seek infertility support, they are coping with infertility too. As you continue on your fertility journey, encourage your male partner to open up, take care of his physical and emotional health, and find helpful outlets for coping with infertility.