Male Infertility: All You Need To Know

Male infertility is any health issue that reduces a man’s chances to conceive with his partner. In infertility cases worldwide, one-third is the man’s fault. In Nigeria, it is as much as 40%. A study was conducted in southeastern Nigeria with 314 couples in Southeastern Nigeria. Male factor infertility was 42% and female factor is 25.8%.

How Sperm Is Produced.

• The male sex hormone (testosterone) and sperm are made in the two testicles (ball-sacs)
• The testicles are located inside the scrotum (the sac located below the penis)
• When sperm leaves the testicles, they go into a tube called the epididymis
• Before ejaculation, the sperm goes from the epididymis into tubes called the vas deferens
• The vas deferens connects to the ejaculatory duct
• When you ejaculate, sperm mixed with fluid from the prostate and seminal vesicles travel through the ureter out of the penis

Signs & Symptoms/ When To See A Doctor

The no 1 sign of male infertility is the inability to conceive. However, there are cases where there are underlying problems. These signs should prompt you to see a doctor.

• Sexual function problems: Difficulty in ejaculating, a small volume of ejaculation
• Pain, swelling, or lump in the testicular area
• Inability to smell
• Low sperm count
• History of testicle, prostate, or sexual problems
• Male breasts (gynecomastia)
• Testicular surgery, penis surgery
• Partner over the age of 35

Causes of Male Infertility

They can be broken down into

• Problems with sperm production and problems with sperm mobility

Problems With Sperm Production

This happens when there is an issue that causes a man to have low sperm count or abnormal sperm cells.

Varicocele: These are swollen veins in the testes. It occurs in 16 out of 100 men. They hurt sperm growth by blocking blood drainage. This makes the testicles too warm to produce sperm.

Undescended Testes (cryptorchism): This is when the testicle has not descended to its normal position in the scrotum

Absence of one or more testes (anorchism): This is when a testis or both are absent in the individual

Infections: Testicles (orchitis), prostate (prostatitis), epididymitis, gonorrhea, testicular inflammation.

Chemotherapy: Undergoing cancer treatment. Some cancer treatment drugs can cause a reduction in sperm production.

Certain medications: Steroids, high blood pressure, and some liver medications can also affect sperm production.

Genetic abnormalities (chromosomal defects): Klinefelter’s syndrome is when a male is born with two x chromosomes and one Y chromosome ( instead of one x and one y chromosome). This can cause abnormal development of male organs.

Hormonal Problems: The pituitary, thyroid, and adrenal glands abnormalities can affect the production of testosterone. Low testosterone in males is called hypogonadism.

Tumors: Cancer and other non-malignant tumors can affect the production of sperm.

Surgeries: Vasectomy, testicular torsion, prostate and bladder surgeries.

Problems Affecting Sperm Mobility

Defects of tubules that transport sperm: Vas deferens surgeries (vasectomy). Trauma to the penis affects the tubules.

Antibodies attacking sperm: In injury or trauma, an immune response is triggered. This impairs sperm from swimming in the cervical mucus or penetrating the ovum.

Obstruction:

• Hypospadias: Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. In boys with hypospadias, the urethra forms abnormally during weeks 8–14 of pregnancy. The abnormal opening can form from just below the end of the penis to the scrotum.
• Absence of Vas Deferens (genetic)
• Retrograde Ejaculation: Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you might ejaculate very little or no semen.

Idiopathic Infertility: This means that the individual has a low sperm count for no identifiable reason.

Environmental Factors

• Overexposure to certain industrial chemicals, pesticides, organic compounds, and inhalation of paint.
• Heavy metal exposure: Exposure to lead and other heavy metals
• Radiation and X-rays: With limited exposure to radiation, sperm levels return back to normal. Exposure to high levels of radiation can lead to a permanent decrease in sperm levels.
• Overheating the testicles: Overuse of saunas, hot tubs, and penis tubs can impair sperm counts.
• Sitting for long periods ( long-distance drivers). Wearing tight clothing. Wearing fabric bad for genital health e.g., satin. Cotton is the best fabric for underwear.

Lifestyle Causes

• Drug Use: Steroids, cocaine, ecstasy pills amongst others.
• Alcohol use
• Tobacco smoking
• Obesity

Risk Factors For Male Infertility

• Smoking tobacco
• Alcohol use
• Obesity
• Exposure to toxins
• Trauma to testicles
• Born with a fertility disorder
• Undescended testes
• Childhood disease- mumps

Tests For Male Infertility

When seeing your doctor, it is advisable that you and your partner go together.

Diagnosing Male Infertility

Physical Exam and Medical History

When you go for consultations, your doctor will ask you questions like this.

• How often do you have sex with your partner?
• Have you had any kids before?
• Are you on medications?
• If you have a history of the treatment of sexually transmitted diseases
• Any history of penile trauma
• Any history of sexual problems

Semen Analysis

• This involves tests to check the shape (morphology) and movement (motility) of the sperm cells
• They will also check for infections
• It is advisable to do different semen analysis over time and in different labs
• Human error can affect the quality of reports produced.

Scrotal Ultrasound: A scrotal ultrasound can be used to detect varicoceles and other obstructions or blockage

Hormone Testing: The pituitary gland and hypothalamus play a major role in sexual development and sperm production. A blood test may be done to measure the levels of testosterone.

Post Ejaculation Urinalysis: Testing your urine can help in diagnosing retrograde ejaculation

Genetic Testing: When sperm volume is low, genetic tests can be done to determine is there is any problem with the Y chromosome.

Testicular Biopsy: This involves taking samples from the testicle with the help of needles

Psychological Impact

It doesn’t matter how much of a man you think you are. When it comes to cases of infertility, even emotionally and mentally stable individuals feel the mental burden. For a man not to be able to go into the world and multiply, is definitely a painful burden.

Men tend to carry this burden alone and sometimes put the blame on their wives (some Nigerian men). They refuse to visit the doctor and do tests. Sometimes, they go to a completely different lab to get a semen analysis done. Once they get the result and it’s not in their favor. They hide the truth from their family.

Depression, apathy, self-loathing. These are but a few psychological effects that could happen to any man. Having someone to talk to helps. Seeking advice from your doctor on different methods of assisted reproduction is the best-recommended path

Some sperm related terms

• Oligospermia: Low sperm count
• Azoospermia: the complete absence of sperm
• Aspermia: No ejaculate
• Anejaculation: Dry ejaculate
• Asthenozoospermia: less than 50% with forward progression

Minimum Criteria for Semen (WHO reference ranges)

• The total sperm count in the ejaculate is 39-298 million
• Volume 2-5ml
• pH 7.8-8.0
• Sperm concentration 15-259 million/per ml
• Total motility( movement) 40-81%
• Sperm morphology (shape) 4-48%

Treatment

Surgical

Varicocele: this can be performed on an outpatient basis. The surgery is called varicocelectomy.

Azoospermia: this means no sperm and is usually a result of blockage. Surgical options to remove the blockage are available.

Microsurgical Vasovasostomy: This is a microsurgery that joins cut parts of the vas deferens in each testicle.

Vasoepididymostomy:  This is the most common microsurgical method to treat epidydimal blocks.

Assisted Reproduction Techniques

Invitro Fertilization: In vitro fertilization is a process of fertilization where an egg is combined with sperm in vitro. The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova from her ovaries, and letting sperm fertilize them in a culture medium in a laboratory.

Intracytoplasmic Sperm Injection: Intracytoplasmic Sperm Injection (ICSI) is a specialized form of In Vitro Fertilization (IVF) that is used primarily for the treatment of severe cases of male-factor infertility. ICSI involves the injection of a single sperm directly into a mature egg.

Intrauterine insemination (IUI): This is a procedure for treating infertility. Sperm that have been washed and concentrated are placed directly in your uterus around the time your ovary releases one or more eggs to be fertilized.

Medications Used In Treating Male Infertility

Clomiphene Citrate: Clomiphene is used to increase the hormones released from the pituitary gland, which in turn, stimulates the production of testosterone and sperm within the testes.

Anastrozole: Anastrozole was created for women and men with estrogen-sensitive breast malignancies (stimulated by estrogen). Excess testosterone is prevented from converting to estradiol in the body’s tissues. When a man’s estradiol levels are high and his testosterone levels are low, anastrozole is commonly utilized.

Human chorionic gonadotropin ( HCG) and Human menopausal gonadotropins(HMG): If you’re one of the few men who doesn’t respond to clomiphene citrate, your doctor will most likely recommend hCG or hMG injections. These have the same adverse effects (and advantages) as the drugs listed above, but because they are injectable treatments, they are only recommended when absolutely necessary.

Even though this is not exactly a treatment, it definitely helps. join a gym, and start exercising. Engage in resistance training with weights. Weight training helps in building testosterone in the human body. Going to the gym also helps build confidence. This in turn tackles anxiety, low self-esteem, and depression. Like I said it’s not exactly a cure but it helps.

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