Guide To Main Articles
Causes Of Male Infertility
Male Fertility Tests
Male Infertility Treatment
|What Is Male Infertility?
Infertility means that a couple has difficulties conceiving a child. In 40 percent of cases infertility can arise because of problems with the woman's reproductive system, and 40 percent of the time it originates with the man (the cause of the remaining 20 percent are never discovered). If a man is diagnosed as infertile it means after a year of actively trying, he cannot make his fertile partner pregnant. Although the focus of
research has traditionally been centered around female infertility, fertility impairment may be just
as common in men. According to the National Survey of Family Growth, 7.5 percent of all sexually active men reported visiting a doctor for help with having a child, and 2.2 percent reported a visit in the past 12 months.
There are many different reasons why a man can have fertility issues including:
Failure to produce enough healthy sperm. This is the most common reason.
Premature ejaculation, particularly if he ejaculates before enough semen is deposited in the vagina.
Retrograde or backward ejaculation. Instead of being ejaculated through the penis, the sperm is ejaculated into the bladder. While this is harmless, it can be frustrating for couples who wish to conceive. It is more common in men with diabetes.
Disorders affecting sperm production such as varicoceles (varicose veins in the tubes of the testes). As many as 15 percent of men have them. They may lead to reduced fertility by increasing the temperature of the testes or causing hormone changes.
Erectile dysfunction, in particular the inability to maintain an erection. 10 percent of men between the ages of 40 and 70 suffer complete erectile failure. Common causes include the use of medications (antidepressants, blood pressure meds); diabetes, thyroid disease, renal failure and a heart attack.
Less common causes include men undergoing treatment for cancer, particularly for testicular cancer. Also, testicular damage due to illness (mumps) or injury.
What Causes It?
The main causes of infertility in men include:
1. Low sperm count - this is the main cause for most men. It can be caused by many things such as the use of certain medications, injury to the testes, radiation therapy for cancer and the use of anabolic steroids to build up body muscle. Smoking and a bad diet can make the problem worse. The average sperm count should be 20 million sperm per milliliter of ejaculate.
2. Sperm that can't swim! Known as immotile sperm. Although you may produce enough sperm it may be that they can't swim or they are unable to swim fast enough to reach the woman's egg before it disappears. A number of factors can affect a sperm's motility.
3. Abnormally shaped sperm (called morphology). If the sperm has a strange head it is called teratozoospermia. If at least 15 percent of your sperm is normally shaped you are considered fertile. Below this is infertile, and below 5 percent is particularly severe.
4. No sperm at all on ejaculation. No sperm in the semen is called azoospermia. Fortunately lifestyle improvements can do a lot to improve a man's sperm count.
How Is Male Infertility Tested?
Male fertility tests: The initial test can be carried out by most doctors and involve a physical examination of the testes area. However most couples prefer to attend a fertility clinic. You will need to provide a semen sample, so you will be asked to ejaculate into a sterile container. This will be analyzed under a microscope in a lab for appearance, sperm count, antibodies and other factors. The next step depends on the results of the semen analysis. If sperm count is low, he is usually encouraged to make lifestyle changes for a few months, after which further testing will be recommended if his partner is not pregnant. Other tests include blood hormone tests, ultrasound scanning and a testicular biopsy.
For more details see, how does a doctor test for infertility in men?
How Is It Treated?
Male infertility treatment will depend on the cause identified. Generally there are a few main categories of causes requiring treatment: sperm problems, hormone imbalances, damage to the testes, ejaculation issues or (rarely) genetic disorders.
The aim of any treatment will be to improve sperm quality. The first step is to make lifestyle changes for 3-4 months (it takes 100 days for sperm to develop). This involves:
1. Avoid drinking alcohol, as few as 2 drinks a day can damage sperm quantity.
2. Quit smoking, it reduces sperm motility.
3. Relax and avoid stress, your body should direct as much energy as possible to sperm production.
4. Drink 2 liters of water a day, semen largely consists of water.
5. Avoid tight fitting underwear, hot climates and saunas.
6. Eat a balanced diet and take a good multi-vitamin. About 35 percent of sperm damage is thought to be caused by free radicals in the body. To protect against free radicals you need to consume more antioxidants vitamin C and E. Foods high in antioxidants are strawberries, blueberries, garlic, plums, red peppers and broccoli.
If sperm quality remains low, assisted reproductive techniques are usually considered. Possibilities include:
1. Artifical Insemination: Sperm is extracted from the man using sperm aspiration, 'washed' and injected into the woman's womb when she has ovulated. This increases the chance of sperm meeting egg.
2. IVF (In Vitro Fertilization): IVF is a common technique that is also used if there are male tubal blockages and unexplained infertility. With this process the woman's egg is fertilized in a lab using a carefully selected sperm and then implanted into the woman.
3. ICSI Procedure (Intracytoplasmic sperm injection) is performed in conjunction with IVF. A single sperm is injected directly into the woman's egg in a lab.
4. Extracting sperm for IVF (also known as sperm aspiration). If there is little or no sperm in the ejaculation fluid, it can sometimes be extracted directly from the testes. This is a minor surgery performed under local anesthesia. If sperm is successfully extracted, it will be used for ICSI. The surgery is performed in a number of ways and may be referred as MESA, TESA, TESE or PESA.
5. Sperm donation: If all other procedures fail, the couple may choose to try sperm donation. The man however will not be the biological father of any resulting child. Sperm banks have a list of screened sperm donors which you can choose from.
While hormones are often associated with female fertility, they also play a huge role in male fertility. Low levels of FSH (follicle-stimulating hormone), LH (luteinizing hormone) and gonadotropin hormones can interfere with sperm production. Technically this is called hypogonadotropic hypogonadism. Sometimes it can be the result of a genetic problem, other times it can be related to illness such as malnutrition or kidney failure. Treatment may involve hormone injections (several times a week) for up to 6 months. The success rate of this therapy is high.
Surgery may be considered if there are blockages such as a hernia. Retrograde ejaculation can sometimes be treated with surgery to recover sperm from the testes. Or it is possible to retrieve sperm from the urine to use for IVF. Varicoceles may be corrected by a small surgery which is performed on an outpatient basis. However only very large varicoceles tend to be operated on these days because the benefits of the procedure are not clear.
Risk Factors For Male Infertility
1. Being age 35 or older.
3. Drinking too much alcohol.
4. Being overweight or underweight.
5. Exposure to toxins such as pesticides.
6. Overheating the testicles (by something as simple as holding your laptop on your lap).
7. Having a vasectomy or vasectomy reversal.
8. Cycling, can damage the testicles, especially if the bike has a very hard seat.
9. Anabolic steroids suppress testosterone.
10. Marijuana reduces sperm production.
11. Cocaine also decreases sperm count and can lead to birth defects in your children.
12. Certain prescription drugs such as those for the treatment of high blood pressure or depression.
About 250 million sperm are ejaculated during sex. It takes that many because very few of the sperm will have the energy and fitness level to make it all the way to the woman's egg.
Sperm swim at about 3 mm per hour.
Of the volume of liquid that is ejaculated during orgasm, about 20 percent consists of sperm.
Roughly 1,500 sperm are produced each second in each testicle.
Unlike women who are only fertile on certain days of the month (see most fertile days), men are fertile all the time.