Understanding male infertility

Infertility is defined as failure to conceive after a year or more of consistent sexual intercourse without contraceptives. It is common, with around 12 per cent of couples struggling with this. Infertility may be misconceived as being due to an issue with the woman in the relationship, but in half of the cases of infertility, male infertility is a factor. In this article, consultant urologist and andrologist Mr Rowland Rees goes over the possible reasons for male infertility.

 

 

In most cases of male infertility, an issue with the sperm is the roadblock to parenthood, but there are also other possible causes of male infertility. It is always recommended to undergo fertility testing for both parties when struggling to conceive. During testing, the doctor will look at hormone levels, sexual history and practices, examine your genitalia, analyse the sperm and blood composition, and perform imaging scans like ultrasounds on the testes and penis to investigate the exact cause of male infertility. Once the diagnosis has been made, treatment can start or adaptations can be put in place to improve male fertility and address the issues.

 

What are the causes of male infertility?

Issues with the sperm include:

• Low sperm count, which means that the number of sperm cells in the semen is too low, decreasing the chances that sperm cells will make it to the egg and fertilise it. A low sperm count is defined as fewer than 16 million per millimetre.
• Poor sperm motility, which refers to the pace at which the sperm cells “travel”. If it is too slow, the sperm are unable to reach the uterus and egg-
• Deformed sperm, where sperm with abnormally big heads or crooked tails, for example. This is because the sperm needs to be a specific shape so it can get through the outer layers of the egg.
• Fragmented sperm DNA, where there are breaks or damage in the genetic makeup of the sperm. This can happen because of genetic mutations or as a consequence to external factors such as having received chemotherapy or having a chronic infection.

In other cases, male infertility can be caused by structural or hormonal issues, such as:

• Hypogonadism, where the sexual glands (in men, the testicles) are not producing sufficient levels of sexual maturation hormones (in men, testosterone) that make the sperm healthy, fast, and properly shaped. Hypogonadism has many possible causes, from pituitary tumours to autoimmune diseases, or it can be congenital.
• Varicocele, a condition where the veins in the testicles become enlarged and engorged with blood, which damages the sperm and obstructs the spermatic cord.
• Prostate issues like an enlarged prostate, which can block ejaculation. A prostate can become enlarged due to prostate cancer, prostatitis, or just because of benign hyperplasia.
• Infections, where invasive pathogens combat sperm and kill them, or trigger an aggressive immune system response like epididymitis, which is the inflammation at the back of the testes.
• Injury and damage to the testes or penis.
• Ejaculatory disorders, such as anorgasmia or retrograde ejaculation.

However, aside from illnesses and health conditions that can impede fertility, male infertility can also be caused by lifestyle habits and environment. This includes exposure to toxins, high stress, smoking and drug abuse, high alcohol consumption, obesity and a poor diet, or overheated testes (like from overusing a hot tub).

 

How can male infertility be addressed?

Male fertility can be improved by making adjustments to their diets and lifestyles and seeking medical therapies to improve the chances of successful conception. For male infertility with unknown causes, seeking a diagnosis with the help of a fertility specialist or doctor can initiate the process of treatment or allow the patient and his partner to explore alternative arrangements if need be, as some conditions will be permanent or the damage caused is irreversible.

Practising healthy habits like nutrient-rich eating, moderate physical activity, managing stress, and being considerate of chemicals and substances that the body is being exposed to can help imrpove male fertility alongside formal medical treatment and therapies.

Treating male infertility will depend on the nature of the issue, for example, prostate ablation for an enlarged prostate, and oral antioxidants to help with fragmented sperm DNA. 

An andrologist may be able to help by modifying lifestyle factors, discussing the role of medical therapy and supplements, treating varicoceles, unblocking blockages, treating ejaculatory problems, or harvesting sperm from the testes or tubes around the testes.