Male Infertility and Treatment

Infertility is when there is a difficulty in having children for more than a year of sexual life. I learnt in wide-angle, infertility is not the case confined only to women. Even men go through male infertility which means an inability to cause pregnancy in a fertile female partner. However there has been silence ruling this topic and it is not much spoken about.

In our country, mostly female infertility shows up when a couple fails in producing their offspring’s. Off late various awareness activities and research has been coming up regarding male infertility. To say, male fertility is a huge problem in India. Of the total infertility cases, 50 per cent of the cause is contributed by male infertility. In an age group from post 25 to late 30s the male fertility plays a prominent factor for pregnancies.

In the start of the last decade, about 12-28million couples per year are diagnosed with infertility in our country. The sperm count of an Indian male back then was 60million / millilitre while it came down to 20million/ millilitre as per the doctors claim. The reproductive anomalies and the male infertility are equally responsible for not being able to bear children. Speaking of worldwide prevalence 7 per cent of the male population are suffering from infertility.

Even when the lifestyle wasn’t this advanced as of now, back in 2015, 27.5 million couples have attempted for the assisted reproductive treatments. That shows how extreme the problem of male infertility could be now. The prevalence in our country in comparison to the worldwide spread has several factors to be considered in contributing to reproductive health. Going forward, let’s dive into the details of this condition. Male infertility generally occurs due to the issues in semen quality, sperm count and several factors working together.

Fertility infographic

Let’s begin by talking about the signs and symptoms of male infertility. The primary and main sign of male being infertile is the inability to conceive a baby. It is an obvious sign than any other. Some other symptoms to conclude male infertility are

a) libido gets reduced. The reasons can be many for them. It can either be painful intercourse or erectile dysfunction or accumulation of fluid also called seminal fluid. However, a man with fertility issues shows a reduced sexual desire also said as hypoactive sexual desire and low sexual satisfaction. These are taken into consideration also for sexual dysfunction which we would be talking about next.

b) Sexual dysfunction: Sexual dysfunction is different from male infertility and also a sign of the latter. It is a phase in man’s reproductive life that causes to lessen the experience from sexual activity. The responses of the sexual cycle that include excitement or arousal, plateau, pleasures or orgasm and resolution get disturbed. Infertility, it’s emotional and psychological stress also underlies the sexual dysfunction. 31 per cent of men report various degrees of this condition. Spoken in specific, sexual dysfunction can be categorised.

  1. Pain disorders: which regarding the pain caused during coitus.
  2. Orgasm disorders: the delay or inability to achieve orgasm in sexual activity.
  3. Arousal disorders: the lack of interest for any sort of sexual activity, the inability to excite during intercourse also to say it is an inability to get physically aroused.
  4. Desire disorders: it is a prominent sign of sexual dysfunction. A male with this disorder shows less or no interest in sex. The libido gets lessened. It is due to the stress, and also the reproductive health issues underlying.

Male reproductive system

Signs and symptoms of sexual dysfunction 

  • Premature ejaculations :that are the time of the ejaculations do not lie under control. Ejaculation occurs involuntarily.
  • Retarded ejaculations: This may happen even if an adequate sexual desire and activity are also there. In this condition, no ejaculation or delay in the ejaculations occurs.
  • The last one is Erectile dysfunction which is a serious contribution to male infertility. It is an inability to achieve ejaculation. For ejaculation to take place, the blood circulation and supply to the penis, cholesterol levels in the blood, high blood pressures, hormones, muscle contractions, ion flow, thickness and width of the blood vessels, etc. everything should work normally and efficiently in their places. To explain ejaculation is the discharge of sperm through semen. The dysejaculation is discomfort or pain that does not allow the ejaculation to take place.

The causes of sexual dysfunction can be cardiovascular issues, hypertension, depression, post-sexual trauma, or issues with the partner, concerns regarding body image and appearances, drug abuse and alcohol addictions, tobacco and illicit drug abuse, chronic renal and respiratory problems, issues in the reproductive system.

c) Gynecomastia:

This is a condition in which the breast tissue increases in size in males abnormally giving the appearance of female breasts. It is one of an endocrine disorder. The onset of this gynecomastia is irrespective of age. Increased levels of estrogens or androgens are the most put forth reason behind this condition. Though this tissue growth is non-cancerous, it can last up to two years or can be a chronic lifetime issue. Even newborns are prone to temporary gynecomastia due to hormonal changes. Gynecomastia makes the individual anxious and stressed out.

d) Low sperm count:

The sperm count in a normal individual can be expected from 15million to 200 million sperm per millilitre of semen. Amount less than 15millions / ml or 39millon per ejaculate is taken as the lowest sperm count. Semen is tested on the basis of the volume of the sperm, it’s shape and motility also called sperm movement. Men with higher blood pressure, high cholesterol, higher body mass index and higher body fat, high body weight, diabetes, and cardiac infarction and heart diseases have chances of getting their sperm production lower. The sperm count is crucial for conceiving a baby. A single sperm is sufficient for an ovum to fertilize into an embryo. But the sperm count is the criteria that decide the fertility of the man. There are some indicated ways to increase the sperm count naturally like taking vitamins, losing weight, exercise, avoiding addictions such as tobacco, drugs, marijuana, cocaine, anabolic steroids, heavy alcohol consumption and also being exposed to environmental factors causing infertility.

d) Pain in the testicular area:

Testes are the male reproductive organs which are destined to produce and mature the sperms. Testicular lumps are the abnormal formations in the testicles. This makes the whole testicular area swollen and becomes painful. The functioning of the testes gets altered. Fever, vomiting, nausea, pain in the abdomen, fatigue are the indications for this condition apart from the pain caused in the scrotum or the scrotal area. In extreme conditions, fluid accumulation occurs in the scrotum making it heavy, swollen and inflamed. Headaches, varicocele, hydrocele and epididymal cysts are also linked with testicular lumps. This may arise either due to infection in any parts of the reproductive system, or either in the testicles, in the epididymis, in the tubes and ducts of the genital tract, or glands. Also, injuries and trauma to any organ inside can direct to the formation of infection. But it eventually induces male infertility due to inadequate levels of testosterone alongside lower sperm production.

e) The size of the testicles:

The average size of the testicles is about 1.8 to 2 inches but it differs from one individual to the other. If the size is less than 1.4 inches, then the testes are considered small. As known, the job of the tested is to produce the sperm and the male hormone testosterone. The small-sized testicles when researched upon showed less density of sperm production. This happens because of the structures like seminiferous tubules that produce sperm cells gets lessened in number. Therefore the size of the testes has a direct role in sperm production and development. Thereafter, making the individual infertile which means they are unable to conceive an offspring because of the absence of sperm.  Research also put forth that people with smaller testicles also have cardiovascular disease.

f) Erectile dysfunction:

It is a problem that arises when a satisfactory sexual performance becomes difficult after several times. Though it is a treatable condition. The cause behind this dysfunction lies in the blood vessels or nerves supply. Hormonal imbalance, or decreased secretion of hormones, and blood flow to the penis are the other justifications. Most of the men may have experienced a problem with the penis becoming hard sometimes in their lifetime. This condition occurring persistently for repeated times should be taken as erectile dysfunction. Other physical causes for erectile dysfunctions as several. A few of them being narrowing or thinning of the blood vessels blocked blood supply, high blood pressure, high cholesterol, diabetes, heavy body weight, thyroid disorders, insufficient hormones such as testosterone deficiency. The structural and functional disorder in the penis as in Peyronie disease also influences erectile dysfunction. Peyronie disease is a condition in which the penis becomes bent due to the formation of plaque inside the penis. Though when it comes about along with erectile dysfunction makes sex difficult.

Other habits like illegal drug abuse, alcoholism, and smoking can make any system in the body complicated so is erectile dysfunction.

Radiation therapies to the pelvic area, and exposure to scans and overheating can damage the organs present in the areas, so is the testes.

Post-surgery and treatments taken for diseases like prostate disease, sclerosis and Parkinson’s disease can induce erectile dysfunction.

Of these told, atherosclerosis is the most common cause of erectile dysfunction. Atherosclerosis is a condition in which the narrowing of blood vessels, arteries and arterioles happen. This prevents the flow of blood to the penis. Whilst the penis needs a network of blood supply continuously. The clogging of blood supply takes place in the penis.

Medications that treat cardiovascular diseases, neurological diseases, diuretics that act against depression, anxiety, peptic ulcers, hormone therapies, anticholinergic drugs, cancer drugs provoke this disease.

g) Respiratory problems and male infertility:

Researchers say that infertility concern in both males and females is associated with respiratory diseases such as cystic fibrosis. They put forth that anatomically the men suffering from cystic fibrosis have an undeveloped vas deferens.

Also in women suffering from asthma, face an inability to become pregnant. Men suffering from male infertility also go through an inability to smell too. Men with chronic respiratory issues along with male infertility are diagnosed with partner’s syndrome. It is an autosomal disorder. This has a group of diseases like sinusitis, bronchiectasis and sinus which are recurrent. Thus they have a somewhat affiliated to male infertility.

Causes for male infertility:

Sperm and egg cell, ovum. Native and natural fertilization

For a male to live a normal reproductive life and remain fertile, there are few things to be functioning normally.

  1. The sperm should be functional and also motile.
    If either the sperm is not functioning properly or it is immobile it can’t reach the egg cell of the female to fertilise it. The sperm body has certain purposes to carry out like to fuse with the egg cell, each of its parts ha to play a part to finish this function successfully. The tail helps in motility, the head the pronucleus and the enzymes required to impregnate into the egg cell, the neck has the centrioles. Overall any lack of this can alter and disturb the sperm purposes.
  2. The production of the sperm should be normal.
    The testes assigned with the sperm production process should be alright. The male reproductive hormones or androgens that stimulate sperm production acts on the testes. Any structural disorders or modifications in the testes hurdles the production of healthy sperm. 3. The sperm count should be adequate. The semen of a man contains lots of other components like seminal fluid formed by the glands like prostate and other glands, enzymes, acids, fructose and glucose, phosphatase, lipids besides the sperm. Still, the count of sperm per millilitre of semen should be adequate to get through the chances of fertilisation. Both the quality and quantity of the semen are considered as a measure of fertility in men. A typical quantity of normal semen is 3.4 millilitre.
  3. Another thing of concern for a normal male is the sperm should be able to pass from the testicles all the way to the penis and mix with the semen. Any obstacle through this pathway also counts for the sperm.
  4. Defects in the tubules:
    The sperm is produced in the testicles, it is passed through the genital tract all the way from testes to the penis traversing tubules and ducts. This brings in the secretions of the glands and adds into the semen. The delicate tubules and ducts like epididymis, vas deferens are prone to defects, which can result in any obstruction to the pathway. This leads to the inadequate or absence of sperm count in the semen. This transport system of sperm can be affected by injuries, trauma, cystic fibrosis, surgeries etc. Blockages in any of those tubules and ducts through accumulations or cuts result in male infertility.
  5. Chromosomal defects:
    Scientists have stressed on this factor for a longer time. In India, most of the cases are due to the defects in the Y chromosome. There is an AZF region in the left arm of the Y chromosome that is responsible for sperm production. Deletions of mutations in this azoospermia factor disturbs the production of sperm. 29.4% of infertile men have these deletions. The underlying factors for these defects can be endogamy and ethnicity of the Indian population. Not only this but also X chromosomes and autosomes plays a crucial role in fertility according to these studies.
  6. Hormonal imbalance:
    The testicles are acted upon by the hormones that are secreted from the pituitary, hypothalamus and thyroid gland. Low androgens that are low amounts of testosterone lowers down the fertility.
  7. Medications:
    Treatments like testosterone replacement hormone therapy, chemotherapy therapy, chronic usage of steroids, usage of antifungal drugs, and gastric drugs also impair the production of sperm.
  8. Surgical procedures:
    Any surgeries done prior like surgery for a hernia, scrotal surgeries, prostate or testicular surgeries, vasectomies, cancer to the rectum and testes etc., blocks the sperm into the semen.
  9. Tumours:
    May the tumours be cancerous or none cancerous, tumours in the reproductive organs or in the organs that produce the male hormones decrease male infertility.
  10. Testicles:
    The testicles get descended from the abdomen into the scrotal sacs during fetal development. In some men, the development does not occur in the proper way and the testes do not descend into the sacs. Decreased fertility is seen in men facing this condition.
  11. Antibodies:
    The immune system in the body produces autoimmune responses. It mistakenly identifies the sperm cells as antigens and produces antibodies to fight them. The anti-sperm antibodies are produced to kill the sperm that enter the female production. Thus the sperm dies.
  12. Varicocele:
    Some veins pass through the testicles. The veins that traverse the testes get swollen inflamed. This gradually affects the quality and quantity of semen. Treating the varicocele can improve the sperm count as well as semen quality increases. Men being treated for varicoceles alongside IVF technology, an assisted reproductive technology has a high chance of bearing children.
  13. Heavy metals:
    Being exposed to heavy metals and usage of Lithium etc metals in daily life makes the sperm count lesser. Exposure to the radiation for prolonged and recurrent times affects sperm production.
  14. Weight:
    Obesity and high cholesterol levels and rapid weight gain that leads to the hormone imbalance directly affect fertility. Depression affects sexual desire, erectile dysfunctions and body concerns are also a reason for depression. Emotional outbursts, chaos and quarrelsome relationships, issues with self, high concerns about appearance etc worsens the sexual activity. It brings disinterest and unlikeliest towards the opposite gender.
  15. Alcohol abuse and drug abuse reduces sperm equality and count.
    Tobacco, marijuana and cocaine impact the quality of the sperm and also the motility and health of the sperm.  These are the habits that are known to worsen any kind of disease.
  16. The last cause can be talked about infections. Any infection caused to the testes, epididymis, seminiferous tubules, ducts, any inflammation and swelling has a great impact on fertility.

How to Prevent Male Infertility :

  • Do not indulge in any kind of alcohol and drug abuse.
  • Stay away from tobacco, cocaine, and marijuana addictions to maintain not only a healthy sex life but also it brings health to other systems of the body.
  • Be cautious about the weight gain, overweight attracts lots of body ailments. So is the case with sperm production. In people with overweight and higher cholesterol levels, reproductive issues are common.
  • Injuries to the reproductive organs or pelvic region, accidents, surgeries done to the reproductive area, cuts and trauma to the Testicles and tubules inside the reproductive tract also responsible for infertility in men. Avoid any such accidents and injuries that harms the reproduction.
  • Don’t go for vasectomy even if you are not planning for any more children. This welcomes a lot of injuries.
  • Avoid things that stress you both emotionally and physically. Maintain a healthy lifestyle above.
  • Stay away from heavy metals, radiation, and frequent scans, toxins and steroid treatments.

Diagnosis and Treatments for Infertility:

After a general physical examination and taking a medical history about sexual habits and development, a semen analysis will be done.

A semen analysis estimates the nature and count of sperm. For a person, different specimens of semen can obtain different values. For more accurate outcome specimens will be collected at the accurate time.

The other treatments include scrotal ultrasound to check for varicocele or structural defects in the pelvic region if any.

A testicular biopsy involves taken from the testes to evaluate the density of sperm production and also for any injuries or issues with the testes.

Hormone test to evaluate the hormone production and imbalance of androgen.

The transrectal ultrasound takes a scan from Rectum to the peritoneum with a camera passed through. This visualizes any blockages through the tubules, the ducts and also the performance of the sperm.

Treatments for male infertility include various ways.

Male Infertility Treatment

  1. varicoceles and blockages are cleared by surgeries.  Sperms from the blocked tubes can be retrieved by sperm retrieval techniques.
  2. Assisted reproductive technology like IVF
  3. Hormonal therapies etc…

Also Read about Endometriosis and its TreatmentAdenomyosis Treatments

References:

  1. Male infertility – Wikipedia
  2. infertility in Indian men
  3. Scientists identify genetic factors responsible for infertility …
  4. Male Infertility: In almost 50% infertility cases, the reason is …
  5. Infertility in men higher than in women – Health Issues India
  6. Signs of Infertility: In Men and Women – Healthline
  7. Male infertility – Symptoms and causes – Mayo Clinic
  8. Ejaculation (disambiguation) – Wikipedia
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