The conversation surrounding infertility has long revolved around a woman’s fertility problems, leaving relatively little space for discourse on male infertility. This has led to a common misconception that women’s reproductive issues are largely the root of couple’s infertility.
In fact, only 30% of infertility cases stem solely from the woman. Another 30% of instances are a result of the man’s reproductive issues, with the remaining cases result from both male and female or unknown causes.
What are the Causes of Male Infertility?
To fertilize the female’s eggs, healthy sperm has to be able to reach them. Thus, if a man has low sperm production, immature sperm, and abnormal sperm production or blockages stopping the sperm, this can be a primary cause of infertility. Some 10-15% of infertile men completely lack sperm, indicating the dependence of fertility upon sperm. However, other factors can affect fertility, including illness, injuries, and lifestyle choices. Some of the most common causes of male infertility are as follows:
Varicoceles
- Varicoceles is where veins in the scrotum become swollen, beginning in puberty but becoming more prevalent with time. They are more common in males aged 15 to 25.
- They are found in 15% of all men, and 40% of men with infertility problems – making them the most common explanation for male infertility.
Sperm Disorders
- Sperm does not always grow fully, can be misshapen, and unable to swim.
- Oligospermia (sperm being made in low numbers) and azoospermia (not being made at all) can decrease the chances of fertility.
Immunologic Infertility
- Sometimes following surgery, injury, or an infection, the antibodies created attack sperm, reducing chances of egg fertilization.
Hypogonadism
- Hypogonadism is when a man has abnormally low levels of testosterone.
- This can be a result of a tumour, Klinefelter syndrome, or taking illegal drugs.
Retrograde Ejaculation
- This occurs when semen instead of leaving the body, which enables it to reach the vagina, moves back into the bladder and therefore prevents fertilization.
- Retrograde ejaculation can be caused by surgery, medicine, or health problems.
- It can be identified through cloudy urine following ejaculation, less fluid during ejaculation, or “dry” ejaculation.
Obstruction
- When the sperm cannot leave the body during ejaculation due to blockages in the tubes that sperm travels through.
- This can be caused by infections, inflammation, scrotal injury, STDs, and rare genetic conditions.
Chromosomes
- The male Y chromosome can be missing parts impacting fertility.
Medication
- Some medications impact how sperm functions, is produced and is delivered.
- This includes medication for cancer, arthritis, depression, anxiety, high blood pressure, and digestive problems.
What are the Symptoms of Male Infertility?
Due to the array of causes resulting in male infertility, there is not a set list of symptoms to cover all cases of infertility. An estimated 7% of all men are affected by infertility, experiencing this in a variety of ways. For some it is not an issue until attempting reproduction, others are aware of it from their youth, and some experience great discomfort or pain because of it. However, some signs may help diagnose male infertility:
- Pain in the testicles (including swelling and lumps).
- Prominent veins in the testicles.
- Problems with sexual functions, such as the struggle to ejaculate, low libido, and erectile dysfunction.
- Blood in the semen.
- Recurring respiratory infections.
- Low sperm count (less than 39 million sperm per ejaculate).
How is Male Infertility Diagnosed?
After one year of regular sex without the use of birth control, it is possible that either you or your partner may be infertile. In these circumstances, some tests can be undergone to help to establish the reason for the fertility problems. For the male, these tests can be:
- Semen Analysis – this is to identify the sperm count, how uniform the sperm are and how well the sperm moves.
- Blood Tests – to check hormone levels, as low testosterone can reduce sperm production, sex drive, and cause erectile dysfunction.
- Testicular Biopsy – this involves tissue from the testicles and being examined under a microscope.
- Ultrasound – can be used to examine the testicles, blood vessels, and the formation of the scrotum.
How is Male Infertility Treated?
Once the reason for infertility is identified, your doctor can consider the best treatment for your individual issue. However, in 50% of cases, the causes of male infertility are unexplained, making it difficult to assign a specific treatment to combat the issues. Despite this, there are some common treatments for male infertility that can help those with a range of infertility issues increase their likelihood of fertilisation. These include:
- Artificial Insemination – this allows the sperm to avoid being stopped by obstructions through inserting the sperm into the cervix, fallopian tubes, or (most commonly) the uterus.
- In Vitro Fertilization (IVF) – similarly to artificial insemination the sperm is collected but instead of being placed inside the woman’s reproductive organs alone, it is mixed with your partner’s eggs outside of the body.
- Intracytoplasmic Sperm Injection (ICSI) – where the sperm is injected directly into an egg before being left in a laboratory dish for fertilization. After the fertilization is complete the embryo is placed back in the uterus.
Conclusion
Male infertility is not discussed enough, which has created a stigma surrounding the topic. Considering that 7% of all men suffer from some form of infertility, it is important to recognise the signs and know that there are often ways to counter its effects. If you suspect that you may have fertility issues, speak to your doctor to consider the next steps.
