The realities of male infertility

Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. This is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fertility.

The sperm’s role

Although it seems quite simple for a sperm to fertilize an egg, the process is very precise. A man’s body must be able to fulfill the following criteria for natural conception to occur:

• Sustain an erection
• Produce enough healthy sperm that are the right shape and can move in the proper ways
• Produce sperm in the ejaculate to be emitted during intercourse

Problems that disrupt this chain of events reduce the chances of pregnancy.

Factors influencing fertility

Many factors resulting in male infertility can be diagnosed and treated, such as structural defects, problems with ejaculation and sperm, and immunologic conditions.

Problems that may reduce the health or number of sperm and affect fertility include:

• Age
• Alcohol, drug use or smoking
• Stress
• Certain medications
• Environmental toxins
• Genetic conditions
• Chemotherapy / radiation

Factors relating to male fertility problems may include:

Pre-testicular causes

Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including hypogonadotropic hypogonadism^. (a condition in which the male testes produce little or no sex hormones), drugs and alcohol, certain medications, genetic abnormalities and strenuous bicycle riding or horseback riding.

Tobacco smoking

Male smokers have approximately 30% higher odds of infertility.  There is increasing evidence that the harmful products of tobacco smoking kill sperm cells. Therefore, some governments require manufacturers to put warnings on packets.

DNA damage

As men age there is a consistent decline in semen quality, and this decline appears to be due to DNA damage. These findings suggest that DNA damage is an important factor in male infertility.

Testicular factors

Testicular factors refer to conditions where the testes produce semen of low quantity and/or poor quality despite adequate hormonal support and include. 

Radiation therapy to a testis decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes.

Post-testicular causes

Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation.

Prevention

Some strategies suggested or proposed for avoiding male infertility include the following:

• Avoiding smoking as it damages sperm DNA
• Avoiding marijuana and alcohol
• Avoiding excessive heat to the testes.
• Sperm counts can be depressed by daily coital activity and sperm motility may be depressed by coital activity that takes place too infrequently (abstinence 10–14 days or more).
• When participating in contact sports, wear a Protective Cup and Jockstrap to protect the testicles.

Getting to the bottom of fertility concerns:

The diagnosis of infertility begins with a medical history and physical exam by a physician, preferably a specialist with experience or who specializes in male infertility. Typically two separate semen analyses will be required. The provider may order blood tests to look for hormone imbalances, medical conditions, or genetic issues.

Often, there are no visible signs of male infertility. That’s why it’s important to have an open discussion with your doctor, urologist or a fertility specialist. Tell your doctor about your medical history, including past illnesses, medications, and surgeries. Also give current information about your lifestyle habits, diet, exercise, and any drug or alcohol abuse. Your doctor may order a semen analysis (SA). This is the single most important test for male fertility.

How is male infertility treated?

Some types of male infertility can be medically or surgically treated. If you are taking a medication that increases the risk of male infertility, your doctor may switch you to another medication. Also, STDs such as gonorrhoea and Chlamydia can lower sperm count and mobility. Your doctor will test for STDs and provide medication if needed. In addition, when trying to get pregnant, it’s important to avoid toxins, alcohol, cigarettes, and other known hazards that may injure your sperm.

See a fertility specialist

Concerned about male fertility? The best route is a quick referral to a fertility center. A reproductive endocrinologist (RE) receives training in both female and male infertility and may be the best professional to explain your testing options.

Male infertility and his manhood

Women often find it helpful to discuss health changes like infertility throughout their lifespan. Men, on the other hand, seem to get by just fine without talking about these things. This is largely due to society’s expectations:

1. Men are encouraged to be strong. He can suppress his feelings about infertility because pain and weakness are not socially acceptable.
2. Men are encouraged to provide for their families. He might feel like a failure for not providing you with a child.
3. Men must be in control at all times. By not fathering a child he feels like he has let you, and others, down.
4. A man often wants to have descendants to carry on his genes and the family name. He is disappointed that he is not fulfilling his end of this bargain.
5. Men are encouraged to be highly sexual, with virile sex organs. Infertility affects his manhood and he may worry that he is less of a man because he is infertile.

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