Infertility among Men

Male infertility

Male infertility is fairly common. Recent statistics reveal that in 60% of all couples experiencing infertility, a male factor is involved. It is primarily a male factor in 40% of these couples and in an additional 20%, it is a combination of male and female factors.

Therefore, when a couple is having trouble conceiving it makes sense not only to evaluate the woman but to evaluate the man as well. As women have traditionally been considered to be the cause of infertility, many men find it especially hard to admit that they might be the one with the sub-fertile condition.

A semen analysis – to assess the sperm – is the first step in fertility testing for men. This simple test can provide fertility specialists with a great deal of insight into a man’s fertility.

Causes Of Male Fertility

Abnormal Sperm Count

This happens about 75% of the time when there is a male contribution to infertility. Oligospermia is a condition where the sperm count is significantly low. The general rule is that the lower the sperm count and poorer the sperm quality, the longer it will take and the more difficult it may be for a pregnancy to occur. However, even men with very low sperm counts may eventually be successful in causing a pregnancy.

If there are no sperm at all in the semen sample, the condition is termed azoospermia. In such cases, further investigations will be needed to determine the course of treatment.

Physical Abnormalities

  • An absence or blockage in the tube from the testes to the urethra (the vas deferens) is an uncommon cause of male infertility, but it is treatable by surgery.
  • A varicocele is a swelling of the veins around the testes was once thought to be a significant cause of infertility – though it is now clear that this is less likely.

    Difficulties with Erections and Ejaculation

  • About 5% of couples with infertility have factors relating to intercourse. This includes the inability to obtain or maintain an erection, premature ejaculation, lack of ejaculation, retrograde (backwards) ejaculation, lack of appropriate timing of intercourse and excessive masturbation. Many men have difficulty with erections under the pressure of trying to conceive.

Genetic Causes

Gene problems are more common in men who have very few or no sperms (about 10%). Whilst most gene abnormalities are not overtly apparent, there is concern that one particular type that is associated with infertility (Y-chromosome deletions) may be passed on to male offspring – when assisted techniques such as ICSI result in pregnancy.

Hormone Disorders

Though rare, a hormone disorder is sometimes a cause of male infertility. It is treatable if the signal from the brain is the problem (gonadotrophin deficiency). But if the testes have stopped working altogether, as happens in around 13% of male infertility, success is unlikely.

Other Factors

  • Men who smoke have a 13-17% lower sperm count than those who do not. High alcohol intake can markedly reduce the sperm count and motility, while low and moderate consumption could also lead to problems.
  • Tight fitting clothes and prolonged periods of sitting can lead to a reduction in sperm count through excessive heating of the testes. Men who have an abnormal semen analysis should wear loose fitting trousers and underwear such as boxer shorts.
  • Cannabis, cocaine and anabolic steroids all reduce the sperm count and affect motility of sperm.
  • Obesity could also be a factor as obese men have been reported to have lower sperm count and are prone to hormonal changes leading to infertility.

Virility vs Fertility

Infertility does not necessarily mean lack of virility. Interestingly, it has been found that very frequent intercourse can lead to demand exceeding the supply. There are quite a number of infertile men whose sex drive is such that they must ejaculate 2-3 times a day. This explodes the myth that links infertility to lack of virility.
As in infertility among women, most of the conditions that contribute to male fertility can be effectively managed today through fertility therapies.

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