Male infertility is raising global concern

Infertility is highly discouraging to people. It is explained as inability to conceive after 1 year of unprotected sexual contact. It is generally found that most people are able to conceive within this time. If there is any problem, physicians recommend that couples must be assessed for fertility problems. Reports of WHO signified that Infertility greatly affect a substantial proportion of humanity.  According to WHO, infertility is a “disease of the reproductive system” and results in disability. Despite the high encumbrance, couples and individuals, who desire but are unable to achieve and maintain a desired pregnancy.

For conception, there is a need of production of healthy egg and sperm, unblocked tubes that allow sperm to reach the egg, the sperms ability to penetrate and fertilize the egg, implantation of the embryo into the uterus and finally a healthy pregnancy. Infertility occurs when there is inability to conceive unprotected sexual intercourse.

In men, hormone disorders; illness; reproductive anatomy, trauma, and obstruction; and sexual dysfunction can momentarily or permanently affect sperm and avert conception. Some ailments become more difficult to treat the longer they persist without treatment.

Major causes of male infertility:

There numerous factors that can deteriorate sperm count or mobility, or degenerate the capability to fertilize the egg. It is observed that major reasons for male infertility are irregular sperm production or function, impaired delivery of sperm, overall health and lifestyle problems. Male infertility also occurs due to disproportionate exposure to environmental conditions.

It is established in reports that problems with male fertility can be triggered by several health issues and medical treatments.

-Reduced production or function of sperm. Many cases of male infertility are due to problems with the sperm. Normal sperm concentration is explained as greater than or equal to 20 million sperm per milli liter of semen. Sperm counts of 10 million or fewer per milli liter of semen specify low sperm concentration. Total failure of the testicles to produce sperm is rare and it affect very few infertile men.

-Varicocele. A varicocele is a puffiness of the veins that drain the testicle. It is the most common alterable cause of male infertility. Though the exact cause of varicoceles is not known, it may be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm. Good treatment of varicocele can increase sperm numbers and function, and may enhance outcome when using assisted reproductive techniques such as in vitro fertilization.

-It is medically recognized that uneven shape and movement of sperm cause infertility. Normal sperm shape and the ability for sperm to move fast and precisely toward the egg is vital for fertilization to occur. If the sperm shape and structure are abnormal or the movement is decreased, sperm may not be able to enter the egg.

-Infection. Some infections can also affect in sperm production or sperm health or can cause scarring that chunks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infection such as HIV. Although some infections can result in permanent testicular damage, most often sperm can still be regained.

-Ejaculation issues. Retrograde ejaculation happens when semen enters the bladder during orgasm instead of appearing in the tip of the penis. Retrograde ejaculation may due to several abnormal health issues such as diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.

-Due to spinal cord injuries or certain diseases, men are not be able to ejaculate semen, even though they still produce sperm. It is established that in these cases sperm can still be retrieved through assisted reproductive techniques.

-Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that wrongly identify sperm as damaging attackers and attempt to remove them.

- Some types of tumors like Cancers and nonmalignant tumors can significantly affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can cause male fertility.

-Undescended testicles: In some males, during fetal development, one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Reduced fertility is more possible in men who have this medical problem.

- Infertility in males can also results from Hormone imbalances. Males who suffer from Hormone imbalances have disorders of the testicles or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone and other hormonal problems have a number of possible primary causes.

-Defects of tubules that transport sperm can lead to male infertility. Many different tubes carry sperm. They can be blocked due to some reason such as inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.

-Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.

- Infertility may due to chromosome defects. Inherited disorders such as Klinefelter's syndrome in which a male is born with two X chromosomes and one Y chromosome. This can lead to abnormal development of the male reproductive organs. Other genetic syndromes related with infertility include cystic fibrosis, Kallmann's syndrome and Kartagener's syndrome.

Figure:1 It depicts causes of male infertility.

- Some males have difficulty in sexual intercourse. These may be trouble keeping or erectile dysfunction, premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that affect sex. These problems lead to male infertility.

-Celiac disease is digestive disorder due to sensitivity to gluten, celiac disease. This may cause male infertility. Fertility may improve after espousing a gluten-free diet.

-Some medications also cause infertility in males. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs can weaken sperm production and decline male fertility.

-If males undergo some surgeries, it may prevent them from having sperm in their ejaculation. These operations include vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles.

Testosterone deficit may lead to infertility.

It has been reported that misplaced urinary opening can cause infertility in males. A defect at birth may cause the urinary opening to be abnormally placed on the underside of the penis. Such condition may avert sperm from reaching the woman’s cervix. It can be corrected surgically.

Male infertility is diagnosed in person whose general health is not good and have poor lifestyle. Infertility related to health and lifestyle occurs due to folloeing conditions:

-Emotional stress may hamper certain hormones required to produce sperm. If person is suffering from prolonged emotional stress, it may cause infertility.

-Poor diet is major cause of male infertility. Certain vitamin deficiencies such as C, selenium, zinc and folate may lead to infertility.

-Medical reports also indicated that obesity strongly impact on general health of males and can cause infertility. More body weight may lead to fertility problems in men.

-Males who consume excessive alcohol and drugs have poor health and this lead to fertility issues.

- Other medical conditions such as severe injury or major surgery may lead to male fertility. Diabetes, thyroid disease or anemia may be associated with infertility.

Age is also a factor that reduce fertility in men. According to reports, men who reaches to 35 or more may have decline in fertility.

-There are cases male infertility due to environmental exposure. Excessive exposure to environmental elements such as heat, toxins and chemicals cause a reduced sperm count, either direct or indirect. Pesticides and other chemicals cause female hormone-like effects in the male body and may be associated with reduced sperm production and testicular cancer. Exposure to lead may cause infertility. Prolonged exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.

Exposure to radiation can lessen sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.

It is also observed that regular use of saunas or hot tubs can upsurge body temperature. This may result in decrease sperm production and lower sperm count.

Tobacco smoking may lead to poor quality and decrease count of sperm.

Main symptoms of male infertility:

The main indication of male infertility is the incapability to conceive a child. In some cases, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes signs and symptoms.

Although male infertility do not have obvious symptoms other than inability to conceive a child, some indications of this condition include:

-Problems with sexual function. Male have difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection.

-Pain, swelling or a lump in the testicle area

-Recurrent respiratory infections

-Inability to smell

-Abnormal breast growth (gynecomastia)

-Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality

-Having a lower than normal sperm count

If disease and conditions like male infertility, it is imperative to prepare for appointment.

If males have never examined by doctor, they can approach family doctor.  They have a known condition lead to infertility or have any abnormalities on testing by primary care doctor, then doctor may refer to a specialist.

There are some helpful tips that assist males to get ready for appointment:

Be aware of any pre-appointment restrictions. Patient must be prepared for anything they need to do in advance.

Prior to appointment with specialist, patient must note down any symptoms they are experiencing.

It is good to know family history of fertility problems when fixing appointment with doctor.

When appoint is scheduled, patients must make a list of all medications, vitamins and supplements that they are taking.

Queries for infertility problem:  People who are experiencing fertility related issues may ask following questions to specialist:

1. What is the reason that hindering my ability to become a father?

2. What are other possible reasons my partner and I have not been able to conceive a child?

3. What kinds of tests do I need?

4. Will my partner also need tests?

5. What is the best treatment options to enhance fertility?

6. What are the alternatives to the primary approach that you are suggesting?

7. Are there some restrictions that I must follow?

8. Are there any brochures or other printed material that I can refer and some websites to gain more information?

Doctors or specialist may ask some question related fertility problem therefore person must be ready to answer these question correctly without any hesitation. Such as:

1. At what age did you start puberty?

2. Have you had any sexual problems in this relationship, including difficulty maintaining an erection, ejaculating too soon or not being able to ejaculate?

3. Have you ever fathered a child?

4. Have you had a vasectomy or other abdominal, pelvic or scrotal surgery?

5. Do you consume illicit drugs, such as marijuana, cocaine or anabolic steroids?

6. Have you been exposed to toxins such as chemicals, pesticides, radiation or lead, especially on a regular basis?

7. Are you currently taking any medications, including dietary supplements?

8. Do you have a history of undescended testicles?

9. Do you consume junk foods?

Tests and diagnosis:

It is suggested to males who are visiting to doctor for their problem of infertility that they must cooperate with doctor in interview session. Doctor examine body of patients for infertility causes. Males suffering from fertile problem have more than one causes therefore they must visit specialist. Doctor may recommend several test to determine chief cause of infertility. These tests are costly.

There are numerous way to diagnose male infertility:

-Infertility can be assessed through General physical examination and medical history. This includes examining patient’s genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Doctor might also ask about sexual habits and about sexual development during puberty.

Semen analysis is performed to evaluate the causes of infertility. Patients have to can provide a semen sample by masturbating and ejaculating into a special container at the doctor's office or by using a special condom to collect semen during intercourse. Semen specimen is analysed for quantity, color, and presence of infections or blood by a laboratory. Thorough analysis of the sperm is completed. The laboratory will determine the sperm count and any misdeeds in the shape and motility of the sperm. Typically sperm counts will vary from one specimen to the next.

It is common to perform a blood test to determine the level of testosterone and other male hormones.

Some laboratory tests include:

•         Urinalysis

•         Semen analysis

•         Semen collection: 48-72 hours of sexual abstinence.

•         Seminal fructose and postejaculate urinalysis

•         Fructose: derived from the seminal vesicle

•         Hormone assessment

•         FSH and testosterone

Sometimes doctor may recommend additional tests to help identify the cause of infertility.

-Scrotal ultrasound is advised for infertility. This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can assist doctor check if there is a varicocele or other problems in the testicles and supporting structures.

-Hormone testing is also done to locate the cause of infertility. Hormones produced by the pituitary gland, hypothalamus and testicles play vital role in sexual development and sperm production. Abnormalities in other hormonal or organ systems might also contribute to infertility. A blood test measures the level of testosterone and other hormones.

-Post-ejaculation urinalysis is recommended to check the fertility issues. Sperm in urine can indicate that sperm are traveling backward into the bladder instead of out penis during ejaculation.

-Genetic tests are also conduct to assure that infertility is there. When sperm concentration is extremely low, there could be a genetic cause. A blood test can show whether there are subtle changes in the Y chromosome, signs of a genetic abnormality. Genetic testing is performed to diagnose various congenital or inherited syndromes.

-Testicular biopsy is also suggested in some cases of infertility. This test involves removing samples from the testicle with a needle. If the results of the testicular biopsy show that whether sperm production is normal or problem is likely caused by a blockage or another problem with sperm transport.

-Specialized sperm function tests are conducted to check how well sperm survive after ejaculation, how well they can penetrate an egg, and whether there is any problem attaching to the egg. Normally, these tests are hardly performed and often do not significantly change recommendations for treatment.

-Transrectal ultrasound is also done to check infertility issue. A small, lubricated wand is inserted into rectum. It allows  doctor to check prostate, and look for blockages of the tubes that carry semen.

Treatment:

It is generally perceived that exact cause of infertility in males is not diagnosed. Infertility treatment rely on the root causes and how long patient been infertile, the age of the partners as well as personal preferences.

Treatments for male infertility are as under:

1. Surgery is one of the option to treat problem of infertility. A varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.

2. Male with infertility problems may have some infections. Antibiotic treatment might cure an infection of the reproductive tract, but it does not always restore fertility.

3. Doctors also give treatments for sexual intercourse problems. Medication or counselling are very helpful to improve fertility in conditions such as erectile dysfunction or premature ejaculation.

4. Doctors also recommend hormone treatments and medications. They might advise hormone replacement or medicines in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.

5. Assisted reproductive technology treatments are also suggested to patient of infertility. Assisted reproductive technology involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on specific case and desire of patient. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.

Sometimes increase frequency of intercourse may augment fertility. Contrariwise, frequent ejaculation can lower sperm quality. An egg can be fertilized for up to 24 hours after ovulation, and sperm live in the female reproductive tract for up to 72 hours.

Doctors also check common sexual problems that is related to impotence or premature ejaculation and provide solution to improve fertility.

Figure: 2 Represent treatment options of male infertility:

In some cases where irregular semen analysis can lead to infertility, Intracytoplasmic sperm injection are recommended. Sperm is taken directly from the testicles or recovered from the bladder and injected into an egg in the laboratory setting.

Pateints of infertility may have queries such as:

1. Is male infertility common? It is reported that male infertility is experienced by several people in a society therefore it is not rare issue. It is a combination of male and female infertility. It is sensible to exam both the male and female partner when dealing with this issue.

2. Which type of lifestyle we must adopt to improve sperm count and quality? According to doctors, males suffering with infertility must quit smoking, do not use recreational drugs, reduce alcohol consumption, and avoid using lubricants while trying to conceive. They are recommended to do moderate aerobic and resistance exercise, avoid high temperatures such as saunas and hot tubs, and regularly take supplemental vitamins if there is deficiency.

3. Whether vasectomy reversal is good option to treat male infertility?

According to medical research, a vasectomy reversal is consider as effective treatment for a couple interested in conceiving after the man has undergone a vasectomy. Upon successful reversal, the sperm count may be sufficient to allow for natural conception.

In brief, Male infertility is a problem of the reproductive system. Male infertility is discouraging for males and to cope with issue is quite difficult. Therefore person with such problems must plan for emotional uproar. They must decide in advance how many and what kind of procedures are emotionally and financially acceptable for them. Sometimes it is recommended to espouse stress-reduction techniques such as yoga, meditation and massage therapy.