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Male Infertility: Causes, Signs & Symptoms | Max Hospital

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Demystifying Male Infertility: Causes, Symptoms, Tests & Treatment Options

By Medical Expert Team

Jul 11 , 2024 | 8 min read

Male infertility is a significant and often overlooked health issue that affects millions of individuals worldwide. It is estimated that around 15 percent of couples globally face infertility, with male infertility contributing to approximately 40-50 percent of these cases. In India, infertility affects about 10-15 percent of couples, with male factors being responsible for about 30-40 percent of the cases. Given the increasing instances of infertility among men, . Understanding male infertility is crucial for addressing this widespread problem and helping couples achieve their dreams of parenthood.

What is Male Infertility?

Male infertility refers to a man's inability to cause pregnancy in a fertile female partner after one year of regular, unprotected intercourse. It can result from various factors affecting sperm production, function, or delivery, and accounts for about 40-50% of all infertility cases. This condition can be influenced by sperm disorders, hormonal imbalances, anatomical issues, infections, genetic disorders, lifestyle factors, and certain medical conditions or treatments. The primary symptom is the inability to conceive, though it may also involve issues with sexual function or signs of hormonal imbalance.

What Causes Male Infertility?

Male infertility can be caused by a range of factors, including:

Sperm disorders

  • Low sperm count (Oligospermia): Having fewer than 15 million sperm per millilitre of semen.
  • Poor sperm motility (Asthenospermia): Sperm that do not swim properly, reducing the chance of reaching and fertilising an egg.
  • Abnormal sperm morphology (Teratospermia): Sperm with irregular shape, which may impair their ability to penetrate and fertilise an egg.

Hormonal imbalances

Imbalances in hormones such as testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) can affect sperm production and function.

Anatomical issues

  • Varicocele: Enlarged veins in the scrotum that can overheat the testicles, impairing sperm production.
  • Blockages: Obstructions in the ducts that transport sperm, such as the vas deferens or epididymis, preventing sperm from being ejaculated.
  • Undescended testicles: Testicles that have not descended into the scrotum, affecting sperm production.

Infections

Infections such as sexually transmitted infections (STIs), orchitis (inflammation of the testicles), or epididymitis (inflammation of the epididymis) can interfere with sperm production or health.

Genetic disorders

Conditions like Klinefelter syndrome, cystic fibrosis, or chromosomal abnormalities can impact sperm production and function.

Lifestyle factors

Factors such as smoking, excessive alcohol consumption, drug use, obesity, and exposure to environmental toxins can negatively affect sperm quality.

Medical conditions and treatments

Chronic illnesses such as diabetes, and treatments for cancer, including chemotherapy and radiation, can impair fertility.

What are the Risk Factors for Male Infertility?

There are a number of factors that can increase a man's risk of infertility. These can be broadly categorised into medical conditions, lifestyle choices, and environmental factors.

Medical conditions

  • Undescended testicles: If a boy's testicles don't descend into the scrotum before birth, it can damage sperm production.
  • Varicocele: This is a swelling of the veins in the scrotum that can impair sperm production.
  • Infections: Infections of the testicles, epididymis (the tube that stores sperm), or urethra (the tube that carries urine and semen out of the penis) can damage sperm production and transport.
  • Hormonal imbalances: Conditions that affect testosterone production, such as Klinefelter syndrome, can lead to infertility.
  • Retrograde ejaculation: This is a condition in which semen ejaculates backward into the bladder instead of out of the penis.

Lifestyle choices

  • Smoking: Smoking can damage sperm quality and quantity.
  • Heavy alcohol use: Alcohol can lower testosterone levels and damage sperm production.
  • Illegal drug use: Cocaine, marijuana, and other illegal drugs can all impair sperm production and function.
  • Obesity: Being overweight or obese can lower testosterone levels and sperm quality.

Environmental factors

  • Exposure to toxins: Exposure to certain toxins, such as pesticides, herbicides, and industrial chemicals, can damage sperm production.
  • Overheating the testicles: Excessive heat exposure, such as from frequent hot tubs or saunas, can impair sperm production.

If you're concerned about your fertility, it's important to see a doctor for testing and evaluation. There are a number of treatments available for male infertility, and many couples are able to conceive with the help of medical intervention.

What are the Symptoms of Male Infertility?

Male infertility often doesn't present any obvious symptoms. The main sign is typically being unable to conceive a child despite trying for a certain amount of time (usually around 6 months to a year). However, there can be some physical signs and symptoms that might indicate an underlying issue. These include:

  • Sexual problems: Erectile dysfunction, trouble ejaculating, low libido, or reduced semen volume.
  • Testicle issues: Pain, swelling, or a lump in the testicles.
  • Hormonal imbalances: Signs like decreased facial or body hair, unusual breast growth, or unexplained fatigue could point to testosterone issues.
  • Respiratory problems: Recurrent infections might be a sign.
  • Reduced sense of smell: This can be uncommon, but can be associated with hormonal problems affecting fertility.

It's important to remember that these symptoms can also have other causes. If you're experiencing any of them, it's always best to consult a doctor to get a proper diagnosis.

How is Male Infertility Diagnosed?

Diagnosing male infertility typically involves a multi-step process. Here's a breakdown of the usual course:

  • Medical history and physical examination: The doctor will likely talk to you about your medical history, including any past illnesses, surgeries, medications, and injuries. They'll also ask about your lifestyle habits and family history. A physical exam will focus on the genitals to check for any abnormalities.
  • Semen analysis: This is the primary test used to evaluate sperm health. You'll provide a semen sample, which will be analysed in a lab for factors like sperm count, motility (movement), and morphology (shape).
  • Blood tests: Blood tests can measure hormone levels like testosterone, which plays a crucial role in sperm production. Other blood tests might check for genetic conditions or infections that could be affecting fertility.
  • Imaging tests: In some cases, imaging tests like ultrasounds or MRIs might be used to get a better look at the testicles and surrounding structures to identify potential blockages or abnormalities.
  • Urinalysis: Sometimes, a urine test after ejaculation (post-ejaculation urinalysis) might be done to check for retrograde ejaculation, where semen travels backward into the bladder instead of out.
  • Testicular biopsy: If the semen analysis shows very low sperm count or no sperm at all, a testicular biopsy might be needed. This is a minor surgical procedure where a small sample of testicular tissue is extracted and examined under a microscope for abnormalities in sperm production.

The specific tests used will depend on your individual situation and the doctor's findings during the initial evaluation. It's important to note that a single abnormal test result might not necessarily mean infertility. The male infertility doctor will consider all the results together to make a diagnosis and determine the cause of infertility, if any.

How is Male Infertility Treated?

Male infertility can be treated using various methods depending on the underlying cause. Here are some common treatments:

Surgery for male infertility

Surgical procedures can correct anatomical problems or obstructions in the male reproductive system. Some common surgeries include:

  • Varicocelectomy: Removal of enlarged veins in the scrotum that can affect sperm production.
  • Vasovasostomy or Vasoepididymostomy: Reversal of a vasectomy or repair of blockages in the vas deferens or epididymis to restore the flow of sperm.
  • Testicular sperm extraction (TESE): Retrieval of sperm directly from the testicles when there is no sperm in the ejaculate.

Hormone therapy for male infertility

Hormonal imbalances can affect sperm production. Hormone therapy may include:

  • Gonadotropin therapy: Injections of hormones like hCG or hMG to stimulate sperm production.
  • Clomiphene citrate: An oral medication that can increase the production of gonadotropins.
  • Bromocriptine or cabergoline: Used to treat high levels of prolactin that can affect fertility.

Artificial insemination for male infertility

Artificial insemination involves directly inserting sperm into a woman’s reproductive tract. Types include:

  • Intrauterine insemination (IUI): Sperm is washed and concentrated before being placed directly into the uterus around the time of ovulation.

In-Vitro Fertilisation (IVF) for male infertility

IVF involves fertilising an egg outside the body and then implanting the embryo into the uterus. Steps include:

  • Ovarian stimulation: Medications stimulate the ovaries to produce multiple eggs.
  • Egg retrieval: Eggs are collected from the ovaries.
  • Fertilisation: Sperm and eggs are combined in a laboratory dish.
  • Embryo transfer: One or more embryos are placed into the woman’s uterus.

Intracytoplasmic Sperm Injection (ICSI) for male infertility

ICSI is often used in conjunction with IVF. It involves:

  • Sperm injection: A single sperm is injected directly into an egg to achieve fertilisation.
  • Embryo transfer: The resulting embryo is transferred to the uterus, similar to the IVF process.

Each treatment option depends on the specific diagnosis and circumstances of the couple. Consulting with a fertility specialist can help determine the most appropriate course of action.

Can Male Infertility be Prevented?

Preventing male infertility involves adopting lifestyle choices and habits that support reproductive health. While not all causes of male infertility can be prevented, here are some general tips to reduce the risk:

Maintain a healthy lifestyle

  • Balanced diet: Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.
  • Regular exercise: Engage in regular physical activity to maintain a healthy weight and overall well-being.
  • Avoid smoking: Smoking can reduce sperm quality and count.
  • Limit alcohol consumption: Excessive alcohol intake can affect sperm production and quality.
  • Avoid drug use: Refrain from using recreational drugs, which can negatively impact fertility.

Protect against environmental toxins

  • Avoid exposure to pesticides and chemicals: Limit contact with harmful substances such as pesticides, heavy metals, and industrial chemicals.
  • Use protective gear: If you work in an environment with potential toxins, use appropriate protective equipment.

Manage stress and mental health

  • Stress reduction: Practise stress-reducing techniques such as meditation, yoga, or deep-breathing exercises.
  • Mental health: Seek support for mental health issues, as chronic stress and depression can affect fertility.

Maintain reproductive health

  • Avoid overheating the testicles: Avoid prolonged exposure to hot tubs, saunas, and tight underwear that can raise testicular temperature and affect sperm production.
  • Regular medical check-ups: Regular health check ups can help detect and address potential issues early.
  • Vaccinations: Ensure vaccinations are up to date to prevent infections that can affect fertility, such as mumps.

Protect Against Sexually Transmitted Infections (STIs)

  • Safe sex practices: Use condoms and practise safe sex to prevent STIs, which can lead to infertility.
  • Regular Testing: Get tested regularly for STIs and seek treatment promptly if needed.

Avoid certain medications and supplements

  • Steroid Avoidance: Avoid anabolic steroids, which can decrease sperm production.
  • Consult a doctor: Discuss any medications or supplements with your healthcare provider, as some can impact fertility.

While these steps can help reduce the risk of male infertility, some factors, such as genetic conditions or underlying medical issues, may not be preventable. Regular consultations with a healthcare provider can help manage overall health and address any concerns related to fertility.

Final words

If you or someone you know has been facing challenges with conceiving, waste no time in seeking medical intervention. Our team of experienced urologists and fertility specialists is equipped to diagnose the cause of infertility and recommend the most effective treatment options. Don't hesitate to schedule a consultation at Max Hospitals and take the first step towards realising your dream of parenthood.


Written and Verified by:

Medical Expert Team