Male Infertility Overview
Approximately 1 in 7 couples face infertility, defined as the inability to conceive after a year of regular, unprotected sexual intercourse. In many of these cases, male infertility is a contributing factor.
Male infertility can occur due to low sperm production, issues with sperm function, or blockages that hinder sperm delivery. Factors such as illnesses, injuries, chronic health conditions, and lifestyle choices may also play a role.
Although the journey to conceive can be challenging and frustrating, there are various treatment options available for addressing male infertility.
Symptoms
The primary indication of male infertility is the inability to conceive a child, often without any other clear signs.
In some cases, underlying conditions such as inherited disorders, hormonal imbalances, or blockages can lead to additional symptoms. These may include:
- Sexual Function Issues: Problems with ejaculation, low volumes of ejaculation, decreased sexual desire, or erectile dysfunction.
- Discomfort in the Testicles: Pain, swelling, or lumps in the testicular region.
- Breast Enlargement: Unusual growth of breast tissue (gynecomastia).
- Hair Loss: Decreased facial or body hair may signal chromosomal or hormonal abnormalities.
- Low Sperm Count: A sperm count of fewer than 15 million sperm per millilitre of semen or under 39 million total per ejaculate.
When to See a doctor
You should consult a doctor if you have been unable to conceive after a year of regular, unprotected intercourse. It's also important to seek help sooner if you experience any of the following:
- Problems with erections or ejaculation, low libido, or other sexual function issues
- Pain, discomfort, lumps, or swelling in the testicle area
- A history of issues with the testicles, prostate, or sexual health
- Previous surgeries involving the groin, testicles, penis, or scrotum
- A partner who is over age 35
Male Fertility Process
Male fertility is a complex process that involves several key steps to get your partner pregnant successfully:
- Healthy Sperm Production: You need to produce healthy sperm, which begins with developing the male reproductive organs during puberty. At least one testicle must function properly, and your body must produce testosterone and other hormones to support sperm production.
- Transporting Sperm: Once sperm are produced in the testicles, they travel through delicate tubes where they mix with semen before being ejaculated from the penis.
- Adequate Sperm Count: The semen must contain enough sperm. A low sperm count, defined as fewer than 15 million sperm per millilitre of semen or under 39 million per ejaculation, reduces the chances of fertilizing your partner's egg
- Sperm Function and Movement: The sperm must be functional and able to swim. If their movement (motility) or function is abnormal, they may struggle to reach or penetrate the egg.
Medical Causes of Male Infertility
Several health issues and medical treatments can affect male fertility, including:
- Varicocele:This condition involves swollen veins that drain the testicle and is the most common reversible cause of male infertility. It may lead to reduced sperm quantity and quality, possibly due to abnormal blood flow.
- Infection: Certain infections can interfere with sperm production or health or cause scarring that blocks sperm passage. Conditions like epididymitis (inflammation of the epididymis), orchitis (inflammation of the testicles), and some sexually transmitted infections (e.g., gonorrhoea, HIV) can impact fertility. While some infections may cause permanent damage, sperm can often still be retrieved.
- Ejaculation Issues: Retrograde ejaculation occurs when semen enters the bladder instead of exiting through the penis during orgasm. This can be caused by diabetes, spinal injuries, medications, or surgeries involving the bladder, prostate, or urethra.
- Antibodies Attacking Sperm: Anti-sperm antibodies are immune cells that mistakenly identify sperm as harmful, attempting to eliminate them.
- Tumours:Both cancers and benign tumours can directly affect the male reproductive organs or the glands that produce reproductive hormones, such as the pituitary gland. Treatments like surgery, radiation, or chemotherapy can also impact fertility.
Environment Causes
Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:
- Industrial chemicals:Extended exposure to certain chemicals, pesticides, herbicides, organic solvents and painting materials may contribute to low sperm counts.
- Heavy metal exposure:Exposure to lead or other heavy metals also may cause infertility.
- They were overheating the testicles:Radiation exposure can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
- Radiation or X-rays: Elevated temperatures may impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.
Sitting for long periods, wearing tight clothing or working on a laptop computer for extended periods may also increase the temperature in your scrotum and may slightly reduce sperm production. But the research isn't conclusive.
Health, lifestyle and other causes
Some other causes of male infertility include:
- Drug Use:Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
- Alcohol Use:Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
- Tobacco Use:Men who smoke may have a lower sperm count than those who don't smoke. Second-hand smoke also may affect male fertility.
- Weight:Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.
Risk Factors
Risk factors linked to male infertility include:
- Smoking tobacco
- Using alcohol
- Using certain illicit drugs
- Being overweight
- Having specific past or present infections
- Being exposed to toxins
- Overheating the testicles
- Having experienced trauma to the testicles
- Having a prior vasectomy or major abdominal or pelvic surgery
- Having a history of undescended testicles
- Being born with a fertility disorder or having a blood relative with a fertility disorder
- Having certain medical conditions, including tumours and chronic illnesses, such as sickle cell disease
- Taking certain medications or undergoing medical treatments, such as surgery or radiation used for treating cancer
Complications
Complications of male infertility can include:
- Stress and relationship difficulties related to the inability to have a child
- Expensive and involved reproductive techniques
- Increased risk of testicular cancer, melanoma, colon cancer and prostate cancer
Prevention
Male infertility isn't always preventable. However, you can try to avoid some known causes of male infertility. For example:
- Don't smoke.
- Limit or abstain from alcohol.
- Steer clear of illicit drugs.
- Maintain a healthy weight.
- Avoid things that lead to prolonged heat for the testicles.
- Reduce stress.
- Don't weartight undergarments or tight jeans for a long time
- Do not sit for longtime
- No laptops on lap
Male Infertility Treatments: PESA, TESA, and MESA
PESA, TESA, and MESA are procedures to treat male infertility. They surgically retrieve sperm from the male partner. These methods are beneficial for couples dealing with severe male infertility issues.
PESA, TESA, and MESA are procedures to treat male infertility. They surgically retrieve sperm from the male partner. These methods are beneficial for couples dealing with severe male infertility issues.
- Obstructive Azoospermia: This condition happens when the body makes sperm but cannot release it. This happens because of a blockage in the reproductive tract. This blockage can occur in the vas deferens. The vas deferens are the tubes that carry semen from the testes to the ejaculatory duct. It can also happen because of a genetic defect. This defect may cause the vas deferens missing or damaged from past surgery.
- Non-obstructive Azoospermia occurs when sperm production is extremely low or absent.
- Retrograde ejaculation occurs when the body sends semen back into the bladder instead of releasing it through the urethra.
- After vasectomy:Men who have undergone a vasectomy may require surgical sperm retrieval.
- Failed Vasectomy Reversal:If a vasectomy reversal fails, this can help retrieve sperm.
The first step in treating male infertility is thoroughly analysing the semen. Suppose the semen contains no sperm. Then, Dr. Arockia Virgin Fernando may suggest surgery to retrieve sperm directly from the testicles.
This sperm retrieval usually goes with IVF/ICSI. This lets the fertility specialist choose healthy sperm. The female partner can then use the sperm to fertilize her eggs.
Doctors use surgical sperm collection when a man has trouble releasing sperm naturally. This can happen because of a blockage, genetic problems, or low sperm production. Researchers separate the sperm from the fluid taken from the testes, prepare it, and then use it for fertilization. In most cases, doctors retrieve sperm and eggs on the same day, but they freeze the sperm for future use if necessary.
The different types of surgical sperm retrieval procedures include:
Testicular Sperm Aspiration (TESA)
A thin needle enters the testis to collect seminal fluid in this procedure. A syringe connected to the needle then suctions the fluid.
PESA – Percutaneous Epididymal Sperm Aspiration
Like TESA, this procedure uses a needle to collect seminal fluid. It takes this fluid from the epididymis. The epididymis is a coiled structure that temporarily stores sperm made in the testis. Doctors perform PESA and TESA under local anaesthesia; the procedures take about 10 minutes.
These are simple aspiration procedures. They are beneficial for men with obstructive azoospermia—a condition with average sperm production but poor sperm release.
MESA – Microsurgical Epididymal Sperm Aspiration
Unlike PESA and TESA, MESA is a surgery. In this procedure, the surgeon cuts the scrotum to access the testis and epididymis. Using an operating microscope, the surgeon identifies a specific tube in the epididymis and aspirates sperm from it.
Doctors perform MESA under general anaesthesia. It is for men with congenital problems, like missing vas deferens or epididymal blockage.
It allows doctors to collect many high-quality sperm. They can use this sperm for several IVF or ICSI cycles. They can also freeze it for future use.
These procedures help men who produce sperm but have a blockage preventing its release. However, for men without a blockage but with poor sperm production, there may be no sperm in the semen. In such cases, doctors need a more invasive procedure. Dr. Arockia Virgin Fernando may recommend the following techniques for sperm retrieval:
TESE – Testicular Sperm Extraction / Testis Biopsy
This procedure involves opening the scrotum with one or more cuts and removing some testicular tissue. A technician retrieves sperm from the tissue under a microscope.
Microdissection TESE
A doctor completes this more invasive procedure a day before the female partner's egg retrieval. The surgeon carefully locates the tissue they will remove using a surgical microscope.
Microdissection TESE reduces damage to the testis. A safer method removes only a small amount of tissue. This procedure can take up to four hours and helps men with sperm production issues.
Dr. Arockia Virgin Fernando will help you with the proper aspiration technique. He will think about several factors. These include the causes of male infertility. He will also consider the age of the male partner.
Finally, he will look at the purpose of the procedure. For instance, doctors often use microdissection TESE to collect sperm for freezing for future use.
If a specific technique does not find any sperm, Dr. Arockia Virgin Fernando may suggest a more invasive procedure. In obstructive azoospermia, the body produces sperm but does not release it, so it's rare to find no sperm.
In non-obstructive azoospermia, the body may make very little or no sperm. This means there may be no sperm to collect. Dr. Arockia Virgin Fernando will discuss this possibility with you before the procedure.
Should you have additional queries, consult Dr. Arockia Virgin Fernando. She can provide a complimentary viewpoint on the most suitable sperm retrieval method for you.