A couple is said to be infertile when the male & female partner are of reproductive age but unable to conceive following one year of regular unprotected sexual intercourse. When the reasons lie with the male, it is called male infertility. While the common belief is that the main problem is on the part of the female, recent studies have shown that male factor infertility affects approximately half of all infertile couples.
What are the reasons for male infertility?
Fertility problems in males may occur as a result of –
- Defective sperm production
- Ineffective delivery of the sperms into the female reproductive tract
What is defective sperm production?
Defective sperm production can be in different forms.
- When there is absolutely zero production of sperms it is known as azoospermia.
- When the optimal number of sperms needed in an ejaculate for a successful conception is not there, it is known as oligospermia.
- When the number of sperms per ejaculate is optimal but the majority are abnormally shaped it is known as teratospermia.
- Sometimes although the number and morphology are both optimal for a successful conception, the ability of the sperm to swim (sperm motility) is the factor impairing fertility.
- A sperm is able to survive for 3 days. Accordingly, it has ample time to swim up to the ovum. But when its lifetime is shorter than normal it undergoes premature death prior to meeting the ovum.
- DNA and chromosome abnormalities.
- Hormonal problems affecting sperm production.
How does ineffective delivery of the sperms take place?
Some reasons for the same include,
- Structural abnormalities such as a blockage in the vas deferens; the main tubular structure that delivers the sperms into the urethra.
- Coital dysfunction such as erectile dysfunction, retrograde ejaculation & premature ejaculation.
- Anti-sperm antibodies attacking the well-formed sperms.
What are the factors promoting infertility in men?
Unhealthy lifestyle practices are among the leading factors that adversely affect men’s fertility. Some of them include,
- Excessive alcohol intake/tobacco smoking/illicit drug use
- Low/high BMI
- Frequent exposure to extreme heat
- Overcrowded situations
- Infections such as severe mumps infection after puberty/acute viral illnesses/urinary infections surgical correction of undescended testis /inguinal hernia
- Exposure to radiation/poisonous chemicals
- Severe trauma to the groin area
How do we test for male infertility?
A semen analysis test is the gold standard fertility test for men. This male fertility test involves examination of a sample of semen under the microscope. The ejaculate sample should be obtained by masturbation after 3 days of abstinence from sexual intercourse. It is collected into a clean dry container properly labelled with the name and date and time of collection. Moreover, condoms should not be used for the sample collection and the sample should be delivered to the laboratory within an hour of ejaculation.
What are the markers assessed during semen analysis?
- Volume – >1.5ml is considered as normal
- Liquefaction time – 30min
- Concentration >15mil/ml
- Total sperms >39 million per ejaculate
- Motility > 40% progressive motility
- Morphology > 4% normal forms
- Viability >58%
The seminal fluid analysis is repeated when an abnormality is detected in the first sample. Abnormalities in the first sample can be due to improper sample collection techniques, an ongoing illness, heavy alcohol consumption or due to the effect of other frequently used drugs.
What is fertility treatment?
Before the advent of modern technology like assisted fertilization using microinjection of sperm, couples had to settle for the option of donated sperm. Nonetheless, with intracytoplasmic sperm injection (ICSI), a single healthy sperm is more than enough to achieve a successful pregnancy. This is the best method available to overcome problems related to the number and quality of sperms.
Sometimes the cause of low sperm count may also be due to low reproductive hormone levels in males; namely gonadotropin. Hence gonadotropin hormone administration not only improves the sperm count per ejaculate but also the sperm motility, which increases fertility. Frequent exercise and healthy diet has also shown to increase testosterone and boost fertility
In vitro fertilization (IVF) and embryo transfer are particularly useful for couples with problems in sperm motility and penetration of the egg. The semen is analyzed and the most active sperm is selected and injected into the egg. Subsequently, the fertilized embryo is transferred to the mother’s uterus.
Donor insemination is the last resort nowadays for a couple after all the above-listed techniques fail to bring about successful conception.