Infertility is defined as an inability of a couple to conceive even after one year of unprotected sexual intercourse. When the inability is due to some condition in male it is known as male infertility. It can occur as result of some female disorders as well and therefore it becomes important to investigate both the partners in case of infertility.
Male infertility has become quite common and it contributes to about 30% of all infertility cases.
What Are The Types Of Male Infertility?
The two types of infertility are primary and secondary infertility. It is called as primary infertility when the couple is unable to conceive after a minimum of one year of having unprotected sex. Whereas in secondary infertility the couple has conceived before but at present they are unable to support a conception. Male infertility has also been classified on the basis of effectiveness of medical intervention to improve natural conception rate. It is untreatable sterility where primary seminiferous tubule failure is present and it is found in approximately 12% of the cases. The treatable conditions include sperm autoimmunity (7%), obstructive azoospermia (10%), gonadotropin deficiency (0.5%), and disorders of sexual function (0.5%), reversible toxin effects (0.02%). The second type is the untreatable subfertility which contributes to 70% of the cases where oligospermia forms 35%, asthenospermia and teratozoospermia 30% and normospermia with functional defects form 5% of the cases.
Male infertility patients who have irreversible sterility can be separated with potentially treatable conditions or sub-fertility on the basis of history of the infertile man(illness or injury to the testes, sex drive and performance, occupation, habits and pubertal development), physical examination (general, virilization, gynecomastia, body proportions and BMI, scrotal examination, testicular size, epididymides, vasa and varicocele) and basic investigations that include semen analysis, hormone measurements, imaging and biopsy of the testis.
The known causes of male infertility include problems in production of sperm that may be chromosomal or genetic causes, failure of testes to descend at birth/undescended testes, infections, torsion of testes (twisting of testis in scrotum), varicocele (enlargement of the veins of the scrotum), certain medications and chemicals, damage due to radiation and some unknown causes. There can also be blockage of sperm transport either due to infections, prostrate related problems, and absence of vas deferens or vasectomy. Some people can have sexual problems related to ejaculation and erection that may be due to damage to nerves, prostrate surgery, spinal cord injury, infrequent intercourse, erectile dysfunction, failure of ejaculation and retrograde and premature ejaculation.
Hormonal problems include pituitary tumors, congenital lack of luteinizing hormone or follicular stimulating hormone from birth, and abuse of anabolic (androgenic) steroids. In some cases sperm antibodies can be seen in people who have undergone vasectomy or have suffered some injury or infection in the epididymis.
There are no obvious signs and symptoms of male infertility, only vague presentations such as changes in hair growth, low sex drive, small firm testicles that may or may not be painful with a lump or swelling and difficulty in erection and ejaculation.
The risk factors for male infertility include excessive smoking, alcohol and drug abuse, exposure to toxins, trauma or overheating to the testicles. Obesity, past or present infections, history of undescended testicles, previous major abdominal or pelvic surgery or vasectomy, chemotherapy, family history of fertility disorder and some tumors and sickle cell disease.
Management Of Male Infertility
Male infertility is most often treated by conventional methods that include taking medications that will help in increasing the production of sperm. Antibiotics are given to treat an infection that may be affecting the testes. Hormone therapy is done to improve hormonal imbalance and avoiding the use of hot tubs and saunas and long hot showers that might cause the overheating of the testicles. It is also advised to wear loose underwear for better functioning of the testes. Supplements are given to boost sperm production. Artificial insemination can be done when a man’s sperm count is very low. In vitro fertilization is another option to overcome male infertility and help in conception.