Dr Tariq Jagnarine, MD, MMed Family Medicine, Endocrinology & Diabetes
Infertility has traditionally been thought of as a woman’s problem. However, as it turns out, up to 15 percent of couples are infertile. This means they are not able to conceive a child, even though they have had frequent, unprotected sexual intercourse for a year or longer. In over a third of these couples, male infertility plays a role.
Being diagnosed with male infertility can be one of the hardest challenges a man can face. For some, it can be devastating. Not being able to father a child can make some men feel like they are failing at one of their most primal responsibilities.
SYMPTOMS OF MALE INFERTILITY
The main sign of male infertility is the inability to conceive a child. There may be no other obvious sign or symptom. Some symptoms are:
* Problems with sexual function — for example, difficulty with ejaculation, or small volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction)
* Pain, swelling or a lump in the testicle area
* Recurrent respiratory infections
* Inability to smell
* Abnormal breast growth (gynecomastia)
* Decreased facial or body hair
* A lower-than-normal sperm count (fewer than 1.5 million sperm per millilitre of semen, or a total sperm count of less than 3.9 million per ejaculate)
CAUSES OF MALE INFERTILITY
Medical causes
A number of health issues and medical treatments can cause problems with male fertility. Some of these include:
* Varicocele. A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it may be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm.
* Infection. Some infections can interfere with sperm production or sperm health, or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhoea or HIV.
* Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.
* Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
* Tumors. Cancers and nonmalignant tumours can 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 tumours can affect 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). Decreased fertility is more likely in men who have had this condition.
* Hormone imbalances.Infertility can result from disorders of the testicles themselves, or an abnormality affecting other hormonal systems, including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
* Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma, or abnormal development such as with cystic fibrosis or similar inherited conditions.
* Chromosome defects. Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs.
* Problems with sexual intercourse. These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
* Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
* Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
* Prior surgeries. Certain surgeries may prevent men from having sperm in their ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.
Environmental 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 benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
* Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
* Radiation or X-rays. Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
* Overheating the testicles. Elevated temperatures 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.
Health, lifestyle and other causes
Some other causes of male infertility include:
* Drug use. 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 smoking. Men who smoke may have a lower sperm count than do those who do not smoke. Second-hand smoke also may affect male fertility.
* Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
* Depression. Research shows that the likelihood of pregnancy may be lower if a male partner has severe depression. In addition, depression in men may cause sexual dysfunction due to reduced libido, erectile dysfunction, or delayed or inhibited ejaculation.
* Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves, as well as by causing hormone changes that reduce male fertility.
Certain occupations, including welding or those involving prolonged sitting, such as truck driving, may be associated with a risk of infertility.
COMPLICATIONS
Infertility can be stressful for both partners. Complications of male infertility can include:
* Surgery or other procedures to treat an underlying cause of low sperm count or other reproductive problems
* Expensive and invasive reproductive techniques
* Stress and relationship difficulties related to the inability to have a child
* Social Taboo and ridicule from peers
PREVENTION
Many types of male infertility are not preventable. However, avoid some of the risk factors that cause male infertility, such as:
* Avoid smoke.
* Limit or abstain from alcohol.
* Avoid illicit drugs.
* Optimal weight
* No Vasectomy with intentions to have kids.
* Avoid things that lead to prolonged heat for the testicles.
* Reduce stress.
* Avoid exposure to pesticides, heavy metals and other toxins.
Finding out that one is infertile is often a shocking and upsetting experience, and in some cases, men can often be unprepared for being told there is a complication with their sperm, affecting their sense of masculinity, sexuality and potency.
While it is normal to have an emotional reaction to infertility, talking with a doctor, a sexual therapist or counsellor can often help with any negative feelings, and treatment options are available. Infertility is more common than most people think.
