Introduction
Whenever fertility treatments get brought up, the focus is primarily on the female. Is she healthy? Is she “too old”? In fact, 30-40% of infertility cases are due to male factors. This shouldn’t really be a surprise since 50% of our population is male. And whilst women may be more likely to talk with close friends about infertility issues or problems with conceiving, men tend not to talk about it.
Male infertility is a topic often shrouded in misconceptions and silence, yet it affects millions of couples worldwide. Delving into the science behind male infertility can provide insights into its causes and pave the way for effective solutions. In this article, we explore the mechanisms of male infertility, covering aspects such as sperm quality, other problems, lifestyle recommendations, and medical solutions.
1. Sperm Quality and Count
Male infertility often stems from issues related to sperm quality and count. Understanding the underlying science can shed light on potential causes and treatments.
Sperm quality refers to the health and functionality of sperm cells, crucial for fertilization. Fertility specialists often look to these three factors when assessing sperm health: quantity (which we will cover in a bit), movement, and structure or morphology. Abnormal morphology or structure includes double head, amorphous head, bent or thick midpieces, or broken, double, or absence of tail.
With movement, or motility, the more the better, as sperm needs to wriggle and swim through the cervix, uterus, and fallopian tubes to reach and fertilize the egg. 40% of mobile sperm is considered the lower limit for pregnancy to occur. Structure pertains to the components: an oval head and a long tail. Both are needed for the sperm to move effectively.
Various factors can affect sperm quality, including oxidative stress, genetic abnormalities, and hormonal imbalances.
- Oxidative stress, caused by an imbalance between antioxidants and reactive oxygen species, can damage sperm DNA, impairing fertility.
- Genetic factors, such as chromosomal abnormalities or mutations in genes related to sperm production, can impact sperm quality.
- Hormonal imbalances, including deficiencies in testosterone or abnormalities in the hypothalamic-pituitary-gonadal axis, can disrupt sperm production and maturation.
Sperm count refers to the concentration of sperm in semen, which is essential for achieving fertilization. The likelihood of fertility is highest when the semen released during a single ejaculation contains a minimum of 15 million sperm per milliliter. Low sperm count, known as oligospermia, makes it harder to fertilize because there are fewer candidates available to reach the egg. Low sperm count can result from various factors, including hormonal imbalances, genetic predisposition, and environmental factors. Environmental factors such as exposure to toxins, radiation, or excessive heat can adversely affect sperm production and viability.
2. Other Issues
Structural abnormalities in the male reproductive system can also contribute to infertility. Understanding these issues is crucial for accurate diagnosis and treatment. One example is varicocele, a common structural problem characterized by the enlargement of veins within the scrotum. It can disrupt testicular temperature regulation, impair blood flow, and cause oxidative stress, ultimately affecting sperm production and quality.
Male bodies may also have obstructions in the reproductive tract, such as blockages in or absence of the vas deferens or ejaculatory ducts. Hindering the transport of sperm during ejaculation means hindering conception. These obstructions may result from infections, trauma, or congenital abnormalities, leading to infertility.
Another issue could be hormonal disruptions. Research indicates that disruptions in the hypothalamus or pituitary gland can result in reduced testosterone and sperm production.
Lastly, testicular diseases have been extensively researched and linked to male infertility. Studies have demonstrated the detrimental effects the inflammation of the testicles often caused by infections, on sperm production and quality.
4. Medical Solutions for Male Infertility
In cases where lifestyle modifications are insufficient, medical interventions may be necessary to address male infertility. If you and your partner have been trying to conceive without success for a year despite unprotected intercourse, it may be a good time to seek evaluation for infertility. Consulting with a fertility specialist can help pinpoint underlying issues and offer tailored treatments to support your journey towards parenthood. Depending on what the issue is, your doctor may discuss these solutions with you:
- Assisted Reproductive Techniques (ART): ART procedures such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) can help overcome male infertility by directly manipulating sperm and eggs in a laboratory setting. Depending on the reason for male infertility, intrauterine insemination (IUI) may be a good starting point as it is less invasive, as it helps to bring the sperm closer to the egg to aid conception.
- Hormonal Therapy: Hormonal imbalances affecting sperm production can be addressed through hormone replacement therapy or medications to stimulate testosterone production.
- Surgical Interventions: Surgery, such as varicocele repair or sperm retrieval techniques, may be recommended to correct structural abnormalities or retrieve viable sperm for assisted reproduction.
4. Medical Solutions for Male Infertility
In cases where lifestyle modifications are insufficient, medical interventions may be necessary to address male infertility. If you and your partner have been trying to conceive without success for a year despite unprotected intercourse, it may be a good time to seek evaluation for infertility. Consulting with a fertility specialist can help pinpoint underlying issues and offer tailored treatments to support your journey towards parenthood. Depending on what the issue is, your doctor may discuss these solutions with you:
- Assisted Reproductive Techniques (ART): ART procedures such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) can help overcome male infertility by directly manipulating sperm and eggs in a laboratory setting. Depending on the reason for male infertility, intrauterine insemination (IUI) may be a good starting point as it is less invasive, as it helps to bring the sperm closer to the egg to aid conception.
- Hormonal Therapy: Hormonal imbalances affecting sperm production can be addressed through hormone replacement therapy or medications to stimulate testosterone production.
- Surgical Interventions: Surgery, such as varicocele repair or sperm retrieval techniques, may be recommended to correct structural abnormalities or retrieve viable sperm for assisted reproduction.
Conclusion
Understanding the science behind male infertility is essential for identifying underlying causes and implementing effective solutions. By addressing factors such as sperm quality, structural problems, lifestyle habits, and medical interventions, couples can take proactive steps to preserve and enhance the chances of achieving successful conception and parenthood.
Citations:
[1] https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility
[2] https://uroweb.org/eau-guidelines/discontinued-topics/male-infertility
[3] https://www.hopkinsmedicine.org/health/conditions-and-diseases/male-infertility
[4] https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/fertility/art-20047584
