Male infertility

Male infertility is the inability to conceive a child after one year of regular intercourse without any birth control. Infertility itself is a symptom. Various signs and symptoms that may be associated with male infertility include:

• Difficulty with ejaculation or small volumes of fluid ejaculated
• Reduced sexual desire
• Erectile dysfunction (difficulty maintaining an erection)
• Pain, swelling, or a lump in the testicle area
• Gynecomastia (abnormal fullness in breasts)
• Hormonal abnormality (decreased facial or body hair)
• Recurrent respiratory tract infections
• Inability to smell
• Reduced body mass
• Obesity

Trying to lose weight? To start your weight loss journey, tap here.

Male infertility is mainly caused due to anatomical abnormalities and ejaculatory disorders. Causes can be broadly classified into the following:

1. Pre-testicular causes

• Quality and quantity of semen: Over 90% of cases of male infertility are related directly to sperm numbers or poor sperm quality.
• Hormonal deficiency/imbalance: Male sex hormones play a significant role in the growth, improvement, and proliferation of testicles. For example, isolated LH and FSH deficiencies are linked to infertility.
• Genetics: Certain chromosomal defects are directly related to male infertility, including myotonic dystrophy, microdeletion, and Kallmann's syndrome.
• Oxidative stress: This phenomenon is caused by an imbalance between the production and accumulation of reactive oxygen species (ROS) in cells, leading to sperm dysfunction and infertility in men.
• Pituitary diseases: The pituitary gland, located at the base of the brain, can cause infertility in men due to disorders such as pituitary insufficiency, hyperprolactinemia, exogenous hormones, and growth hormone deficiency.

2. Testicular causes

• Orchiectomy: This refers to the surgical removal of both testes.
• Primitive testicular dysfunction: This may result from testosterone deficiency or impaired sperm production, leading to male infertility.
• Cryptorchidism: A condition in which one or both of the testes fail to descend from the abdomen into the scrotum.
• Atrophic testes: Refers to small or shrunken testicles.
• Varicoceles: Enlarged veins on the scrotum associated with male infertility.
• Epididymitis: Swelling or pain in the back of the testicle caused by sexually transmitted infections.
• Malignancies: Testicular tumors or adrenal tumors leading to excess androgens, as well as radiotherapy and chemotherapy, can result in male infertility.
• Chromosomal disorders: Disorders such as Klinefelter’s syndrome and XYY male affect the testicles and can lead to infertility.
• Sertoli-cell-only syndrome: Also known as del Castillo syndrome or germ cell aplasia, this is one of the most common causes of the absence of sperm in infertile men, affecting sperm production.

3. Post-testicular causes

• Ejaculatory duct obstruction: A pathological condition characterized by the obstruction of one or both ejaculatory ducts, which can be present at birth or acquired later in life.
• Cystic fibrosis: A congenital condition affecting the lungs, heart, and other organs. Most men with cystic fibrosis are infertile due to the congenital bilateral absence of the vas deferens (CBAVD).
• Antisperm antibodies: Antibodies that work against sperm, severely impacting sperm quality, count, and motility.

Male infertility is influenced by many biological and environmental factors. The factors that can increase the risk of infertility include:

1. Local factors

• Genito-urinary infection: Infections in the male genital tract can lead to male infertility due to inflammation. These infections are generally sexually transmitted.
• Trauma to testicles: Men can experience problems with fertility after trauma to the testicles due to an injury or accident.

2. Environmental factors

• Obesity: Overweight (BMI 25–<30 kg/m²) and obese (BMI 30 kg/m²) males are associated with low seminal discharge volume, low sperm concentration, and low total sperm count.
• Smoking: Tobacco chewing and smoking are responsible for DNA damage, leading to lower sperm count and severely affecting fertility.
• Alcohol: Heavy consumption of alcohol can cause changes in the shape and size of sperm. Additionally, liver damage from alcohol can lead to male infertility.
• Diet: Studies indicate that regular overconsumption of red and processed meat, fatty dairy products, refined grains, caffeine, and sweetened beverages can lead to poor semen quality.
• Stress: Long-term stress can be detrimental to male reproductive potential, linked to diminished testosterone levels, decreased sperm counts, altered sperm morphology, and decreased motility.
• Sleep disturbances: Insufficient sleep and poor sleep quality can adversely affect male fertility.
• Advanced paternal age (APA): Some studies find advancing paternal age a risk factor for infertility, typically between 35 and 50 years of age in men.
• Exposure of the genitals to high temperatures: Excessive heat to the genital organs can damage the testicles, increasing the risk of infertility.
• Chemicals: Factors such as volatile organic solvents, silicones, chemical dust, air pollution, and pesticides negatively affect male fertility.
• Radiation: Radiation can destroy sperm cells and stem cells that produce sperm. Radiation therapy to the brain may damage the pituitary gland, decreasing sperm production and causing testosterone imbalance.

3. Systemic conditions

• Diabetes: Uncontrolled diabetes can damage blood vessels and nerves, increasing the risk of erectile dysfunction, decreased sex drive, ejaculation problems, and inflammation of the foreskin.
• Medications: Cannabinoids, opioids, psychotropic drugs, and certain antibiotics and antifungal agents are known to cause male infertility.
• Systemic infection: Tissue damage and inflammation from bacterial infections can negatively affect sperm production and testosterone levels, leading to male infertility.

4. Other factors

• Early or late puberty: Studies demonstrate that pubertal timing is likely associated with male reproductive health, affecting semen quality.
• Hernia repair: Though extremely rare, hernia surgeries can narrow the tube and prevent sperm from being delivered into the prostate.

Did you know? The use of mobile phones is potentially linked to male infertility. Studies have shown that exposure to radiofrequency electromagnetic waves emitted by mobile phones may have harmful effects on the testis.

Diagnosing the exact cause of infertility is important in determining the course of treatment. Most of the time, there is more than one cause of infertility. Here are a few tests that doctors at fertility clinics may conduct:

1. Medical History
   • Taking a detailed reproductive history, medical history, any history of past surgeries, and current medications.
2. Physical Examination
   • General Appearance: Assessment of hair distribution and body habitus.
   • Abdominal Examination: Examination for hernias or surgical scars.
   • Genital Examination: Conducted in both standing and supine positions, involving palpation of the testes, epididymis, vasa deferentia, spermatic cord, and phallus.
   • Digital Rectal Examination: Recommended for men over 40 years of age, especially if there are lower urinary tract symptoms (LUTS) or low sperm volume.
3. Semen Testing
   • Semen Analysis: Semen samples are sent to laboratories to measure the number, motility, and morphology of sperm. Multiple tests are often conducted for accuracy.
   • Semen DNA Fragmentation: Evaluates lifestyle risk factors, recurrent miscarriages, and failures in IVF and IUF treatments.
   • Semen Oxidative Stress Measures: Indicated in unexplained infertility to detect varicocele, history of genitourinary infection, and evaluate lifestyle risk factors.
4. Blood Tests
   • Hormone Testing: Measures levels of hormones produced by the pituitary gland, hypothalamus, and testicles, including:
     • Testosterone
     • Luteinizing Hormone (LH)
     • Follicle Stimulating Hormone (FSH)
     • Prolactin
     • Estradiol
   • Immunobead Test (IBT): Detects the presence of antibodies (IgA) in motile sperm.
5. Genetic Screening
   • Sperm Chromatin and Abnormal DNA Assays: A new diagnostic tool to detect sperm samples with high DNA fragmentation.
   • Chromosome and Genetic Studies: Evaluates male factors for signs of genetic abnormalities affecting the Y chromosome.
6. Testicular Biopsy

   A procedure in which a small portion of the testicle is removed for examination. The sample is viewed under a microscope to check for abnormalities. Bilateral testicular biopsy (TBO) is recommended for diagnosing male infertility, particularly useful for investigating decreased or absent sperm.

7. Imaging Tests
   • Ultrasound: Scrotal or transrectal ultrasounds may be conducted to identify issues with the testicles or prostate gland affecting fertility.
   • Doppler Blood Flow: Checks for inflammation, swelling, or torsion of testicles in the case of varicocele.
   • MRI Pituitary: Indicated to detect true prolactinoma (a noncancerous tumor of the pituitary gland producing prolactin).
   • MRI Pelvis/Scrotum: Checks for undescended testes and suspicious testicular lesions.
   • Vasography: Primarily used to rule out obstructions, especially before surgery.

Get all the tests done in one place, under the guidance of trusted technicians and doctors. Book your tests now.

Consume a healthy diet

A healthy, balanced, and wholesome diet plays a pivotal role in the prevention of male infertility. Here are some food items that you should prefer and others you should avoid in your diet.

Foods to prefer:

• Green leafy vegetables
• Legumes
• Whole fruits
• Whole grains like wheat, brown rice, jowar, ragi, and bajra
• Low-fat or fat-free milk or yogurt
• Eggs, fish, seafood, lean poultry

Foods to limit or avoid:

• Refined grains like white flour or white bread
• Table sugar
• Sugar-sweetened beverages
• Packaged foods
• Red and processed meats

Shed those extra kgs:

A healthy weight can keep infertility at bay. Regular exercise and a healthy diet are the cornerstones of attaining and maintaining a healthy weight.

Stay away from recreational drugs:

Drugs like marijuana, cocaine, anabolic-androgenic steroids (AAS), opiates (narcotics), and methamphetamines can negatively influence male fertility. Say no to drugs not just for boosting fertility but also for overall health.

Quit smoking:

Tobacco can harm your health and affect fertility. Heavy smoking increases the risk of erectile dysfunction. Those trying to conceive should consider quitting to optimize their chances.

Be mindful while consuming alcohol:

Excessive drinking can alter sperm count, shape, size, and motility. It can lower testosterone levels and affect ejaculation. Try to avoid or limit alcohol consumption.

Keep calm and manage stress:

While everyone experiences stress, excessive stress is a significant risk factor affecting male infertility. You can de-stress by working out, reading, meditating, or engaging in enjoyable activities.

Give importance to sleep:

Research shows that insufficient sleep may reduce sperm quality in men. Getting adequate sleep of at least 7-8 hours is vital for maintaining reproductive health.

Avoid heat around your testicles:

Heat near the testicles can kill sperm cells and lead to the production of abnormally shaped sperm. Avoid placing your laptop on your lap while working, take cold showers, and wear loose clothing.

Did you know?

Cycling is associated with increased testicular heat. Some studies indicate that long-term low-to-intensive cycling training may adversely affect sperm. Cyclists should take sufficient rest after training sessions to ensure healthy sperm parameters.

There are several treatment options available for infertility in men. They include:

1. Medications
   • Antioxidants: These are used to reduce oxidative stress, which can cause male infertility. The most commonly used ones include:
     • Vitamin C
     • Vitamin E
     • Zinc
     • Clomiphene
     • Carnitines
   • Dopamine antagonists: Indicated for the treatment of infertility and pituitary tumors. The drugs used are:
     • Bromocriptine
     • Cabergoline
   • Selective estrogen receptor modulators (SERMs): These compounds act as agonists or antagonists on the estrogen receptor. They increase sperm production by elevating LH and FSH levels. Drugs used are:
     • Clomiphene citrate (CC)
     • Tamoxifen
     • Toremifene
   • Aromatase inhibitor (AI): Prescribed for men with idiopathic azoospermia (no sperm). Anastrozole is the most commonly used drug in this category, although its use in treating male infertility is off-label.
2. Hormonal therapy

   When infertility is due to decreased hormone levels, doctors may suggest replacements or medications such as hormone replacement therapy. These include:

   • Testosterone replacement therapy
   • Human chorionic gonadotropin (rec-hCG)
   • Recombinant LH (rec-hLH)
   • Recombinant FSH (rec-hFSH)
   • Purified urinary gonadotropins (GTs)
   • Combined therapy of hCG, LH, FSH, GnRH, and human menopausal gonadotropin (HMG)
3. Surgery

   Surgery may be advised in cases of varicocele or obstruction. Surgical techniques are classified into microsurgical, laparoscopic, and conventional open methods. These include:

   • Laparoscopic varicocelectomy: Surgery to repair a varicocele, with significant improvement rates and fewer complications.
   • Vasoepididymostomy (VE) and Vasovasostomy (VV): Procedures used to bypass obstructions in the male genital tract.
   • Microsurgical epididymal sperm aspiration/testicular sperm extraction (MESA/TESE): Procedures used to retrieve sperm-containing fluid from optimal areas.
4. Assisted Reproductive Technology (ART)

   This encompasses treatments that involve obtaining sperm from a man through normal ejaculation or surgical extraction to insert it into the female genital tract. They include:

   • Artificial insemination: This method deposits healthy sperm at the entrance of the cervix or directly into the female uterus.
   • IVF, GIFT, and other techniques: In vitro fertilization (IVF) and gamete intra-fallopian transfer (GIFT) involve collecting sperm, mixing it with the partner’s eggs, and implanting them into the female fallopian tube.
   • Intracytoplasmic sperm injection (ICSI): A single sperm is injected into an egg, and fertilization occurs under a microscope. The fertilized egg is then placed in the female uterus.

Did you know? There is a biological clock ticking for men as well. Studies show that plummeting sperm counts and declining sperm quality are observed in men after the age of 40. To address both male and female biological clocks, men may consider freezing their sperm.

Male infertility can sometimes be due to poor lifestyle choices. Follow all the points mentioned in the prevention section along with these important home care remedies:

• Avoid certain prescription medications: Certain prescription medications like anti-androgens, anti-inflammatories, antipsychotics, opiates, antidepressants, and steroids can potentially decrease healthy sperm production. Talk to your doctor about their replacement.
• Try the fenugreek (methi) supplement: Studies show that fenugreek can be used to improve sperm count and overall sperm quality.
• Get your daily dose of vitamin D: Studies suggest that Vitamin D increases sperm motility and supports sperm health. Try to maintain optimum levels of vitamin D by basking in morning sunlight or through foods or supplements.
• Take ashwagandha: Also known as Indian ginseng, this traditional medicine acts as a remedy for several forms of sexual dysfunction. Studies show that oral intake of Ashwagandha roots has been found to improve sperm count and motility.
• Load your plate with antioxidant-rich foods: Several vitamins and minerals act as antioxidants, such as Vitamin C, Vitamin E, selenium, and zinc. Make sure to add food items that are rich in these antioxidants to boost fertility. If you are unable to meet your daily requirements with your diet, add supplements after consulting with your doctor.
• Keep your cell phones at bay: Cell phones emit electromagnetic radiation, and especially when kept in pant pockets or near the groin region, they can negatively affect the testis.

Complications Of Infertility in Males

Complications of infertility in men are generally related to emotions and mental health, as the treatment itself can be a long journey. These complications can include:

• Issues with the marital relationship: Infertility can often lead to issues in communication, frustration, or in extreme cases, depression.
• Psychological distress: Continuous trying and treatment can lead to feelings of stress, depression, guilt, or anxiety in men. This can cause psychogenic impotence, resulting in feelings of inadequacy.

Although the treatment options may work for you and your partner, some individuals may need to explore alternative options. Here are some alternatives:

• Acupuncture: Acupuncture involves inserting tiny, delicate needles into specific body locations. Research indicates that acupuncture can help restore fertility in patients by improving sperm quality and balancing the endocrine system and hormones.
• Sperm Donation: A sperm donor is a man who donates his semen to assist an individual or couple trying to conceive. The donated sperm can be injected into a woman's reproductive organs or used to fertilize mature eggs through IVF. Before proceeding with the procedure, the donor must undergo a series of tests to ensure there are no risk factors.

There are a lot of treatments available for infertility; all you need to do is embrace this journey with grace. Some tips that might help include:

• Get your facts right: If you have been trying for a long time and are unable to conceive, don’t jump to conclusions. Consult an expert, get your sperm tested, ask questions, and read extensively. Understanding your specific issue and what you can do to improve your chances of conception is crucial.
• Set your expectations: Before deciding on any procedure, consider your and your partner’s expectations, your financial situation, and your recovery time.
• Know all your options: Discuss all available options such as adoption, IVF, or donor sperm before making any decisions. Exploring potential avenues will help you prepare for setbacks and have alternative options ready that you and your partner may want to consider.
• Talk about it: Open communication with your partner and doctor can be key to managing the stress and anxiety surrounding infertility. Your doctor can help you understand how each procedure works and suggest methods that align with your expectations.

Infertility comes with its own share of myths. Bust some myths!