Everything You Need To Know About Male Infertility

What is Male infertility?

Any health condition in a man that lowers his chances of getting his female partner pregnant is known as male infertility. Having a baby is generally a natural and simple process. But unfortunately, there are couples for whom the experience can be tough and it can be difficult for them to conceive. Approximately, 13 out of every 100 couples fail to make their partners pregnant even with unprotected sex. According to medical reports, 1 in every 7 couples is infertile, which means for some reason or the other, they have not been able to conceive a child, even after trying unprotected sex for more than a year. In half of these cases, male infertility is the major contributing factor for the infertility issue in the couple.

What happens in male infertility?

A man plays a significant role in making his female partner pregnant since the pregnancy depends upon the quality and the quantity of his sperm. In case the male fails to produce the required amount of sperm or the sperm is of poor quality, it may be impossible for the male to impregnate his female partner. If you and your partner are trying to conceive a baby but failing to do so even after trying unprotected sex for more than a year, you should check with a urologist or an infertility specialist.

Male-Infertility Causes & Symptoms

Causes

Sperm Disorders (not fully grown/ oddly shaped/ low in numbers/ do not move the right way)
Hormones
Varicoceles
Retrograde Ejaculation
Immunologic Infertility
Obstruction
Medication
Undescended testicles

Symptoms

Problems with sexual functioning
Inability to smell
Pain and swelling in the testicle area
Gynecomastia (abnormal growth in the breast tissues)
Sperm count lower than normal
Decreased facial hair due to hormonal abnormality

Male-Infertility Diagnosis

Tests

Semen Analysis
Semen analysis is a routine test for male infertility that is done in labs. The test helps in determining the exact cause of male infertility. In most cases, the test is done twice to find out the exact cause. The semen is usually collected in the lab. The man is required to masturbate and provide his sperm in a sterile cup. Once the semen is collected, the sample is sent for evaluation. During the evaluation, the doctor studies your sperm count, the concentration and movement of the sperm, and the structure of the sperm. The sperm quality tells the doctor about your ability to help a woman conceive.

If the produced sperm turns from pearly gel into liquid within 20 minutes, the semen is considered to be normal. If this does not happen, something is likely wrong with the man’s sex glands and seminal vesicles.

If the semen analysis shows no sperm at all or low sperm count, it may indicate that the male is permanently infertile. In such a case, the doctor may either proceed with further tests or may recommend you consult with an infertility specialist.

Transrectal ultarsound
In many cases, men are asked to undergo a transrectal ultrasound to diagnose their infertility issues. During the ultrasound, sound waves bouncing off an organ are used to get an image of the organ. A probe is placed in the rectum. The probe beams sound waves to the nearby ejaculatory ducts. During the ultrasound, the healthcare provider can find out if there is any abnormality or blockage in the seminal vesicles or the ejaculatory duct in the man.

Testicular biopsy
If the semen analysis shows a very low sperm count or no sperm at all, the doctor may proceed with a testicular biopsy. Testicular biopsy is done under either local or general anesthesia. During the procedure, a small cut is made in the male’s scrotum. The test can be done at a clinic or lab. The doctor first numbs the scrotal area and then takes a small piece of tissue from each testicle. The tissue samples are then studied under a microscope. The testicular biopsy serves two purposes – it helps the doctor determine the cause of infertility. Additionally, if there is any semen sample in the tissue, it can be used in assisted reproduction.

Hormonal profile
In this test, the doctor checks your hormones. Once the detailed hormonal profile is received, the doctor can understand how well your testicles make sperm. The test can also help rule out other problems. In the hormonal profile test, the patient is required to give a blood sample. The doctor runs a series of tests with that blood sample to obtain a complete hormone profile. The doctors evaluate the levels of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Testosterone, Prolactin, and Sex Hormone Binding Globulin (SHBG) to test infertility in the man.

Self-diagnosis

Infertility is a very common issue, and both male and female infertility equally contributes to the problems. If a male fails to make his female partner pregnant, that could be a prime indicator of male infertility. In such a situation, the male should check with an infertility specialist without delay. Apart from this, the male can also check if there is any swelling and enlargement in the veins of his scrotum. This could be a symptom of varicocele. The male should also pay attention to his testicles, in case there is any swelling or unusual indication, it could be a possible factor of male infertility.

Diagnosis by doctor

Your healthcare provider or doctor will begin the diagnosis procedure by taking a note of your health and surgical histories. It is highly likely that the doctor would ask several questions and want to know everything about your health condition that might lower your fertility. These might include defects in your reproductive system, low hormone levels, trauma, or injury to any part of the male genitals from any accident or previous health complication.

Your doctor will ask you about your current health problems, childhood illnesses, or medications that may alter your sperm production. During your consultation, the doctor will look for possible complications in your penis, vas deferens, epididymis, and testicles. The doctor will also check if you are suffering from varicocele. These problems can easily be evaluated with a physical examination.

Male-Infertility Grades of sperm motility

Grade A (fast-progressive)

Sperms are those which swim forward fast in a straight line – like guided missiles.

Grade B (slow-progressive)

Sperms swim forward, but either in a curved or crooked line or slowly (slow linear or non-linear motility).

Grade C (non-progressive)

Sperms move their tails, but do not move forward (local motility only).

Grade D (immotile )

Sperms do not move at all.

Complications of male infertility

Severe stress

The major complications of male infertility is often psychological. The inability to conceive a child can lead anyone to stress and relationship difficulties. The condition often hurts the male ego which further creates rifts and complications in his personal relationship with his partner and other family members.

Expensive reproductive procedures

If the male is permanently infertile or if the sperm motility is too low, the couple has to resort to expensive techniques of assisted reproduction. In simple terms, male infertility can lead a couple to heavy expenses of undergoing alternative reproductive techniques.

Increased risk of health complications

Male infertility caused due to any abnormalities in the reproductive organs, if left untreated, can lead to melanoma, colon cancer, testicular cancer, and prostate cancer.

Prevention of male infertility

Prevention of male infertility

There is no way you can prevent infertility caused due to physical deformities in cases where the vas deferens are missing. If the infertility is a result of addictions, infections, or other reversible conditions, timely treatment can help a male treat his infertility issues. Infertility issues that are caused due to lifestyle0related problems can be prevented or managed with proper physical care. Below mentioned are some of the lifestyle issues which can be helpful in preventing male infertility.

Maintain a healthy body weight – Obesity and overweight have been directly associated with infertility problems. To prevent obesity from contributing to infertility issues, it is important for the man to maintain healthy body weight.
Maintain an optimum testicular temperature – Wearing tight-fit clothes for a long time can affect blood flow to the genitals and can also alter the testicular temperature. The higher testicular temperature has been medically associated with altered sperm production.
Quit alcohol, smoke, and drugs – Substance abuse can significantly disturb the functioning of the biological process of the body. Excess consumption of any form of intoxicating substance can ruin your reproductive health.
Keep a check on your diet – You are what you eat. Most people are not aware of this, but one cannot deny the fact that a person’s reproductive health is very closely associated with what the person eats in a day. If you want to enhance your sperm production, add a lot of vitamin C, zinc, and healthy nutrients to your system.
Swear by the benefits of exercise – Exercise is the best way to ensure a healthy immune system. If you are not physically active, your body is likely to become more susceptible to inflammations and infections which might contribute to infertility down the line.
Keep gadgets away from your genitals – electronic gadgets like laptops and mobile phones emit low-level radiation which can affect sperm production. To prevent infertility problems, you need to make sure that you do not keep mobile gadgets and laptops in your pocket for a long time.

Myths and facts about male infertility

Myth 1 – Infertility is not a man’s problem.

Fact – If a couple fails to conceive a child, in most circumstances, the female is held responsible or incapable of bearing a child. This is a very common social structure in India. Most people fail to understand that the problem could equally lie in the man. Globally, infertility affects up to 15 percent of couples. In almost half the cases, infertility is caused due to some reproductive and genital issues in males. While it is easily assumed that infertility is a female problem, the fact that male fertility has a role to play in making a woman pregnant often goes unnoticed and unattended.

Myth 2 – Boxers can manage sperm health, it’s better than briefs.

Fact – There is an age-old belief that boxers are better than briefs in managing sperm health. Most people believe that boxers are better than briefs for reproductive health since it prevents the temperature of the scrotum that can be caused due to wearing briefs for ling hours. But there is no medical evidence to support this age-long belief.

Myth 3 – The ability to father a child has nothing to do with the man’s age.

Fact – Age has a direct correlation with a man’s age. After a man reaches 40 years of age, his sperm quality and quantity begin to decline. Unlike women, men do not go through menopause and hence they do not completely lose the ability to produce sperm. But sperm production definitely goes on a downward dip which is a major cause in many couples for their inability to conceive.

Myth 4 – If the ejaculate looks normal, the sperm is of optimum quality.

Fact – Most of the ejaculated fluid is not sperm. Sperm is microscopic and the motility and quality can only be evaluated after a thorough test. The only way to determine the quality of the sperm is by doing a sperm analysis from trained lab technicians.

Male celebrities who struggled with infertility

Jimmy Fallon – Jimmy Fallon, the former SNL star and current host of The Tonight Show had struggled with infertility issues for quite a long time. Later, he and his partner Nancy Juvonen succeeded with a daughter. Jimmy Fallon has been open with his issue and went on to advise on TODAY,

“If there’s anybody out there who is attempting and they’re simply losing expectation, simply hold tight.”

Mark Zuckerberg – Facebook founder, Mark Zuckerberg opened up to the world about his struggle with infertility. After a long period of disappointment, the couple was blessed with a baby girl in 2015. In a Facebook declaration, Mark shared that they had experienced three miscarriages. He trusted the post would help many couples struggling to become parents not lose hope and supported an exchange about fertility issues. They are currently guardians of two kids, Max and August.

Hugh Jackman – Celebrated Hollywood actor, Hugh Jackman is one of the very few male celebs who has come out and has been openly speaking about his struggle with infertility. The actor has always been honest and candid about what the couple has gone through.

Gordon Ramsay – Gordon Ramsay is yet another celebrated figure who has been very vocal about his infertility issues. The celebrated chef had struggled with major infertility issues. Reports that surfaced on the internet said that his wife Tana had polycystic ovarian syndrome (PCOS) but Gordon Ramsay suffered fertility issues too. He was diagnosed with low sperm count, which made it very tough for his wife to conceive a baby, who was already dealing with PCOS.

When to consult a doctor for male infertility?

One should contact a doctor if one is unable to conceive a child after a year of frequent, unprotected sex or if one experiences any symptoms and signs of male infertility. A man should also consult a specialized urologist if he notices any form of abnormalities in his scrotum or testicles such as swelling in any veins in the scrotum or unusual sensation and swelling in testicles. If the man experiences any difficulty in maintaining an erection or ejaculating, he should consult with a urologist at the earliest to rule out potential complications.

Male-Infertility Treatment options & cost

Non-surgical therapy for male infertility

1. Anejaculation

Anejaculation is when there’s no semen. It’s not common, but can be caused by:

• spinal cord injury
• prior surgery
• diabetes
• multiple sclerosis
• abnormalities present at birth
• other mental, emotional or unknown problems

Drugs are often tried first to treat this condition.

1. Congenital Adrenal Hyperplasia (CAH)

CAH is a rare cause of male infertility. It involves congenital problems in certain enzymes. CAH causes abnormal hormone production. CAH is most often diagnosed by evaluating the steroid level in the blood and urine. CAH can be treated with hormone replacement.

1. Retrograde Ejaculation

Retrograde ejaculation is a condition in which the semen flows back instead of going out of the penis. It can be caused by:

• prostate or bladder surgeries
• diabetes
• spinal cord injury
• anti-depressants
• certain anti-hypertensives
• medications used to treat prostate enlargement (BPH)

Retrograde ejaculation can be treated with drugs.

Surgical treatment for male infertility

Surgical treatment is recommended in case of infertility caused due to the following conditions:

1. Varicocele Treatments-Varicocele is a condition in which the veins in the scrotum become enlarged. The condition can be fixed with minor outpatient surgery called varicocelectomy. Fixing these swollen veins helps sperm movement, numbers, and structure. If you are suffering infertility issues due to varicocele, you can get in touch with our vascular experts.
2. Azoospermia Treatments-If your semen lacks sperm (azoospermia) because of a blockage, there are many surgical choices. TESA, PESA, MESA can be used to retrieve sperm.
3. Microsurgical Vasovasostomy-Vasovasostomy is used to undo a vasectomy. It uses microsurgery to join the 2 cut parts of the vas deferens in each testicle.
4.  Transurethral Resection of the Ejaculatory Duct (TURED)

Ejaculatory duct blockage can be treated surgically. During the surgery, a cystoscope is entered into the urethra and a small incision is made in the ejaculatory duct. Thereafter, the doctor successfully unblocks the ejaculatory duct obstruction.

Treatment for unknown causes of male infertility

While most cases of male infertility can be diagnosed and treated, there are also conditions, where it becomes difficult to tell what is the exact cause of infertility in a man. Such conditions are known as ‘idiopathic’ or ‘non-specific’ male infertility. In cases where the cause is not clearly determined, or where no other forms of treatment work, infertility specialists suggest the patient undergoes the following infertility treatment techniques.

1. Assisted Reproductive Techniques

If all other infertility treatment fails to provide desired results, there are ways by which a couple can get pregnant without having sex. These methods are called assisted reproductive techniques (ARTs). Based on the specific type of infertility and the cause, the infertility specialist may suggest any of the following ARTs.

A. In Vitro Fertilization (IVF)

IVF is the most common and trusted ART in which the egg of a female partner or donor is fertilized with sperm of the male partner or sperm donor in a lab petri dish. For IVF, the ovaries must be efficiently stimulated. This is often done with drugs as the first step of the whole procedure. It allows multiple mature eggs to be retrieved. After 3 to 5 days of growth, the fertilized egg (embryo) is implanted into the uterus. IVF is used mostly for women with blocked fallopian tubes. But the procedure is also relied upon in cases where the man has very severe and untreatable oligospermia (low sperm count).

B. Intrauterine Insemination (IUI)

IUI or intrauterine insemination is a fertility treatment where the sperm is directly placed in the uterus. The chances of conception in IUI fertility treatment are more since the process allows a higher concentration of healthy sperm to come closer to the egg. IUI is often suggested for couples where the male suffers low sperm count and movement problems, retrograde ejaculation, and other causes of infertility.

C. Intracytoplasmic Sperm Injection (ICSI)

ICSI is a variation of IVF. It has revolutionized the treatment of severe male infertility. A single sperm is injected into the egg with a tiny needle. Once the egg is fertilized, it’s implanted in the female partner’s uterus. Your infertility specialist may recommend ICSI if the male partner has very poor semen quality. It is also used if you have no sperm in the semen, a block or testicular failure that can’t be fixed. Sperm may also be taken from the testicles or epididymis by surgery for this method.

Sperm Retrieval for ART

Many microsurgical methods can remove sperm blocked by obstructive azoospermia (no sperm). The goal is to get the best quality and number of cells. This is done while trying not to harm the reproductive tract. These methods include:

1. Percutaneous Epididymal Sperm Aspiration (PESA)PESA is a low-cost treatment done by most experienced urologists under local or general anesthesia. The urologist sticks a needle attached to a syringe into the epididymis. Then he or she gently withdraws fluid from the testicle ducts. PESA is often a successful treatment but in case sperm is not retrieved through this technique, the doctor may recommend open surgery.
2. Microsurgical Epididymal Sperm Aspiration (MESA)MESA helps in retrieving sperm from the epididymal tubes. This method uses a surgical microscope. MESA yields high amounts of motile sperm. They can be frozen and thawed later for IVF treatments. This method limits harm to the epididymis. It keeps blood out of the fluid. Even though MESA calls for general anesthesia and microsurgical skill, it has a lower problem rate. It’s also able to collect larger numbers of sperm with better motility for banking.

How to prepare for surgery for treatment of male infertility

Irrespective of the surgical treatment that the male infertility specialist doctor recommends, it is important to follow the below-mentioned tips to prepare for the surgery:

Inform your doctor about your medications
If you are under any medication, it is important for you to tell your doctor everything about the same. Some medications may cause adverse health reactions and may increase the risk of bleeding. If you taking any medication, including pain relief medicines and over-the-counter pills, inform your doctor.

Take your medicines as the doctor prescribes
Your doctor is likely to prescribe you certain medications before proceeding with the surgery. After informing the doctors about your medications, the doctor may ask you to stop taking certain medicines or cut down the dosages of some other. Take your medicines as directed by the doctor to prevent complications and ensure maximum benefits.

Avoid eating before the surgery
If you are suggested to undergo any surgery for male infertility, it is important for you to stop taking any heavy meals at least 12 hours prior to the surgery. Eating food right before the surgery can increase your risk of vomiting after you receive general anesthesia. Ask your doctor to thoroughly guide you on what to eat, how much to eat and what to avoid.

Shaving the surgical site yourself might call for complications, leave it to the doctor
If your treatment for male infertility requires you to undergo surgery, the doctor will need to shave the pubic hair or the hair at the surgical site (if any other body part). You might think of shaving it yourself, but that may put you at unwanted risk of trauma and injury. So, it would be better if you leave the shaving to be done by the professionals.

Arrange for transportation and care
Going under anesthesia can make you feel groggy and tired. It would be safe if you arrange for someone, a relative, or a friend to be there with you at the hospital and drive you back home after the surgery.

Recovery after male infertility treatment

The recovery process and the timeline solely depend on what treatment method. If the treatment is medications, there is nothing that the patient would need to recover from. However, male infertility treatment with medications is a long process and the patient might require to continue the medications for several weeks and months. For a patient who undergoes surgical treatment for male infertility, such as varicocele surgery, the patient may need a month or two or even longer to recover, depending upon how severe was the health condition and how major was the surgery. Recovery after testicular or epididymal sperm retrieval depends on the method used. Recovery time can range from a few days to a week. During the recovery process, the patient will have to avoid strenuous activities. The patient will be advised to wear a jockstrap until full recovery, take medicines prescribed by the doctor without fail and use ice packs at the surgical site to heal better from the surgery. Most men after sperm retrieval can return to work within 24 to 48 hours. However, for some others, it may take a longer time to recover completely.