Understanding Male Infertility: Diagnosis and Treatment
Starting and expanding a family is a dream come true for many couples. Unfortunately, infertility impacts one in eight couples in the U.S. and many who desire to start a family or expand their family size may face challenges in conception. Male factor infertility is responsible for about 20-30% of infertility cases. Genetic and acquired medical conditions that affect the reproductive tract in males are responsible for male infertility.In this article, we discuss the common causes and diagnosis of male infertility as well as the therapeutic interventions available.
What is Male Infertility?
Male infertility occurs when male reproductive factors cause an inability to conceive. Inherited or acquired defects in the male reproductive tract can cause male infertility. Abnormalities may occur at various sites in the male reproductive tract and affect the chances of achieving conception. For instance, male infertility occurs when medical conditions destroy sperm-producing cells in the testis or hinder sperm transport.The clinical symptoms and therapeutic interventions in male infertility differ based on the underlying causes. For example, the therapy for individuals with a primary disorder in the testis is different from those with sperm transport disorder. Resolving male infertility starts with an accurate diagnosis of the cause.
Causes of Male Infertility
There are various causes of male infertility, but unfortunately, in a large percentage of patients, we are unable to identify the exact cause. Fertility experts classify these causes into groups for clinical management purposes. Here is a classification of the common causes that we can identify.
Genetic disorders account for 15-30% of male infertility cases. Genetic disorders could result from alterations that disrupt the structure and number of chromosomes (the cellular structure that contain the genes for sperm production). Males with a genetic or sex chromosomal defect are prone to male infertility.These genetic disorders affect the hormonal regulation and quality of sperm produced in the testis. An example of this would be a "microdeletion" of a part of the Y chromosome responsible for sperm production that can lead to very low or even absent sperm numbers. Males with genetic causes of infertility may also have a collection of other co-existing medical disorders. This is called a medical syndrome. Examples are Klinefelter syndrome, Young syndrome, Kallmann syndrome, etc.
Hormones from the pituitary gland and testosterone influence sperm production in the testicles. Medical conditions that alter the blood concentration and balance of testosterone and pituitary hormones cause male infertility. Oftentimes, when these medical issues are addressed, sperm production normalizes.Examples of such conditions are iron overload syndrome, head trauma, intracranial radiation, hyperthyroidism, etc. Included in this category would be problems in sperm production caused by men taking testosterone supplementation. If men take regular testosterone injections or use testosterone gels or creams, sperm production often ceases completely. We, therefore, recommend any man interested in getting pregnant with his partner should not be taking testosterone or other steroids.
Typically, during fetal development, the testes descend from the abdomen into the scrotal sac. However, in some individuals, one or two testicles do not fully descend into the scrotum. Males with undescended testes are more prone to infertility, especially if the undescended testicle is not brought down into the scrotum surgically at a very young age.
Blockage in Sperm Transport Tubules
The testicles have tubules that transport sperm after production in the testis. When these tubules are blocked, it leads to infertility. One situation that everyone knows about that fits into this category is having had a vasectomy. Sperm cells are still produced but are unable to enter the ejaculate because the vas deferens (the tube that connects the testicle to the penis) have been interrupted.There can be genetic reasons for this too. Some men who are carriers of Cystic Fibrosis are actually born without vas deferens leading to infertility. Common risk factors of acquired blockages are physical trauma, prior pelvic surgeries, and infections. Chronic infections cause prolonged inflammatory changes that damage men's health and may produce car tissues that block these tubules.Poorly treated sexually transmitted diseases are one of the most common causes of blockage in sperm transport tubules. Thus, if you suspect you could have a sexually transmitted disease, consult your doctor for prompt treatment.
Apart from infections, some health conditions cause male infertility. For example, swelling in the veins located in the testis. These are known as "varicoceles." These swollen veins alter the blood supply to your testes. Consequently, impaired blood flow affects sperm production and the quality transported in the tubules. In addition, some immunological disorders and tumors may damage the regulatory hormone-producing glands. Examples are tumors in the testis and pituitary glands.
Some medications, such as chemotherapy drugs or steroids, affect sperm formation and increase male infertility risk. Discuss therapeutic options with your doctor if your medications adversely affect your fertility.
Exposure to Environmental Toxins
Persistent exposure to Industrial chemicals and radiation disrupts sperm formation in the testis. This results in a reduction in sperm count if unchecked. Periodic health screening in a fertility clinic is beneficial if your profession exposes you to heavy metals and radiation.
Unhealthy Lifestyle and Habits
Self-care is critical to your reproductive health. Stay active, eat healthily and avoid unhealthy habits such as alcohol and tobacco intake. We also recommend that you not smoke or use marijuana frequently if you are attempting pregnancy with your partner. Neglecting these self-care practices raises your risk of male infertility. An unhealthy lifestyle may affect the formation and quality of sperm produced.
Symptoms of Male Infertility
Although the male infertility symptoms vary depending on the cause. Much of the time, there are no symptoms that you would be able to notice. However, here are some signs you may notice:
- Sexual dysfunction such as difficulty obtaining or maintaining an erection.
- Reduced fluid volume ejaculated.
- Pain or swelling in your testis.
- Abnormal breast growth.
- Decreased facial or body hair.
If you notice any of the symptoms above, consult your doctor for further clinical evaluation.
Diagnosis of Male Infertility
Your doctor typically starts with a thorough clinical history and physical examination before conducting further investigations for diagnosis. During the clinical history, your doctor will take an exhaustive history to understand your unique health needs. Your doctor will ask questions related to your family history, sexual history, social history, and medical history to identify possible risk factors.During the physical examination, your doctor inspects your body for visible signs of defects or features that suggest hormonal imbalance. Also, your doctor may examine your genital for any abnormalities.
Tests You Can Expect for Male Infertility
Semen analysis is the major test for diagnosing male infertility. For your doctor to get the best results, here are some tips:
- Observe between two and five days of sexual abstinence.
- Submit semen samples within 30 minutes of collecting the semen.
Sometimes, your physician or laboratory may request you submit two semen samples at an interval of no sooner than one month. Your semen is analyzed for the following:
- presence of white blood cells.
- "Sperm count" or concentration
- Sperm motility
- Sperm morphology (shape)
In addition to semen analysis, the clinical findings from history taking and physical examination guide your doctor on the type of investigations to conduct. For example, suppose there is a history of multiple sexual partners with signs of a sexually transmitted infection (S.T.I.). In that case, your doctor may request blood and urine tests for S.T.I diagnosis.If your semen analysis results are significantly abnormal, or if your medical history indicates that you need more intensive assessment, you may be referred to a male infertility urology specialist.Other possible investigations are:
- Scrotal ultrasound scan
- Testicular biopsy
- Hormonal profile.
Your Options for Male Fertility Treatments
The specific treatment for male infertility depends on the underlying cause. If you have an unhealthy lifestyle, your doctor may recommend adjustments such as weight loss, physical activity, stoppage of alcohol and tobacco smoking, and intake of supplements. Here are some male fertility treatments that could put you on the path to parenthood.
This is the therapeutic option for males with hormonal causes of infertility. Your doctor may prescribe these medications to normalize the blood concentration of hormones that affect sperm production. Examples of these medications are aromatase inhibitors or Clomid.
There are various types of surgical interventions. For instance, males with varicocele (distended veins in the testis) may benefit from a surgical repair. Also, individuals with obstruction along the transport tubules in the male reproductive tract are sometimes candidates for surgical correction.
These are medications for treating infections caused by microbes. Males with underlying sexually transmitted infections will benefit from antimicrobial therapy.
Intracytoplasmic Sperm Injection
This is a procedure in which sperm cells are injected into the egg for fertilization outside the body. This occurs in conjunction with an IVF (in vitro fertilization) treatment with your partner. The American Society for Reproductive Medicine recommends intracytoplasmic sperm injection for couples with male factor infertility. Intracytoplasmic sperm injection is safe and effective and can often overcome even the most significant male factor.
Assisted Reproduction Technology
The American Center for Disease Control (C.D.C.) defines assisted reproduction technology as fertility-based treatments in which the eggs or embryos are manipulated to aid conception. This is what is commonly known as IVF. Here are the stages of an assisted reproduction technology procedure:
- Stimulation: This involves using medications to boost egg production in the female.
- Egg retrieval: Here, the fertility doctor conducts a minimally invasive procedure to retrieve eggs in the female.
- Insemination and fertilization: This step involves placing sperm cells and selected eggs under favorable conditions for fertilization.
- Embryo culture: After successful fertilization, the fertilized egg undergoes cellular divisions in a regulated environment to become an embryo from the 5th day.
- Embryo transfer: The doctor retrieves the embryo and transfers it into the uterus for implantation.
Do You Need Help Starting a Family?
Male infertility occurs due to various factors such as genetic or acquired causes such as untreated sexually transmitted diseases, physical trauma, or the use of some medications. If you notice symptoms such as erectile dysfunction, painful swelling in your testis, or abnormal breast growth, see your doctor.As part of men's health awareness, regular clinical screening and checks will aid the early diagnosis of medical conditions that may cause infertility.Your doctor will typically diagnose male infertility after conducting a clinical history, examination, and semen analysis. A fertility expert decides the most effective therapeutic option based on clinical findings and test results.At Advanced Fertility Care, we want to help you start a family. Our fertility experts use evidence-based best practices combined with innovative technology, which increases your chances of conceiving and fulfilling your dreams of being a parent. To join other happy parents who have used our services, take one step today by contacting us.