Male Infertility: Symptoms, Diagnosis And Treatment

Among one in six couples facing infertility issues, one in three have male infertility, causing troubles to conceive (1). Abnormal sperm, low sperm count and motility, and issues in the delivery of sperm can lead to infertility in men. Certain lifestyle factors, health issues, and injuries can contribute to issues with the quality and quantity of the sperms. Therefore, it is recommended to visit an infertility specialist if the couple cannot conceive after trying for several months. Many cases of male infertility are treatable with medications and lifestyle changes. Read on to know more about the causes, diagnosis, and treatment of male infertility.

Defining Male Infertility

Experts define male infertility as the inability of a man to impregnate a woman even after one year of unprotected sexual activity. It mostly depends on the quality and quantity of his sperm (2).

Causes Of Male Infertility

Male infertility occurs if the number of sperms ejaculated is low, or if they are of poor quality. Without healthy sperms, the chance of conceiving is almost none.

Hormones can affect fertility by bringing down sperm motility (movement) and count.

A man’s lifestyle, physical problems, and psychological or behavioral health concerns can all influence the health of his fertility (3). Let’s see some of the most influential factors (4):

Certain factors increase a man’s risk of being infertile.

Factors That Increase The Risk Of Male Infertility

• The risk factors include (5):
• Overweight
• Prior infections
• Genital exposure to high temperatures
• A family history of fertility disorders
• Mumps after puberty
• Prior vasectomy or pelvic or abdominal surgery
• Tumors or other chronic illnesses
• Taking certain prescription medications or undergoing medical procedures

How does one know if these factors or the previously mentioned causes have led to infertility? In most cases, the inability to conceive is the only sign of infertility (5). However, in some cases, the underlying hormonal or physical problems show a few other signs.

Signs Of Male Infertility

Some possible signs and symptoms could be (6).

• Difficulty in erection or ejaculation, ejaculating low fluids and low sexual desire
• Pain, lump or swelling in the testicle region
• Abnormal breast growth
• Decreased body or facial hair
• Reduced muscle mass
• Recurrent respiratory infections
• Lower sperm count

If you are unable to conceive and/or facing any of the above issues, then see a healthcare provider for diagnosis of the problem.

How Is Male Infertility Diagnosed?

Both the partners may have to get the diagnosis done. The initial diagnosis includes an analysis of the medical history, physical examination, and common lab tests, and probably a few semen tests (7) (8).

Medical history analysis includes:

• A complete review of past conditions, medications, and surgeries
• Knowing about the family history of infertility or birth defects
• A review of social history and exposure to occupational hazards to understand if they had an impact on fertility
• A review of sexual habits and practices

Physical examination evaluates the genitals including the penis, testes, scrotum, and prostate.

Laboratory tests include:

• Urinalysis to detect the presence of infections.
• Semen analysis to evaluate the motility (movement), shape (morphology), and maturity of the sperm, the volume and liquidity of ejaculation, and the actual sperm count. The sperm counts mostly fluctuate from one analysis to the other. Therefore, multiple semen evaluations are done over a period to get accurate results.
• Hormonal tests to evaluate the levels of testosterone and follicle stimulating hormone (FSH) to understand the overall hormonal balance and state of sperm production. Sometimes, the initial hormonal testing indicates the need for other hormonal tests such as serum luteinizing hormone and prolactin.

If the above diagnostic tests are unable to determine the condition, further testing is done to identify the cause of infertility.

• Scrotal ultrasound uses high-frequency sound waves to detect obstructions or problems in the testicles and other supporting structures.
• Transrectal ultrasound is done by inserting a tiny and lubricated wand into the rectum to check the prostate and tubal blockages (ejaculatory ducts and seminal vesicles) that they might carry.
• Post-ejaculation urinalysis helps detect the sperm in the urine indicating retrograde ejaculation, where the sperm travels backward into the bladder.
• Seminal fructose test checks if seminal vesicles are producing fructose in the semen. The fructose sugar provides energy to the sperm.
• Semen leukocyte analysis checks for white blood cells in the semen.
• Anti-sperm antibodies test looks for the presence of antibodies that could cause infertility.
• Sperm penetration assay (SPA) identifies the ability of the sperm to fertilize.
• Kruger and the World Health Organization (WHO) morphology detect the sperm morphology and motility closely.
• Testicular biopsy checks for the impairment or a blockage in sperm production.
• Vasography detects the structure of the ducts and finds obstructions.
• Genetic testing identifies mutations in gene regions of the Y chromosome and diagnoses various inherited or congenital syndromes.

The treatment depends on the cause of infertility.

Treatment for Male Infertility

Male infertility is treatable with medications and other options. In some cases, where the treatments do not work, the couple may have to go for sperm donors or adopt a child.

Medications and devices:

• Gonadotropin injections are suggested for hypogonadism to improve fertility. They trigger sexual glands to produce testosterone and sperm (9).
• Pseudoephedrine medications work in treating retrograde ejaculation. They close the opening of the bladder thereby helping the sperm to ejaculate through the penis (10).
• Sildenafil (Viagra) helps treat the ejection issue (11).
• In the case of problems with erection, your doctor might suggest you try a vacuum pump. You need to place the pump over the penis and pump the air out to create a vacuum. It causes the blood to shift into the penis, thus erecting it. A constriction band is placed at the base to maintain the erection (12).

Surgery

• Varicocele (swollen veins in the scrotum) is corrected through surgery to improve the quality of your sperm.
• Obstructive azoospermia is surgically treated by removing the blockage.
• Vasectomy (surgery that stops sperm from going into the semen) can also be reversed.

Assisted reproductive technologies (ARTs)

If the above treatments have not worked, your doctor would suggest ARTs. These are powerful and high-technology based options that offer an extra boost to the sperm to move into an egg. The sperm is collected from ejaculated semen or through a needle from the testicle. It is then processed and released into eggs through several methods (13).

• Intrauterine inseminations (IUI): The sperm (yours or the donor’s) is directly injected into the uterus during ovulation. Your partner would be given medications to trigger ovaries for increasing the number of eggs. This option is recommended if there is a problem with erection, and having sex is difficult.
• In-vitro fertilization (IVF): The sperm is combined with the partner’s eggs in a test tube. They are made to fertilize and form embryos. The embryos are then placed in the uterus.
• Intracytoplasmic sperm injection (ICSI): A single sperm is injected into an egg through a small needle, and made to fertilize. The fertilized embryo is then transferred into the uterus. It is usually recommended when the sperm count is low or the sperm is abnormally shaped.

What can you do at home?

You might take a few steps at home to improve your chances of conceiving.

• Have unprotected sex during ovulation when there is a high chance of fertilization. It happens in the middle of the menstrual cycle.
• Do not use lubricants as they will impair sperm function and motility. Avoid products such as Astroglide, K-Y jelly lotions and saliva.

You may also try some natural means to improve your fertility. Click here.

Are There Any Complications Associated With Male Infertility?

Yes, male infertility increases the risk of:

• Inherited disorders including Klinefelter syndrome and cystic fibrosis
• Hormonal abnormalities
• Cancers, such as melanoma, testicular, colorectal and prostate
• Stress and difficulty in relationships

Next, we answer a few queries our readers frequently ask us.

References

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