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Infertility is a clinical term used for both men and women who are unable to conceive a child within or after one year of having unprotected intercourse. Infertility is a global problem that affects around 15% of couples the world over. While the prevalence of infertility in the general population is 15-20%, the male factor contributes to nearly 20-40% of this share, and in India, this percentage is 23%.
Male infertility refers to a male’s inability to impregnate a woman successfully. In over one-third of clinical infertility cases, male infertility is the reason. In about 50% of the cases, it is challenging to find the root cause of male infertility. However, most often the problem lies in how a man’s testicles function, including their sperm production ability or sperm delivery to the female reproductive tract.
As we mentioned earlier, in almost half of the male infertility cases, doctors are unable to identify the exact cause for infertility in males. However, there are specific environmental, genetic, and other factors that may lead to the condition. And, they are:
● Prolonged exposure to excess heat: For instance, some occupations, such as welders or firefighters require men to stay in constant exposure to heat and also wear tight clothing
● Misuse or abuse of drugs: Men who regularly intake anabolic steroids, alcohol, marijuana, etc., record a high risk for infertility
● Exposure to toxicants like pesticides, herbicides, paint and heavy metals (lead, mercury, etc.)
● Chronic diseases like anaemia, diabetes, cancer, malnutrition or neurological disorders
● Male genital tract diseases, including infection, retrograde ejaculation, trauma and cancer
● Excessive exercising, especially bicycling, can lead to many problems in males
● Surgeries performed on the male genital tract, such as for the treatment of undescended testicle or hernia, may also cause complications in male fertility
● The presence of varicocele – a condition in which the veins inside the scrotum get enlarged
● The deficiency of essential nutrients and minerals in the diet, including zinc, calcium, vitamin C, folic acid, etc.
● Stress and obesity
Due to the increasing level of environmental pollution, stress at the workplace, and bad lifestyle choices, the issue of male infertility is escalating worldwide. Male infertility is much more common in environments having high levels of pollution, including water contaminants from toxic industrial run-off, pesticides, and herbicides. According to the medical practitioners of All India Institute of Medical Sciences (AIIMS), in India, nearly 12-18 million couples are diagnosed with infertility every year. They maintain that while the sperm count of a normal Indian adult male used to be 60 million/ml three decades ago, today it is a meagre 20 million/ml.
Going by the recent stats on infertility, 13 out of 100 couples are unable to get pregnant even with regular unprotected sex. About 10% to 15% of infertile men completely lack sperm (azoospermia). While in others, there are hormonal imbalances or the blockage of sperm movement. Some men also face infertility issues like oligospermia (low sperm count), varicocele or other testicular disorders.
Although there may be hardly any common sign of infertility in men, in most cases, there’s an underlying problem behind the infertility issue. This may be a hereditary disorder, hormonal imbalance, dilated veins around the testicle or difficulties in the passage of sperm.
Yes, genetics has a crucial role to play in male infertility. It is one of the most complex aspects of male infertility (since both semen and testis histological phenotypes are heterogeneous, and over 2,000 genes are involved in spermatogenesis).
To date, the most significant share – nearly 25% – of identified genetic factors contributing to male infertility is in azoospermia. However, the number of known genetic anomalies in semen and aetiological categories is steadily growing. For instance, anomalies in sex chromosomes have major roles in severe spermatogenic impairment. Chromosomal anomalies and microdeletions of the azoospermia factor (AZF) region of the Y chromosome are the most common genetic causes of spermatogenic failure. Sex chromosome aneuploidies like 47, XXY (Klinefelter’s syndrome), 47, XYY, and 46, XX males are the most common chromosomal anomalies that occur at birth in the population of infertile males.
Furthermore, autosome-linked gene mutations are the primary reasons behind central hypogonadism, monomorphic teratozoospermia or asthenozoospermia, congenital obstructive azoospermia, and familial cases of quantitative spermatogenic disturbances. To combat such genetic problems leading to male infertility, men require proper genetic screening along with genetic counselling from expert medical practitioners.
Recent studies have established that the age of males, just like females, also has a considerable bearing on the fertility factor. As women age, their egg count and quality continue to decline (since females are born with all the eggs they’ll ever have in a lifetime). However, in men, the declining fertility factor works a bit differently. Unlike women who have a limited number of eggs, healthy males produce over 100-200 million fresh new sperms each day. So, while men are not at risk of running out of sperms with age, their sperm count, quality and agility may decline over time. Generally, male fertility starts to decline in men over 40 years of age.
While doctors may not be able to point to the root cause of male infertility in a large number of cases, they often prescribe certain standard procedures for treating male infertility, such as:
Doctors can perform reverse vasectomy and even surgically correct conditions like varicocele or obstructed vas deferens. For cases where there is no sperm at all, doctors directly retrieve sperms from testicles or epididymis using advanced sperm retrieval techniques.
Doctors usually prescribe medicines and offer appropriate counselling to help improve fertility in conditions like premature ejaculation or erectile dysfunction.
Infections in the reproductive tract can be treated with antibiotics. However, this does not always ensure fertility restoration.
If doctors determine that the cause of infertility is mainly hormonal, they recommend hormone replacement or medications to balance out the high or low levels of specific hormones in the male body.
In ART treatments, sperms are obtained through either normal ejaculation or from donors or via surgical extraction, depending on the case at hand. Once sperms are extracted, they are then directly pushed into the female genital tract or used to perform in-vitro fertilization or intracytoplasmic sperm injection.