Advanced Guide to Male Infertility

The Reality of Male Infertility

For a long time, infertility was mistakenly viewed as a "female issue." However, the medical reality is that in about 40-50% of couples struggling to conceive, a male factor is the primary or a contributing cause. Male infertility is often defined as any health issue in a man that lowers the chances of his female partner getting pregnant.

At GEM Hospital & IVF Centre, we are dedicated to breaking the stigma around male infertility. We provide a supportive, private environment where men can undergo comprehensive testing and access the world's most advanced treatments. Understanding the cause is the first step toward a solution, and most male infertility issues are treatable with modern science.

What Causes Male Infertility?

Male fertility depends on your body making healthy sperm and then delivering them. The process starts when the hypothalamus and pituitary gland in your brain signal your testes to make sperm. A problem at any point in this process can affect fertility.

1. Medical Causes

Problems with male fertility can be caused by a number of health issues and medical treatments. These include:

• Varicocele: A varicocele is a swelling of the veins that drain the testicle. It's the most common reversible cause of male infertility. Varicoceles result in reduced quality of the sperm.
• Infection: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testes (orchitis) and some sexually transmitted infections, including gonorrhea or HIV.
• Ejaculation Issues: Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.
• Antibodies that Attack Sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
• Tumors: Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes.
• Undescended Testes: In some males, during fetal development one or both testes fail to descend from the abdomen into the sac that normally contains the testes (scrotum). Decreased fertility is more likely in men who have had this condition.
• Hormone Imbalances: Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands.

2. Environmental Causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

• Industrial Chemicals: Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead might contribute to low sperm counts.
• Heavy Metal Exposure: Exposure to lead or other heavy metals also may cause infertility.
• Radiation or X-rays: Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
• Overheating the Testicles: Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.

Symptoms and Signs

The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, a hormonal imbalance, dilated veins around the testicle or a condition that blocks the passage of sperm causes signs and symptoms.

• Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction).
• Pain, swelling or a lump in the testicle area.
• Recurrent respiratory infections.
• Inability to smell.
• Abnormal breast growth (gynecomastia).
• Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality.
• A lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate).

Diagnostic Evaluation at GEM Hospital

A comprehensive evaluation is essential to determine the best course of action. Our diagnostic protocols include:

• General Physical Exam and Medical History: This includes examining your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility.
• Semen Analysis: Your sperm count is checked for abnormalities in the number (concentration), shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections.
• Scrotal Ultrasound: This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor see if there's a varicocele or other problems in the testes and supporting structures.
• Hormone Testing: Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems might also contribute to infertility.
• Post-Ejaculation Urinalysis: Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
• Genetic Tests: When sperm concentration is extremely low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality.

Advanced Treatment Options

Often, the exact cause of infertility isn't identified. Even if the exact cause isn't clear, your doctor might be able to recommend treatments or procedures that will lead to conception.

• Surgery: For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm-retrieval techniques.
• Treating Infections: Antibiotic treatment might cure an infection of the reproductive tract, but doesn't always restore fertility.
• Treatments for Sexual Intercourse Problems: Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
• Hormone Treatments and Medications: Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
• Assisted Reproductive Technology (ART): ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used for IVF or ICSI.

Lifestyle and Sperm Health

Men can take proactive steps to improve their sperm health through simple lifestyle changes:

• Stop Smoking: Smoking is linked to lower sperm counts and decreased motility.
• Reduce Alcohol Consumption: Heavy drinking can reduce testosterone levels and sperm quality.
• Exercise Regularly: Moderate exercise boosts antioxidant levels and improves sperm health.
• Keep Cool: Avoid tight underwear and long hours of sitting, which can increase scrotal temperature.
• Dietary Supplements: Certain vitamins and minerals like Zinc, Vitamin C, and L-carnitine have been shown to support sperm production.