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Understanding Male Infertility: Unveiling the Causes of Male Factor Infertility

Reports show that 17.5% of adults have fertility issues globally, where infertile males account for about 50% of all cases. This article explores the common causes, symptoms, and treatment options for male infertility. Moreover, it will look at unexplained infertility in men and how male infertility can affect your reproductive health. 

Understanding Male Infertility

Male infertility is a man's inability to impregnate a woman. This condition results from various factors that affect the quality and quantity of sperm released per ejaculation. Thus, your semen may contain sperm with suboptimal parameters like low sperm count, poor motility, or morphology;

• Having a low sperm count means your semen contains fewer viable sperm to fertilise your partner's egg, ultimately reducing the chances of conception.
  
  
• With poor sperm motility, sperm cannot swim up the female reproductive system and fertilise the eggs.
  
  
• Poor sperm morphology or irregularly shaped sperm may be unable to penetrate and fertilise the egg, making it difficult for your partner to get pregnant naturally.



However, thanks to assisted reproductive technology (ART), a fertility specialist can help you achieve a successful conception through in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Therefore, if you and your partner are struggling to get pregnant, you should seek a fertility specialist to receive an evaluation.

Common Causes of Male Infertility 

Male infertility can result from various conditions and factors, including sperm abnormalities, hormonal imbalances, infections, genetic factors, lifestyle factors, and other issues related to the reproductive health of men. 

Sperm Abnormalities

Irregular sperm parameters such as poor motility, abnormal sperm morphology, and low sperm count are one of the primary causes of male infertility. These factors can significantly minimise your potential to start a family. 

Hormonal Imbalances

Imbalances in hormone levels are another primary cause of infertility. Hormones are critical in sperm production. Hence, instability, like inadequate testosterone or excessive prolactin, can contribute to infertility.

Infections 

Some sexually transmitted infections (STIs), such as gonorrhoea and chlamydia, can result in scarring and inflammation in your reproductive system. These effects can cause blockages, hampering sperm movement. 

Genetic Factors

Genetic abnormalities like cystic fibrosis gene mutations, Klinefelter syndrome, and Y chromosome microdeletions can negatively impact sperm production function and production.

Lifestyle Factors

Some habits, including alcohol abuse, smoking, and the use of illegal drugs like cocaine, can negatively influence your sperm quantity and quality. Similarly, poor diet and obesity can impede your fertility. Moreover, prolonged exposure to toxic substances like heavy metals, certain chemicals, and pesticides may damage your reproductive health.

Other Factors

Some underlying conditions and treatment procedures like radiotherapy and chemotherapy can contribute to infertility. Such conditions include:

• Retrograde ejaculation (a condition where semen moves into the bladder during ejaculation)
  
• Varicocele (enlargement of veins in the testicles blocking sperm movement).

Symptoms of Male Infertility 

Male infertility signs and symptoms may vary from one person to another, depending on underlying causes. Although the symptoms are an indication of possible fertility problems, they do not automatically constitute infertility. 

Erectile Dysfunction

Struggling to attain or sustain an erection is one of the most common signs of infertility, as you may be unable to participate in sexual intercourse and achieve conception.

Low Libido

Reduced or absence of interest in sex is another common sign of infertility. Low libido may occur due to psychological factors, hormonal imbalances, or other underlying conditions.   

Abnormal Ejaculation

Ejaculation problems such as retrograde ejaculation, painful ejaculation, or premature ejaculation can be a sign of infertility.

Variations in Testicle Texture or Size

Changes in testicle texture, size, or shape may suggest the presence of hormonal imbalances or sperm production problems. The variations include small, abnormally hard, or soft testicles. 

Swelling or Pain in the Testicles

Persistent discomfort or pain in your testicles may indicate infections such as varicocele, orchitis, or epididymitis, which can contribute to infertility. 

Abnormal Semen Characteristics

Unusual semen characteristics like inconsistency in volume or colour may be a sign of problems with sperm transport or production.

Hormonal Imbalances

Hormonal imbalances are also an indicator of infertility. Signs of hormonal imbalances include abnormal hair growth, reduced muscle mass, and fatigue.

Exploring Male Factor Infertility 

As discussed above, male-factor infertility refers to the diminished ability of a man to initiate a pregnancy with his female partner. This condition significantly contributes to reproductive challenges facing couples in their attempt to conceive. Male infertility arises due to factors like;

• Sperm abnormalities
  
• Hormonal imbalances
  
• Genetic disorders
  
• Structural abnormalities in the male reproductive system
  
  

On the other hand, female infertility can result from conditions such as;



• Uterine fibroids
  
• Endometriosis
  
• Polycystic ovary syndrome (PCOS)
  
• Issues with cervical mucus
  
• Poor nutrition
  
• Damage or blockage of the fallopian tubes
  
  

Unlike female infertility factors, most male infertility factors like sperm count, morphology, and motility are measurable. Therefore, definite diagnostic tests, including semen analysis, can help assess male fertility. However, in some cases, male and female infertility coexist. Therefore, if you have difficulty conceiving, you and your partner should take a fertility evaluation to establish the potential cause.

Reproductive Health and Male Infertility 

There is a direct link between your reproductive health and fertility. Living a healthy lifestyle is critical to enhancing your reproductive health, thus minimising the risk of infertility. Some of the ways you can improve your reproductive health include:

• Maintaining a healthy weight: Obesity can disrupt hormone levels and lead to infertility. Regular physical activities can help improve your reproductive health and reduce your risk of infertility.
  
  
• Eating a balanced diet: consuming a balanced diet rich in vegetables, lean proteins, healthy fats, and fruits can provide your body with antioxidants and essential nutrients to enhance your reproductive function.
  
  
• Making healthy choices by avoiding excessive alcohol consumption, illicit drugs, and smoking can positively impact your reproductive health.
  
  
• Managing stress by engaging in activities like meditation, hobbies, and exercise and getting sufficient sleep can be helpful. Poor sleep quality and chronic stress can disrupt hormone levels, hindering sperm production and hence increasing infertility risk. 
  
  
• Not engaging in unprotected sex; practising safe sex habits like using a condom during intercourse can protect you from STIs that can cause reproductive health problems and infertility.



Treatment Options for Male Infertility

Although no proven treatment can improve sperm quality, some techniques exist that can help increase your chances of conception. Some available treatment options for male infertility include:

Medical Intervention/Hormone Therapy

If low sperm count or poor motility is diagnosed as the cause of infertility, your doctor can recommend medication to boost spermatogenesis and improve motility. The drugs aim to trigger the pituitary glands to produce FSH and LH hormones needed for sperm production.

Surgery

Your doctor may recommend surgery to correct varicocele veins or unblock sperm ducts and enhance sperm movement.

Assisted Reproductive Technology (ART)

Sometimes, after a fertility evaluation of both partners, your doctor may advise using ART methods to improve your potential of achieving a successful conception. Some of these methods include intrauterine insemination, in-vitro fertilisation, and intracytoplasmic sperm injection. 

Intrauterine Insemination (IUI)

During an IUI treatment, the doctor collects your sperm sample, prepares it in the lab, and injects it into your female partner's uterus using a catheter. This treatment option is recommendable if:

• You have a low sperm count
  
• Your female partner's cervical mucus impedes sperm movement
  
• You have functional issues like erectile dysfunction or impotence
  
• Your seminal fluid contains anti-sperm antibodies
  
  

In-Vitro Fertilisation (IVF)

During IVF treatment, the doctor collects your sperm and harvests mature ovum from your partner. After some procedural preparation in the lab, they mix the eggs with sperm and let fertilisation occur. Then, they implant the fertilised egg (embryo) into your partner's womb to develop. 

Intracytoplasmic Sperm Injection (ICSI)

ICSI involves injecting an egg with one healthy sperm and later transferring the embryo into your female partner's uterus. The procedure is similar to IVF except that the physician only uses one sperm and injects it directly into the egg. This procedure is recommendable if you have poor sperm morphology. 

Lifestyle Changes

Some lifestyle changes that can help minimise the risk of infertility in men include:

• Quit smoking cigarettes and marijuana.
  
• Limit your coffee intake to three or fewer cups daily.
  
• Quit drinking alcohol or limit your consumption to a maximum of 2 bottles weekly.
  
• Adopt a healthy diet with more vegetables and fruits.
  
• Keep a healthy body weight by exercising regularly.
  
• Do not use performance-enhancing supplements such as anabolic steroids, which can reduce your sperm count, increasing the risk of infertility.
  
• Make sure you get an adequate amount of sleep.
  
• Minimise your exposure to harmful environmental toxins that can cause infertility.
  
  

These lifestyle changes can significantly improve sperm health and increase your chances of successful conception.

Unexplained Infertility in Men

Unexplained infertility in men is when there is no definitive cause of the fertility challenges experienced by the individual. Research shows that unexplained infertility in men accounts for approximately 25% of all male infertility cases. If you have unexplained infertility, all the regular fertility evaluation test results show optimal parameters. This condition can be challenging and stressful, especially if you aspire to start a family.

Diagnosing Unexplained Male Infertility

The primary challenge in diagnosing unexplained infertility is that semen analysis, the most applied assessment procedure, has inadequacies. The study can only scrutinise basic parameters like sperm count, morphology, and motility without clarifying any genetic abnormalities or functional aspects that may contribute to infertility. 

Therefore, diagnosing unexplained infertility requires more extensive assessment, including a thorough physical examination, medical history, genetic testing, and hormonal profiling. Moreover, studies haven't exhaustively covered all potential male infertility causes, making diagnosis even more complicated. 

Managing Unexplained Male Infertility

Addressing unexplained infertility calls for an all-inclusive approach focusing on all aspects of your health. Since lifestyle is a critical factor, you should consider adopting a healthy lifestyle and making healthy choices that can help improve your reproductive health. It is also vital to manage any chronic medical conditions that can lead to infertility. 

Moreover, your doctor may prescribe specific medications and supplements to boost sperm quantity and quality. Antioxidants like coenzyme Q10 and vitamins C and E can also help improve sperm health and lower infertility risk.

Most importantly, psychological support is crucial in dealing with infertility. The frustration and uncertainty can take a toll on your emotional well-being. Therefore, it can be helpful to join local support groups or seek professional counselling to ease the emotional burden and improve your chances of successful conception. 

Besides, remember that unexplained infertility does not necessarily mean you can't have children. You can still achieve your dream of starting your family through ART treatment. 

Conclusion

Overall, male infertility is a complex reproductive health issue affecting many men of reproductive age. Symptoms may vary from one man to another, depending on the underlying causes. The potential causes of infertility in men range from sperm abnormalities and hormonal imbalances to genetic and lifestyle factors.  

The available treatment options include hormone therapy, surgery, and ART treatment. Eating a balanced diet, quitting harmful habits, practising safe sex, and living a healthy lifestyle can help improve your reproductive health and lower infertility risk. 

In cases where you and your partner have difficulties getting pregnant, you should consider consulting with a fertility healthcare provider to receive an evaluation. A fertility specialist will help you establish potential causes and recommend suitable treatment to improve your chances of having a baby.

References

• De Kretser, D. M. (1997). Male infertility. The lancet, 349(9054), 787-790. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)08341-9/fulltext

• Agarwal, A., Baskaran, S., Parekh, N., Cho, C. L., Henkel, R., Vij, S., & Shah, R. (2021). Male infertility. The Lancet, 397(10271), 319-333. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32667-2/fulltext

• Iammarrone, E., Balet, R., Lower, A. M., Gillott, C., & Grudzinskas, J. G. (2003). Male infertility. Best practice & research Clinical obstetrics & gynaecology, 17(2), 211-229. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1521693402001475

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