What is male infertility?
Infertility or the inability to successfully reproduce is a problem that affects both men and women. Some studies claim that of all couples who struggle with infertility, between 30-50% of those cases are due in some part to male infertility. The list of possible factors and causes is long and patients may require multiple tests and consultations before a diagnosis can be determined.
In order to impregnate a partner, male partners must have at least one functioning testicle, be producing testosterone and other hormones to maintain sperm production, and have a sufficiently high sperm count consisting of healthy sperm with normal motility. If there are problems with at least one or more of these areas, there is a high probability that the man will struggle with fertility.
Causes and influencing factors
Causes of male infertility are ultimately related to the sperm, including problems such as low sperm production, abnormal sperm function, or physical blockages that prevent sperm from traveling the necessary path to an egg. These problems can be a result of a genetic disorder, hormone imbalance, or dilated veins surrounding the testicle. Complicating factors include illness, injury, chronic health issues, and lifestyle choices such as diet and exercise.
There are a number of medical causes that may result in challenges with fertility. These include:
- Antibodies that attack sperm. Some men suffer from immune system cells that identify sperm as harmful and try to eliminate them.
- Celiac disease. This sensitivity to gluten can cause infertility. Fertility may improve with a gluten-free diet in some cases.
- Chromosome defects. Some genetic disorders can cause abnormal development of male reproductive organs.
- Defects of tubes which transport sperm. There are many tubes that transport sperm. These can be blocked for a multitude of reasons and can occur within the testicle, in the tubes which drain the testicle, in the ducts which carry sperm to the urethra, or in the urethra itself.
- Ejaculation issues. One ejaculation dysfunction, called retrograde ejaculation, is when semen enters the bladder rather than exiting through the penis during orgasm. This problem can be caused by diabetes, spinal injuries, medications, or surgeries in the surrounding area such as the bladder or prostate.
- Hormone imbalance. Dysfunction with any one of multiple hormone systems can result in loss of fertility.
- Infection. Some infections can interfere with sperm health or production, or cause permanent scarring that blocks the delivery of sperm. These include inflammations as well as sexually transmitted diseases.
- Medications. Some medications such as anabolic steroids, chemotherapy, antifungals, or ulcer drugs can inhibit fertility.
- Problems with sexual intercourse. These can include problems such as maintaining an erection, premature ejaculation, painful intercourse, anatomical abnormalities, or psychological problems that interfere with normal sexual activity.
- Surgeries. Procedures like vasectomies, hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries can impact the ability to reproduce.
- Tumors. Any cancers or other tumors can affect the reproductive organs, including the glands that release hormones necessary for reproduction.
- Undescended testicles. Decreased fertility is more likely in men who have testicles that have failed to descend into the scrotum.
- Variocele. This is the swelling of the veins that drain the testicle, which results in reduced quality of the sperm. The exact cause of this condition is unknown but is the most common reversible cause of male infertility.
An overexposure to certain environmental factors like heat, toxins, and chemicals can weaken sperm production or function. These include exposure to industrial chemicals such as pesticides and painting materials; heavy metals; and radiation or x-rays. Additionally, overheating of the testicles should be avoided. Sitting for long periods, wearing tight clothing, or working on a device like a laptop computer can result in elevated temperatures that harm sperm production.
Additional causes of male infertility may come from lifestyle choices such as drug use, alcohol use, tobacco smoking, and poor diet and exercise routines that lead to obesity. Emotional stress can also interfere with sperm count.
While the primary sign of male infertility is the inability to conceive a child (such as lack of pregnancy), there may be other symptoms that signal difficulties with procreation. These include problems with sexual function such as difficulty maintaining an erection, difficulty with ejaculation and/or small volumes of fluid being produced, and reduced sexual desire. Other reported symptoms men may encounter include pain, swelling or lumps in the testicles, recurring respiratory infections, loss of the ability to smell, abnormal breast growth, decreased body hair, and signs of a chromosomal or hormonal abnormality. Another symptom requiring medical testing is a lower than normal sperm count, which is commonly reported as fewer than 39 million sperm per ejaculation.
If after a year of regular, unprotected intercourse you have been unable to conceive a child and notice problems with sexual function and/or pain or lumps in the testicles, it is recommended that you see a doctor. Individuals who have a history of such problems or have had groin, testicle, penis, or scrotum surgery should also consult a medical professional.
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