Understanding Male Infertility
What is male infertility?
Male infertility is caused primarily by male factors encompassing: abnormal semen parameters or function; anatomical, endocrine, genetic, functional or immunological abnormalities of the reproductive system; chronic illness; and sexual conditions incompatible with the ability to deposit semen in the vagina.
According to the World Health Organization and the International Committee Monitoring Assisted Reproductive Technologies (ICMART), failure to get pregnant is defined as clinical infertility if pregnancy is not established after 12 months or more of regular unprotected sexual intercourse.
While either one or both of the partners may contribute to the reproductive challenges of the couple, male infertility, like female infertility, is a clinical diagnosis that can only be determined after formal assessment and testing.
How common is male infertility?
At least one in eight couples have trouble getting pregnant or sustaining a pregnancy. Approximately one-halfthird of infertility is attributed to the female partner, one-quarterthird attributed to the male partner and one-quarter third is caused by a combination of problems in both partners or, is unexplained.
Male infertility is more common in environments with high levels of environmental pollution, including water contaminants, pesticides and herbicides. Some recent population studies have suggested that sperm counts have been declining universally even though infertility has not been increasing substantially.
What causes male infertility?
In at least half of male infertility cases, doctors cannot identify an exact cause. For the remaining cases, infertility is either due to male reproductive system functional or anatomic abnormalities, environmental, genetic or other identifiable factors.
Common Environmental Causes of Male Infertility
- Excess heat, for example due to the male’s occupation, such as truck drivers, welders, or firefighters, or habits, such as excessive use of the hot tub or tight clothing.
- Drugs, including certain antibiotics and prescription medicines, anabolic steroids, alcohol, marijuana.
- Toxicants, such as pesticides, herbicides, heavy metals, lead, mercury, or paint
- Stress
- Excess exercise, including bicycling
- Chronic disease, such as anemia, malnutrition, cancer, neurological disease, or diabetes
- Dietary deficiencies, such as zinc, vitamin C, folic acid
- Varicocele, a condition in which the veins enlarge inside the scrotum
- Diseases of the male genital tract, including infection, cancer, trauma, or retrograde ejaculation
- Surgery on the male genital tract, such as for the treatment of an undescended testicle, or hernia
- Obesity
Genetic Causes of Male Infertility
- Mutations inside the genes that determine the male sex, called the Y-chromosome
- Other irregular changes in the genes. For instance, some men have a condition called Klinefelter’s XXY syndrome in which they have an extra copy of the female-sex determining genes (the X chromosome)
- Hormonal issues, such as: diabetes, high levels of the milk-producing hormone prolactin, or problems with the hormone-producing organs like the thyroid or adrenal gland
Male Fertility Treatments
Not all male infertility is permanent or untreatable; it is not uncommon for men to treat infertility through one or a combination of actions, even though the clinical effectiveness of many of these treatments has not been proven..
- Avoiding damaging environmental factors, such as smoking, heat exposure, heavy exercise, toxicants, certain drugs, or excessive alcohol
- Reducing stress
- Taking medications, which include antibiotics (if an infection is suspected); fertility medications (Clomiphene, Human Chorionic Gonadotropin (hCG) or LH/FSH injections)
- Vitamins, such as folic acid, zinc, or L-carnitine
- Antioxidants
- Alternative medicine. However, certain types of herbs may be harmful. Acupuncture is generally not harmful or helpful.
- Surgery, such as reversing a vasectomy or repairing a condition called a varicocele, in which the veins inside the scrotum are enlarged
- Intra-uterine insemination (IUI) may enable more moving sperm to be placed closer to the eggs at the right time and improve fertility in cases in which appropriate timing of intercourse or other cervical factors create unfavorable circumstances for pregnancy through sexual intercourse
- In vitro fertilization, which is usually done via a process called Intra-cCytoplasmic Sperm Injection (ICSI)
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