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Male factor infertility challenge (1)

Male factor infertility challenge (1)

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Dr. Abayomi Ajayi

Starting and raising a family is one of life’s most satisfying experiences, but when some couples are struggling with infertility, it is often assumed that the women are the ones with issues. Inability of the average couple to conceive is often more stressful and frustrating for the woman in particular usually because of common perception that she is the one at fault.

The truth, however, is that male factor infertility is more common than most people realise. In a number of cases, it is the man that is unable to get the woman pregnant for one reason or another. Approximately, one in four couples is not able to conceive a child even though there has been frequent, unprotected sexual intercourse for a year or longer. In about half of these cases, male factor infertility plays a role. This is incontrovertible.

In this 2-part series, we would be addressing male factor infertility. This week, focus is on the signs and symptoms as well as the common and uncommon causes of male infertility. Next week, discussion will be about the diagnosis, treatment and prevention approaches.

When a couple is struggling to conceive a child, there may be no obvious signs or symptoms to point at the man, but in certain cases, an underlying problem could be the cause. These could range from an inherited disorder, hormonal imbalance or a condition that blocks the passage of sperm.  Male infertility is often caused by a number of factors including low sperm production, abnormal shape or immobile sperm, and blockage that prevents the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors are part of the problem.

Common male infertility signs and symptoms may include problems with sexual function such as difficulty with ejaculation or difficulty maintaining an erection, pain, swelling or a lump in the testicle area.  Another pointer is having a lower than normal sperm count (fewer than 15 million sperm per millilitre of semen or a total sperm count of less than 39 million per ejaculate).

It is essential to understand that male fertility is a complex process. For a man to get a woman pregnant, he must produce healthy sperms. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of his testicles must be functioning correctly, and his body must produce a hormone called testosterone and other hormones to trigger and maintain sperm production. Then the sperm has to be transported into the semen.

Once sperms are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. There needs to be enough sperm in the semen. If the number of sperm (sperm count) is low, it decreases the chances of fertilisation of the egg. A low sperm count is considered as one that is fewer than 15 million sperm per millilitre of semen or fewer than 39 million per ejaculate. Sperm must be shaped correctly and able to move. If the movement (motility) or shape (morphology) is abnormal, the sperm may not be able to reach or penetrate the egg.

Problems with male fertility can be caused by wide range of health issues and medical treatments, for instance, a varicocele, which is a swelling of the veins that drain the testicle. It’s a common cause of male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm. Some infections can interfere with sperm production or sperm health, or can cause scarring that blocks the passage of sperm.

Infections such as some Sexually Transmitted Infections (STIs) including chlamydia and gonorrhoea are significant. Inflammation of the prostate and testicles due to mumps are also indicated. A condition known as “retrograde ejaculation” that occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis can cause male infertility. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.

Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. Some antibodies attack sperm. They are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them. Cancers and non-malignant tumours can affect the male reproductive organs directly or can affect the glands that release hormones related to reproduction, such as the pituitary gland. In some cases, surgery, radiation or chemotherapy to treat tumours can affect male fertility.

In some males, during fetal development, one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition. Infertility can also result from disorders of the testicles or an abnormality affecting other hormonal systems. Also, the tubes that carry sperm can be damaged by illness or injury. Some men experience blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one or both of the tubes that carry sperm out of the testicles. Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether. Inherited disorders have their own role in male infertility.

One condition called Klinefelter’s Syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs.  Problems with sexual intercourse can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis, or psychological or relationship problems that interfere with sex.

Overheating the testicles arising from frequent use of saunas or hot tubs may temporarily lower sperm count. Sitting for long periods, wearing tight clothing or working on a laptop placed around the groin area for long stretches of time also may increase the temperature in the scrotum and slightly reduce sperm production. The type of underwear a man wears is unlikely to make a significant difference in male fertility.

Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of sperm as well. It is known that drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production.

At the same time, certain occupations can increase risk of infertility, including those associated with extended use of computers or video display monitors, shift work, and work-related stress. Men who smoke may have a lower sperm count than do those who don’t smoke. Second-hand smoke also may affect male fertility. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect sperm count.

It is time to see the doctor if as a couple, you are unable to conceive after a year of regular, unprotected sexual intercourse. As a woman, encourage your spouse or partner to go to the doctor if he cannot have an erection normally or is affected by ejaculation problems, low sex drive, or other problems with sexual function. Symptoms such as pain, discomfort, a lump or swelling in the testicle area are also indicators of an underlying problem.

For the man, take your wife or partner along when going to see the doctor. Normally, a couple is treated together when investigating infertility, so your partner may also need tests to see whether she has any fertility problems that could be preventing pregnancy. It’s also good to have your partner present to help keep track of any instructions your doctor gives you or to ask questions you may not think of.

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