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Since time immemorial, there has been a general misconception about fertility issues. Even today, most people consider it to be a woman’s problem alone; that something is physically not okay with the woman. Too appalling that most people are not aware but male infertility is quite a common issue. If you have recently discovered that you are dealing with male infertility issues or want to know the whats and whys of the condition, this content piece can help you understand the issue, its causes, and the available treatment options.
Since time immemorial, there has been a general misconception about fertility issues. Even today, most people consider it to be a woman’s problem alone; ... Read More
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Pristyn Care Ferticity, Malviya Nagar, New Delhi Pristyn Care Ferticity,Malviya Nagar, New Delhi Plot no: 116, Lumbini Enclave Gachibowli, HyderabadAny health condition in a man that lowers his chances of getting his female partner pregnant is known as male infertility. Having a baby is generally a natural and simple process. But unfortunately, there are couples for whom the experience can be tough and it can be difficult for them to conceive. Approximately, 13 out of every 100 couples fail to make their partners pregnant even with unprotected sex. According to medical reports, 1 in every 7 couples is infertile, which means for some reason or the other, they have not been able to conceive a child, even after trying unprotected sex for more than a year. In half of these cases, male infertility is the major contributing factor for the infertility issue in the couple.
A man plays a significant role in making his female partner pregnant since the pregnancy depends upon the quality and the quantity of his sperm. In case the male fails to produce the required amount of sperm or the sperm is of poor quality, it may be impossible for the male to impregnate his female partner. If you and your partner are trying to conceive a baby but failing to do so even after trying unprotected sex for more than a year, you should check with a urologist or an infertility specialist.
Semen analysis is a routine test for male infertility that is done in labs. The test helps in determining the exact cause of male infertility. In most cases, the test is done twice to find out the exact cause. The semen is usually collected in the lab. The man is required to masturbate and provide his sperm in a sterile cup. Once the semen is collected, the sample is sent for evaluation. During the evaluation, the doctor studies your sperm count, the concentration and movement of the sperm, and the structure of the sperm. The sperm quality tells the doctor about your ability to help a woman conceive.
If the produced sperm turns from pearly gel into liquid within 20 minutes, the semen is considered to be normal. If this does not happen, something is likely wrong with the man’s sex glands and seminal vesicles.
If the semen analysis shows no sperm at all or low sperm count, it may indicate that the male is permanently infertile. In such a case, the doctor may either proceed with further tests or may recommend you consult with an infertility specialist.
In many cases, men are asked to undergo a transrectal ultrasound to diagnose their infertility issues. During the ultrasound, sound waves bouncing off an organ are used to get an image of the organ. A probe is placed in the rectum. The probe beams sound waves to the nearby ejaculatory ducts. During the ultrasound, the healthcare provider can find out if there is any abnormality or blockage in the seminal vesicles or the ejaculatory duct in the man.
If the semen analysis shows a very low sperm count or no sperm at all, the doctor may proceed with a testicular biopsy. Testicular biopsy is done under either local or general anesthesia. During the procedure, a small cut is made in the male’s scrotum. The test can be done at a clinic or lab. The doctor first numbs the scrotal area and then takes a small piece of tissue from each testicle. The tissue samples are then studied under a microscope. The testicular biopsy serves two purposes – it helps the doctor determine the cause of infertility. Additionally, if there is any semen sample in the tissue, it can be used in assisted reproduction.
In this test, the doctor checks your hormones. Once the detailed hormonal profile is received, the doctor can understand how well your testicles make sperm. The test can also help rule out other problems. In the hormonal profile test, the patient is required to give a blood sample. The doctor runs a series of tests with that blood sample to obtain a complete hormone profile. The doctors evaluate the levels of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Testosterone, Prolactin, and Sex Hormone Binding Globulin (SHBG) to test infertility in the man.
Infertility is a very common issue, and both male and female infertility equally contributes to the problems. If a male fails to make his female partner pregnant, that could be a prime indicator of male infertility. In such a situation, the male should check with an infertility specialist without delay. Apart from this, the male can also check if there is any swelling and enlargement in the veins of his scrotum. This could be a symptom of varicocele. The male should also pay attention to his testicles, in case there is any swelling or unusual indication, it could be a possible factor of male infertility.
Your healthcare provider or doctor will begin the diagnosis procedure by taking a note of your health and surgical histories. It is highly likely that the doctor would ask several questions and want to know everything about your health condition that might lower your fertility. These might include defects in your reproductive system, low hormone levels, trauma, or injury to any part of the male genitals from any accident or previous health complication.
Your doctor will ask you about your current health problems, childhood illnesses, or medications that may alter your sperm production. During your consultation, the doctor will look for possible complications in your penis, vas deferens, epididymis, and testicles. The doctor will also check if you are suffering from varicocele. These problems can easily be evaluated with a physical examination.
Sperms are those which swim forward fast in a straight line – like guided missiles.
Sperms swim forward, but either in a curved or crooked line or slowly (slow linear or non-linear motility).
Sperms move their tails, but do not move forward (local motility only).
Sperms do not move at all.
The major complications of male infertility is often psychological. The inability to conceive a child can lead anyone to stress and relationship difficulties. The condition often hurts the male ego which further creates rifts and complications in his personal relationship with his partner and other family members.
If the male is permanently infertile or if the sperm motility is too low, the couple has to resort to expensive techniques of assisted reproduction. In simple terms, male infertility can lead a couple to heavy expenses of undergoing alternative reproductive techniques.
Male infertility caused due to any abnormalities in the reproductive organs, if left untreated, can lead to melanoma, colon cancer, testicular cancer, and prostate cancer.
There is no way you can prevent infertility caused due to physical deformities in cases where the vas deferens are missing. If the infertility is a result of addictions, infections, or other reversible conditions, timely treatment can help a male treat his infertility issues. Infertility issues that are caused due to lifestyle0related problems can be prevented or managed with proper physical care. Below mentioned are some of the lifestyle issues which can be helpful in preventing male infertility.
Myth 1 – Infertility is not a man’s problem.
Fact – If a couple fails to conceive a child, in most circumstances, the female is held responsible or incapable of bearing a child. This is a very common social structure in India. Most people fail to understand that the problem could equally lie in the man. Globally, infertility affects up to 15 percent of couples. In almost half the cases, infertility is caused due to some reproductive and genital issues in males. While it is easily assumed that infertility is a female problem, the fact that male fertility has a role to play in making a woman pregnant often goes unnoticed and unattended.
Myth 2 – Boxers can manage sperm health, it’s better than briefs.
Fact – There is an age-old belief that boxers are better than briefs in managing sperm health. Most people believe that boxers are better than briefs for reproductive health since it prevents the temperature of the scrotum that can be caused due to wearing briefs for ling hours. But there is no medical evidence to support this age-long belief.
Myth 3 – The ability to father a child has nothing to do with the man’s age.
Fact – Age has a direct correlation with a man’s age. After a man reaches 40 years of age, his sperm quality and quantity begin to decline. Unlike women, men do not go through menopause and hence they do not completely lose the ability to produce sperm. But sperm production definitely goes on a downward dip which is a major cause in many couples for their inability to conceive.
Myth 4 – If the ejaculate looks normal, the sperm is of optimum quality.
Fact – Most of the ejaculated fluid is not sperm. Sperm is microscopic and the motility and quality can only be evaluated after a thorough test. The only way to determine the quality of the sperm is by doing a sperm analysis from trained lab technicians.
Jimmy Fallon – Jimmy Fallon, the former SNL star and current host of The Tonight Show had struggled with infertility issues for quite a long time. Later, he and his partner Nancy Juvonen succeeded with a daughter. Jimmy Fallon has been open with his issue and went on to advise on TODAY,
“If there’s anybody out there who is attempting and they’re simply losing expectation, simply hold tight.”
Mark Zuckerberg – Facebook founder, Mark Zuckerberg opened up to the world about his struggle with infertility. After a long period of disappointment, the couple was blessed with a baby girl in 2015. In a Facebook declaration, Mark shared that they had experienced three miscarriages. He trusted the post would help many couples struggling to become parents not lose hope and supported an exchange about fertility issues. They are currently guardians of two kids, Max and August.
Hugh Jackman – Celebrated Hollywood actor, Hugh Jackman is one of the very few male celebs who has come out and has been openly speaking about his struggle with infertility. The actor has always been honest and candid about what the couple has gone through.
Gordon Ramsay – Gordon Ramsay is yet another celebrated figure who has been very vocal about his infertility issues. The celebrated chef had struggled with major infertility issues. Reports that surfaced on the internet said that his wife Tana had polycystic ovarian syndrome (PCOS) but Gordon Ramsay suffered fertility issues too. He was diagnosed with low sperm count, which made it very tough for his wife to conceive a baby, who was already dealing with PCOS.
One should contact a doctor if one is unable to conceive a child after a year of frequent, unprotected sex or if one experiences any symptoms and signs of male infertility. A man should also consult a specialized urologist if he notices any form of abnormalities in his scrotum or testicles such as swelling in any veins in the scrotum or unusual sensation and swelling in testicles. If the man experiences any difficulty in maintaining an erection or ejaculating, he should consult with a urologist at the earliest to rule out potential complications.
Anejaculation is when there’s no semen. It’s not common, but can be caused by:
Drugs are often tried first to treat this condition.
CAH is a rare cause of male infertility. It involves congenital problems in certain enzymes. CAH causes abnormal hormone production. CAH is most often diagnosed by evaluating the steroid level in the blood and urine. CAH can be treated with hormone replacement.
Retrograde ejaculation is a condition in which the semen flows back instead of going out of the penis. It can be caused by:
Retrograde ejaculation can be treated with drugs.
Surgical treatment is recommended in case of infertility caused due to the following conditions:
Ejaculatory duct blockage can be treated surgically. During the surgery, a cystoscope is entered into the urethra and a small incision is made in the ejaculatory duct. Thereafter, the doctor successfully unblocks the ejaculatory duct obstruction.
While most cases of male infertility can be diagnosed and treated, there are also conditions, where it becomes difficult to tell what is the exact cause of infertility in a man. Such conditions are known as ‘idiopathic’ or ‘non-specific’ male infertility. In cases where the cause is not clearly determined, or where no other forms of treatment work, infertility specialists suggest the patient undergoes the following infertility treatment techniques.
If all other infertility treatment fails to provide desired results, there are ways by which a couple can get pregnant without having sex. These methods are called assisted reproductive techniques (ARTs). Based on the specific type of infertility and the cause, the infertility specialist may suggest any of the following ARTs.
A. In Vitro Fertilization (IVF)
IVF is the most common and trusted ART in which the egg of a female partner or donor is fertilized with sperm of the male partner or sperm donor in a lab petri dish. For IVF, the ovaries must be efficiently stimulated. This is often done with drugs as the first step of the whole procedure. It allows multiple mature eggs to be retrieved. After 3 to 5 days of growth, the fertilized egg (embryo) is implanted into the uterus. IVF is used mostly for women with blocked fallopian tubes. But the procedure is also relied upon in cases where the man has very severe and untreatable oligospermia (low sperm count).
B. Intrauterine Insemination (IUI)
IUI or intrauterine insemination is a fertility treatment where the sperm is directly placed in the uterus. The chances of conception in IUI fertility treatment are more since the process allows a higher concentration of healthy sperm to come closer to the egg. IUI is often suggested for couples where the male suffers low sperm count and movement problems, retrograde ejaculation, and other causes of infertility.
C. Intracytoplasmic Sperm Injection (ICSI)
ICSI is a variation of IVF. It has revolutionized the treatment of severe male infertility. A single sperm is injected into the egg with a tiny needle. Once the egg is fertilized, it’s implanted in the female partner’s uterus. Your infertility specialist may recommend ICSI if the male partner has very poor semen quality. It is also used if you have no sperm in the semen, a block or testicular failure that can’t be fixed. Sperm may also be taken from the testicles or epididymis by surgery for this method.
Many microsurgical methods can remove sperm blocked by obstructive azoospermia (no sperm). The goal is to get the best quality and number of cells. This is done while trying not to harm the reproductive tract. These methods include:
Irrespective of the surgical treatment that the male infertility specialist doctor recommends, it is important to follow the below-mentioned tips to prepare for the surgery:
If you are under any medication, it is important for you to tell your doctor everything about the same. Some medications may cause adverse health reactions and may increase the risk of bleeding. If you taking any medication, including pain relief medicines and over-the-counter pills, inform your doctor.
Your doctor is likely to prescribe you certain medications before proceeding with the surgery. After informing the doctors about your medications, the doctor may ask you to stop taking certain medicines or cut down the dosages of some other. Take your medicines as directed by the doctor to prevent complications and ensure maximum benefits.
If you are suggested to undergo any surgery for male infertility, it is important for you to stop taking any heavy meals at least 12 hours prior to the surgery. Eating food right before the surgery can increase your risk of vomiting after you receive general anesthesia. Ask your doctor to thoroughly guide you on what to eat, how much to eat and what to avoid.
If your treatment for male infertility requires you to undergo surgery, the doctor will need to shave the pubic hair or the hair at the surgical site (if any other body part). You might think of shaving it yourself, but that may put you at unwanted risk of trauma and injury. So, it would be better if you leave the shaving to be done by the professionals.
Going under anesthesia can make you feel groggy and tired. It would be safe if you arrange for someone, a relative, or a friend to be there with you at the hospital and drive you back home after the surgery.
The recovery process and the timeline solely depend on what treatment method. If the treatment is medications, there is nothing that the patient would need to recover from. However, male infertility treatment with medications is a long process and the patient might require to continue the medications for several weeks and months. For a patient who undergoes surgical treatment for male infertility, such as varicocele surgery, the patient may need a month or two or even longer to recover, depending upon how severe was the health condition and how major was the surgery. Recovery after testicular or epididymal sperm retrieval depends on the method used. Recovery time can range from a few days to a week. During the recovery process, the patient will have to avoid strenuous activities. The patient will be advised to wear a jockstrap until full recovery, take medicines prescribed by the doctor without fail and use ice packs at the surgical site to heal better from the surgery. Most men after sperm retrieval can return to work within 24 to 48 hours. However, for some others, it may take a longer time to recover completely.
The outlook of any form of infertility treatment depends upon the individual and his or her partner. Every infertility treatment is different and every person has expectations from the treatments. While in most cases, the treatments are successful and help everyone live the joys of parenthood, there are also cases where either no form of treatment works or they have to keep continuing with the treatment for a long time. Most people give up mid-way of the treatment; some stick to it with hope and patience. In some cases, medications go a long way, while in others even surgical treatments fail to provide the desired results. Infertility treatment, unlike many others, does not come with any guarantee. Medical advancements, lifestyle changes, and the person’s individual outlook towards the issue, everything has a role to play here.
When male infertility cannot be treated, what are the alternatives?
Treatments of male infertility in most cases are successful if you consult an experienced doctor. But unfortunately, sometimes, the treatments are not successful and there is no alternate treatment option. In that case, what next? Parenthood is a very personal decision and as such the couple should make a personal decision based on their preferences and values. Even if you cannot have a baby of your own, there are still ways you can be called a mother and father. After all, parenthood comes from the heart!
Ritesh (38) and Anamika (34) (both names changed due to privacy concerns) have been trying to conceive a baby for the past 6-7 years before they came to Pristyn Care. They had tried almost all treatment methods and had spent a major amount of their income and saving in the years of treatment. Nothing seemed to work in their favor and the couple almost gave up trying. In the words of Anamika, “In used to track my ovulation and plan intercourse as guided by the doctors. Eventually, I lost interest and decided it’s okay if I don’t become a mother. It seemed too much of an effort. All the money that was spent on the tests and other sundry tasks also made me want to stay away from doctors. Many hospitals have also set charges 10 times their cost and we did not have that much money.” The couple wanted to give their luck one last try and came to Pristyn Care, after 11 years of their marriage. With the best medical treatment in line and one of the best infertility specialists at Pristyn Care, Ritesh and Anamika were blessed with twins in December 2020.
There are several health problems – from kidney disease to testicular cancer – that can cause male infertility. “Whole-body” health problems and metabolic disorders, and ordinary fevers and infections can also alter sperm growth. Genetic problems such as cystic fibrosis may result in no sperm in a man. Not many people are aware of this, but there are several health problems that can cause male infertility.
With infertility treatment at an early stage, the exact issue in the man can be treated to a large extent. But, the effects of infertility can be different from man to man. Only your doctor can say the answer to this question after proper diagnosis.
Following are some of the common symptoms which can tell that a man is infertile – abnormal change in his hair growth, low sexual desire, swelling, lump or pain in and around the testicles, problems having an erection, and small and firm testicles.
Fertility preservation is an option for a man who:
The sperm will be collected at a licensed laboratory, fertility centre, sperm bank or a licensed fertility hospital. You should not go to any other place apart from these options to donate your sperm.
