Male infertility

Male infertility is fairly common and can affect almost 50% of couples who fail to conceive. There are many causes of male infertility which can lead to significant psychosocial and marital stress.

What is male infertility?

The male reproductive system is designed to make, store and transport sperm. Two hormones ­– Testosterone and Follicle Stimulating Hormone (FSH) regulate the male reproductive system. During orgasm, sperm, that is suspended/mixed in the seminal fluid, is secreted from the male reproductive glands, the prostate and paired seminal vesicles.

Male infertility refers to a health issue in a man that lowers the chance of his female partner getting pregnant. The development, maturation and transport of healthy sperm is necessary for fertilisation. Sperm that is unable to reach the fallopian tube does not have the capacity to penetrate and fertilise the egg.

When a couple fails to achieve pregnancy after 12-months of regular, unprotected sexual intercourse, a screening evaluation of both partners is essential. For the male partner this includes history, physical examination, hormone assessment, and semen analysis. There are several lifestyle and environmental factors that can have a negative impact on male fertility.

What are the causes of male infertility?

As a male, your fertility generally depends on the quantity and quality of your sperm. If the number of sperm you ejaculate is low, or if the sperm are of a poor quality, it will be difficult and, in some cases, impossible to get pregnant naturally. Fertility treatments however, aim to overcome these obstacles and make something that may be impossible naturally, possible with the help of laboratory techniques.

Infertility may be caused by:

All the factors listed above can impair the normal production of sperms cells thereby decreasing their number and quality.

Other factors:

Azoospermia refers to a condition where there is no sperm in the ejaculate.

With Azoospermia, the chances of biologically fathering a child are non-existent without medical intervention (surgical sperm retrieval) and this condition accounts for 10-15% of male infertility. This condition is triggered by various hormonal or chromosomal deficiencies and is linked to testicular failure, damage to the epididymis, vas deferens or ejaculatory ducts of the reproductive system. Certain congenital or acquired problems, including infections, can also be contributing factors.

A vasectomy is an example of an acquired condition that leads to azoospermia. During a vasectomy procedure, the vas deferens is cut and sealed, preventing sperm from moving through the reproductive tract. For men who have undergone a vasectomy, 70% of them resume sperm production after a reversal, although half often develop sperm antibodies which affects the ability of the sperm to fertilise an egg.

Erectile Dysfunction occurs when a man is unable to get or keep an erection firm enough for sexual intercourse. Often referred to as impotence, erectile dysfunction is a sign of a physical or psychological condition that can cause stress, relationship strain and low self-confidence.

Some of the causes of erectile dysfunction include:

  1. Physical illness
    Erectile dysfunction is often associated with any physical illness that affects blood flow and can include diabetes, high cholesterol, high blood pressure, cigarette smoking, heart disease, obesity, and multiple sclerosis.

  2. Psychological
    Sexual drive and performance can be affected by stress associated with work, relationships, or financial concerns. Depression and anxiety about poor sexual performance can also be a cause of erectile dysfunction.

  3. Medications
    Erectile dysfunction can be associated with medications used to treat high blood pressure, high cholesterol, depression, and psychiatric disorders.

Treatment for erectile dysfunction will begin by treating any known causes. Other treatments include a review and possible change of your prescription medications, oral medications (e.g., Viagra), vacuum penile pump, injections into penis, penile implants, vascular surgery, and hormone therapy. Non-invasive treatment options include psychotherapy and counselling.

Retrograde Ejaculation is a condition where the semen flows backwards into the bladder instead of ejaculating through the penis. This is a lesser-known issue and is often the result of a dysfunction in the bladder neck. Surgical sperm retrieval (SSR) is often the best treatment for this condition.

How do I test for male infertility?

Testing for male infertility typically involves a clinical examination of the man along with a semen analysis. Ideally, more than one semen test should be performed as results may vary considerably from day to day.

Other tests that may be needed include:

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