Understanding male infertility: causes, diagnosis, and treatments

What is male infertility?

Male infertility refers to a man’s inability to achieve a pregnancy with a fertile woman. This can happen due to various issues affecting sperm production, function, or delivery. Problems with sperm production can lead to a low sperm count or abnormal sperm shape, while issues with sperm function can prevent sperm from swimming properly or penetrating the egg. Delivery problems might include blockages or ejaculation issues. Understanding these factors is essential for diagnosing and treating infertility effectively.

Causes of male infertility

Problems with sperm production

One main cause of male infertility is problems with sperm production. This can include having a low sperm count, meaning there aren’t enough sperm to fertilise an egg. Poor sperm motility can also be an issue, where the sperm cannot swim properly to reach the egg. Abnormal sperm shape can make it difficult for sperm to penetrate and fertilise the egg. These issues can significantly impact your ability to achieve a pregnancy.

Medical conditions

Various medical conditions and treatments can contribute to male infertility. For instance, varicocele (enlarged veins in the scrotum) can heat the testicles and impact sperm production. Infections can interfere with sperm production or health, and conditions like retrograde ejaculation cause semen to enter the bladder instead of exiting through the penis. Hormonal imbalances and genetic disorders like Klinefelter’s syndrome can also play a significant role in male infertility.

Lifestyle factors

Your lifestyle can greatly impact the quality of your sperm. Smoking, excessive alcohol consumption, and drug use can harm sperm production and function. Being overweight, eating badly, not exercising regularly, or being stressed can also affect hormone production needed for sperm. Try to move more, eat healthier, manage stress, and drink less alcohol.

Environmental factors

It’s not just what’s going on inside you that can affect your fertility. External factors can also play a role, for example, exposure to toxins like pesticides, heavy metals, and radiation can affect sperm production. Using hot tubs or saunas frequently or wearing tight clothing can raise the temperature around the scrotum, impairing sperm production. Avoiding these can help improve your chances of conceiving.

Testing & diagnosing male infertility

Struggling to conceive can be a distressing experience for couples, but understanding when to seek help can make a significant difference. Dr. Vladimiro Silva, Scientific Director of Ferticentro, advises on the ideal timing for male infertility testing:

“You should consider testing for male infertility if you and your partner have been trying to conceive for over a year without success, or six months if the woman is over 35. Additionally, if there are any known issues such as a history of testicular problems, surgeries, infections, or if you have concerns about your sperm health, it’s a good idea to get tested sooner. Early testing can help identify any issues and allow you to start appropriate treatments sooner.”

Diagnosing male infertility involves a few important steps. First, your doctor will review your medical history, lifestyle factors, and perform a physical exam to check for issues like hormonal imbalances or varicocele.

A fertility specialist will also analyse your semen to measure the quantity and quality of your sperm, specifically looking at sperm count, motility (how well they swim), and morphology (shape). If these show any problem, you may be asked to undergo blood tests to check your hormone levels, including testosterone and other hormones that regulate sperm production. Genetic tests can identify specific genetic disorders that might affect fertility, while ultrasounds can detect any blockages or structural problems in the reproductive organs. With this information, your doctor can understand what might be causing infertility and recommend the best treatment options for you.

Treatment options for male infertility

If you’re struggling with fertility issues, hope is not lost. Fertility clinics offer some treatments and strategies to help overcome these challenges.

Medications

Medications can help with various issues. Hormone replacement therapy can address hormonal imbalances affecting sperm production, while antibiotics can treat infections impacting fertility, and specific medications can resolve ejaculation issues. Your doctor will recommend the best course of treatment for you.

Surgical interventions

Surgical treatments are another option. Varicocele repair can improve sperm quality by fixing enlarged veins in the scrotum. If you’ve had a vasectomy, a vasovasostomy can reverse it to restore sperm flow (even though this procedure is not always possible to perform).

TESE (Testicular Sperm Extraction) and TESA (Testicular Sperm Aspiration) are two other  techniques that can help with the most serious cases of male infertility. These techniques are used to retrieve sperm directly from the testicles. They are useful if you have very low sperm counts or no sperm in your ejaculate (azoospermia). TESE involves making a small incision in the testicle to extract a tissue sample, processed to retrieve sperm. TESA, on the other hand, uses a needle to aspirate sperm directly from the testicular tissue. Both procedures are done under local anaesthesia and always used with ICSI (Intracytoplasmic Sperm Injection).

Assisted reproductive technologies (ART)

ART offers several options to help achieve pregnancy. ICSI, in particular, has revolutionised the treatment of male infertility by allowing fertilisation to occur even when sperm quality or quantity is significantly low. ICSI is a specialised technique used during IVF (In Vitro Fertilisation).

This method is particularly beneficial for men with very low sperm counts, poor sperm motility, or abnormal sperm morphology. During ICSI, an embryologist selects a single sperm and injects it directly into an egg. This process bypasses many of the natural barriers to fertilisation, significantly increasing the chances of fertilisation.

Here’s how ICSI works:

1. Sperm is collected either from your ejaculate or directly from the testicles using procedures like TESE or TESA.

2. Eggs are retrieved from your partner’s ovaries in a minor surgical procedure.

3. The embryologist selects a single healthy sperm for each egg.

4. The selected sperm is injected directly into the centre of the egg using a fine needle.

5. The injected egg is monitored for signs of fertilisation and embryo development.

6. Embryos are then cultured in special time-lapse incubators and their development is controlled 24/7.

7. One or more healthy embryos are transferred to your partner’s uterus for implantation and pregnancy.

Lifestyle changes

You can significantly improve your fertility through lifestyle changes. Eating a healthy diet and getting regular exercise can boost your sperm production and quality. Reducing exposure to environmental toxins, quitting smoking, and limiting alcohol consumption can make a big difference. Stress management techniques such as meditation, yoga, and counselling can help reduce anxiety and improve your overall well-being, positively impacting your fertility.

Emotional and psychological support

Dealing with infertility can be an emotionally challenging journey, and seeking support is essential to help you navigate this difficult time. Professional counselling can play a crucial role in managing the emotional impact of infertility. A therapist can provide you with coping strategies, emotional support, and a safe space to express your feelings and concerns.

Joining a support group can also be incredibly beneficial. In a support group, you can connect with others who are facing similar challenges. Sharing experiences, advice, and encouragement with people who truly understand what you’re going through can provide immense comfort and help reduce feelings of isolation.

Maintaining open communication with your partner is equally important. Infertility can put a strain on relationships, so it’s vital to keep the lines of communication open. Discuss your feelings, fears, and hopes with each other. Supporting one another emotionally and being patient and understanding can strengthen your bond and help you navigate the emotional aspects of infertility together.

It is also worthwhile exploring relaxation and stress-reduction techniques such as mindfulness, meditation and yoga. These practices can help you manage anxiety and improve your overall well-being, making it easier to cope with the emotional ups and downs of the infertility journey.

Remember, you don’t have to go through this alone. Reach out for support and take care of your mental and emotional health as you work towards building your family.

Help is here!

Facing male infertility can be a challenging and emotional journey but remember that you have options and support available to you. With the right diagnosis and treatment, many men can improve their fertility and achieve successful pregnancies, even if sometimes the problem will still be there. Understanding the causes, undergoing appropriate diagnostic tests, and exploring various treatment options can help you and your partner navigate the challenges of infertility.

At Ferticentro, we bring extensive expertise and experience in helping couples overcome male infertility. Our dedicated team of specialists is here to guide you through every step of the process, from diagnosis to treatment, with compassion and personalised care.