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male causes of infertilityLooking for the underlying factors of infertility can be trying for a couple – there may be guilt, blaming, feeling like a failure – a host of emotions.  While it can be tough, it is important to try to get to the underlying cause.  In this respect, male causes of infertility must be examined along with female.  Here are some things to look for and address:-

Sexual Dysfunction

The first consideration in assessing male infertility is his functionality in sexual intercourse. Sexual dysfunction may take the form of low sexual desire or arousal, which limits the frequency of intercourse, or erectile failure (impotence), which prevents intra-vaginal ejaculation of sperm.

Reduced sexual desire may be due to factors such as a strict ‘religious’ upbringing, in which sexuality was either not discussed or considered ‘dirty’, a poor relationship with their partner, or illness, either physical or psychological (including depression).

Approximately 50% of cases of erectile failure are due to illnesses, such as diabetes, alcoholism (liver disease), neurological disease e.g. MS or hypothyroidism, or the effects of drug such as antihypertensives, and some antidepressants and tranquillizers. The other 50% are due to psychological causes, including depression (as cause or effect), marital discord, ‘performance anxiety’ and fear of failure.

Sperm Production

Deficiencies in sperm production, or irregularities in the sperm produced, are common factors in male infertility. A semen analysis seeks to assess not only the sperm count, but also the volume, abnormal forms and motility of the sperm.

Azoospermia is a complete absence of sperm in the seminal fluid; oligospermia is a major reduction in the numbers of sperm being produced. Causes may include trauma to the sperm-producing cells, such as excessively high temperatures or inflammation, or radioactive damage to the cells.  Problems with motility are common – there may be enough sperm, but if they’re not swimming, they can’t get to where they need to go to meet the egg.

Anatomical Factors

One of the most common anatomical conditions in male infertility is an obstruction to the spermatic cord which contains the vas deferens, and passes the sperm from each testicle to the urethra. There may be a cluster of varicose veins in the spermatic cord around the vas on either or both sides, known as a varicocele. This greatly affects sperm production. Rarely there is a defect in the anatomical development of the penis itself, preventing the sperm being deposited high up within the vagina during intercourse. Retrograde ejaculation is an unusual condition whereby the sperm are not ejaculated through the urethra into the woman’s vagina, but instead are ejaculated backwards into the bladder. This may occur in diabetic men or when there has been previous urethral surgery.

Hormonal Factors

Irregularities in levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin and thyroid hormones should be assessed as possible causes of infertility in the male. FSH levels above three times normal indicates that a man’s testicles will not produce sperm, although testosterone is still being produced. High levels of prolactin usually manifest in erectile failure, but may be confirmed by blood test.

Infections

White blood cells in the semen may indicate a chronic infection that may have been asymptomatic and thus undetected. Such infections include gonorrhea, non-gonococcal urethritis (NGU), or other unknown causes, and are reported to account for about 10% of male infertility. A level of above 5 million leucocytes/ milliliter of semen indicate an infection is present. Infections may also affect the seminal vesicles, ducts or prostate, which all in turn have an impact on fertility.

Immunological Factors

Similar to what can happen in women, a man producing auto-antibodies to his own sperm will be jeopardizing the viability of those sperm.

Nutritional Factors

Studies have shown that certain vitamins, minerals and elements may be deficient in infertile men, and thus contributing factors in male infertility. A study by the Journal of the American Medical Association showed that men with sperm agglutination had borderline levels of serum ascorbic acid, and when supplemented, the levels of agglutinated sperm had dropped from over 20% to 11%. Other studies reported a rise in conception when taking ascorbic acid similar to that when taking mesterolone, a synthetic form of testosterone. Low serum zinc status may also retard sperm production and motility, as well as affect the activity of the prostate in providing nourishment for the sperm. Amino acids have also been examined as factors in male infertility, with arginine receiving particular attention. L-Arginine supplementation is claimed to be beneficial for infertile men. Vitamin E in normal doses is also reported to be beneficial in improving sperm motility.

Lifestyle Factors

There are many factors in a man’s lifestyle that may play some part in preventing conception. While the individual incidences of some of the following may not be high, each should be given consideration as possible contributing factors.

Smoking is known to reduce spermatogenesis, as well as the motility of sperm.  Smoking marijuana is equally detrimental. Alcohol in excess will also reduce the sperm count and the production of the hormone testosterone. Therefore a lifestyle incorporating these two habits is not optimum if trying to conceive. Stress is also a major consideration here. A man who is tired, stressed and overworked from his job is unlikely to want to be as sexually active at home, and therefore may be less enthusiastic about having sex, even at his partner’s most fertile time. Stress may affect his hormone production and glandular function, and hence the health of his sperm. Heat is another factor in sperm production and viability, therefore long hot baths and tight fitting underwear, which raise the testicles and hold them closer to the body, are not recommended. Some workers may have occupational hazards that may interfere with fertility, such as working near radiation, chemicals and pesticides.

The starting point for assessing male infertility is typically a semen analysis, but bloodwork incorporating cholesterol, thyroid, testosterone (free and total), FSH, prolactin, vitamin D, RA factor/ ANA should also be done routinely.  Any information is good information in helping couples navigate the causes of infertility, as many of those factors can be corrected.