What is Infertility?

Infertility means not being able to conceive after having unprotected intercourse for a year. It is also termed Infertility when a woman gets pregnant but keeps having miscarriages or stillbirths. 

There are two types of Infertility-

Primary Infertility- It is called Primary Infertility when a couple has never conceived or even if they have, they end up with miscarriage or stillbirth.

Secondary Infertility- It is called Secondary Infertility when a couple has a child but is unable to conceive again.

In most cases, couples suffer from Primary Infertility.

However, contrary to the common belief that women are the only ones who can be infertile, males can be infertile as well. Both have equal chances of being infertile.

What is Male Infertility?

Male infertility is a situation in which health problems in males make it difficult for their female partners to get pregnant. 

Normally, during sex, sperms travel through their female partner’s vagina, where if they get fertilized with an egg, pregnancy is achieved, but if any of the partners is infertile, conception is not possible.  

What are the Causes of Male Infertility?

Infertility in men could be caused due to many reasons. For better understanding, we have divided them into 2 categories; Medical causes; Health, Lifestyle, and other causes.

Medical Causes- Male infertility might be caused due to health reasons. They are as follows-

• Varicoceles- This is one of the most common reasons for infertility in men (40 out of 100). It is a type of medical condition, in which the veins around the testicles get swollen, which causes the testicles to heat up, which further affects the sperm count and shape.
• Retrograde Ejaculation- This occurs when instead of coming out of the penis, semen enters the bladder. This happens when during ejaculation, the muscles fail to contract, and thus the semen ends up in the bladder. This may be caused due to many reasons like spinal injuries, diabetes or medications, etc.
• Immunologic Infertility- This is a rare type of male infertility, in which antibodies are formed in the body, which attacks the sperm and prevents them from working and moving normally. These antibodies are made due to infection, injury, or surgery. 
• Undescended Testicles-  This is a situation, in which, during the time of fetal development, the testicles (one or both) do not ascend from the abdomen into the sac which is supposed to contain the testicles.
• Hormonal Disorder- Hypothalamus and pituitary glands in the brain produce hormones that maintain normal testicular function, any damage to either of these glands may lead to excessive or insufficient production of male hormones, which ultimately harms sperm production.
• Medication- Certain medications can also cause infertility in men. Medication for health problems like- diabetes, arthritis, cancer, depression, digestive problems, high blood pressure, and infections can bring changes in sperm production, function, and delivery. 
• Blockage- A blockage in any part of the male reproductive tract can stop the sperm from leaving the body during ejaculation. This blockage can be caused due to many reasons like- vasectomy, testicular surgeries, infections, swelling, etc. Obstructive Azoospermia.

Other factors 

There are some other factors based on health, lifestyle, etc that can also cause male infertility. They are as follows-

• Age- It is wrong to assume that men can reproduce at any age. In fact, after the age of 45 male potentials to reproduce drops down. If they father a child after the age of 45, the child is more likely to face health issues.
• Obesity- Obesity can reduce fertility in men as it directly impacts sperm quality and also causes hormonal changes. The odds of infertility increase by 10% for every 9 kg a man is overweight.
• Excessive Alcohol Drinking- Alcohol consumption causes testosterone levels to lower down, which causes erectile dysfunction and decreases the production of sperm.  Liver diseases due to excessive drinking can also lead to fertility issues.
• Smoking and Drug Use- Men who smoke tend to have a lower sperm count than those who don’t smoke. Drugs (taken for any reason) can lead to the shrinkage of testicles and also decrease the number and quality of sperm.

What are the problems in Sperm, which can cause Infertility in Men?

• Azoospermia- This is a situation, in which the semen doesn’t contain any sperm. This may be caused due to any blockage in the tubes or testicular failure.
• Oligospermia- In this situation, the semen does contain sperm, but in a very less number. The number is so low that it is not sufficient to conceive a baby.
• Teratozoospermia- The streamlined shape of a healthy sperm helps it to penetrate the surface of the woman’s egg. Sperm with abnormal morphology might fail to do this.
• Asthenozoospermia (Poor Motility)-  Motility refers to the ability of sperm to move independently with the help of metabolic energy. Within 48 years of ovulation, sperm has to flow up to the fallopian tube where the egg is waiting to be fertilized. Sperm with poor motility might be unable to do this.

What are the signs of infertility in men?

Even though not being able to conceive a child is the biggest symptom of infertility, there can be some other signs of infertility in men you might notice. They are-

• Change in Libido- When a man is infertile, his sexual desire tends to change as it is directly linked with the hormones.
• Pain or Swelling in Testicles- Although testicles can swell or pain due to various reasons, it is one of the symptoms of infertility in men.
• Erectile Dysfunction- Symptoms of male infertility might also include- difficulty in maintaining an erection, loss of sexual desire, difficulty in ejaculation, or a small amount of fluid ejaculated.

Others- Inability to smell, reduction in facial and body hair, decrease in sperm count are also symptoms of male infertility.

How to Prevent Infertility in Men?

Even though you cannot always prevent male infertility, there are certain things you should avoid doing to ensure healthy sperm production. They are-

• Smoking cigarettes
• Excessive Alcohol Consumption
• Obesity
• Intake of drugs
• Stress
• Anything which causes prolonged heat to the testicles
• Exposure to harmful chemicals.

How is Infertility in Men Diagnosed?

To Diagnose male infertility, the doctor usually follows 2 stages. They are- 

• Physical Examination and Medical History
• Semen Analysis

The doctor might do a Physical Examination of your genitals and ask questions related to your medical history like- hereditary and other diseases, injuries, surgeries, sexual habits, etc, that could affect fertility.

In Semen Analysis, you give your semen sample to the doctor, who sends it to the lab to check the number and functioning of your sperm, to see if the infertility is due to poor sperm quality.

The doctor might also ask you to get some tests done to know more about the cause of infertility. The tests could be Scrotal Ultrasound, Transrectal Ultrasound, Genetic Tests, Post-Ejaculation Urinalysis, Hormone Testing, or Testicular Biopsy.

How to Treat Male Infertility?

The advancement in technology has brought to us various ways male infertility can be treated. Male infertility treatments include-

• Rectal probe electroejaculation- RPE, which is usually done under anesthesia is used to retrieve much sperm from a man. However, fertility may be low if sperm movement and shape are not adequate.
• Penile vibratory stimulation- This technique vibrates the tip and shaft of the penis to help get a natural climax. 

• Varicocele Treatments- This treatment is used to cure Varicoceles. It helps in fixing the swollen veins which help in sperm movement, numbers, and structure. 

• Azoospermia Treatments- Azoospermia can be treated surgically by finding sperm, together with assisted reproduction.

• Microsurgical Vasovasostomy- It is used to undo a vasectomy. Here, via microsurgery, 2 cut parts of vas deferens in each testicle are joined.

• Vasoepididymostomy- Vasoepididymostomy is a microsurgical method that is used to treat epididymal blocks. In this, the upper end of the vas deferens (main sperm pipeline) and the epididymis are joined together.
• Transurethral Resection of the Ejaculatory Duct (TURED)- This procedure helps to remove the blockage in the Ejaculatory duct and allows the sperm to mix with the semen for a healthy ejaculation. But, only 1 in 4 couples get pregnant naturally after this treatment.

Assisted Reproductive Techniques

With the advancement in technology, it is possible to conceive a child without having intercourse.  These methods are called Assisted Reproductive Techniques (ART). These techniques are used to obtain sperm through normal ejaculation, via surgery, or by using donor sperm. The sperm is then fertilized with the female egg to have a baby. These days, instead of using the treatments mentioned above, people opt for Assisted Reproductive Techniques. ART is readily available in India for infertile couples and at an affordable cost.

Your doctor might suggest you an ART treatment based on the type of infertility you are facing. Some of the Assisted Reproductive Techniques are-

• Intrauterine Insemination (IUI)- IUI is a simple procedure, in which the sperm is directly placed inside the woman’s uterus through a tube. This saves the time and distance for the sperm to travel, thus making it easier to fertilize with the female egg. This treatment is used in the case of retrograde ejaculation, low sperm count, and movement problems.
• In Vitro Fertilization (IVF)- IVF is a more recognized type of Assisted Reproductive Technology. In IVF, the male sperm and female eggs are fertilized together in a lab and then the fertilized embryo is put inside the uterus. If the male is infertile, instead of using his own sperm, Donor sperm is used. In the case of female infertility, donor eggs or donor embryos can be used.
• Intracytoplasmic Sperm Injection (ICSI)- ICSI is a procedure that is sometimes done with IVF. Here, a single sperm is injected into the egg with a needle. After fertilization, the embryo is put inside the woman’s uterus. For this method, in case of male infertility, sperm may be taken from the testicles by surgery or donor sperm.

Sperm Retrieval for ART-

Some sperm retrieval methods are used to take out sperm. The objective is to take out the sperm in good quality and quantity without harming the reproductive tract. These methods include- 

• Testicular Sperm Extraction (TESE)- TESE is a procedure, which can be used to find out the cause of azoospermia. The tissue taken is also used for the extraction of sperm. And the sperm taken from the testicle can be frozen (cryopreservation) or used fresh.
• Testicular Fine Needle Aspiration (TFNA)- TFNA is a technique that helps collect sperm from the testicle by puncturing the scrotal skin with a needle and syringe.  
• Percutaneous Epididymal Sperm Aspiration (PESA)- In PESA, the liquid containing sperm is taken out from the epididymis by inserting a needle attached to a syringe in it. 
• Microsurgical Epididymal Sperm Aspiration (MESA)- in MESA, a surgical microscope is used to take sperm from the epididymal tubes. It can retrieve a large quantity of motile sperm. Which can be frozen and used later for IVF.

What are the foods to increase male fertility?

Food plays a major role in not only female reproductive health but male reproductive health also. There are certain foods that can enhance male fertility by increasing the production of male testosterone, which ultimately leads to an increase in sperm quality, quantity, and motility. Below is a list of those foods-

• Green vegetables
• Eggs
• Beef
• Oysters and Salmon
• Fruits- Bananas, Pomegranate, Berries, Kiwi
• Dark chocolate
• Maca roots
• Asparagus
• Walnuts
• Pumpkin seeds
• Zinc-rich foods
• Tomato
• Lentils
• Ashwagandha  (Ginseng)

Can male infertility be permanent?

No, in most cases, male infertility can be cured. It is not permanent and can be cured if one follows a certain course of action. It includes-

• Don’t smoke.
• Don’t do alcohol or drug abuse.
• Avoid exposure to excessive heat and heavy exercising.
• Don’t take too much stress.
• If you have had a vasectomy or any other infertility issue, get surgery done to cure it.
• Take antibiotics if you have an infection that is affecting your fertility.

Male infertility care at Vinsfertility

Vinsfertility has a team of experienced medical professionals, who will guide for the correct treatment to cure male infertility.