Understanding Male Infertility

What causes infertility in men? 

The sperm may be less in number, less able to swim forwards (less mobile), and/or have an irregular shape. 

Some of the  risk factors that can influence sperm production and male infertility. This includes: 

• Current or previous testicular infection (e.g., mumps). 

• Previous or current infections of the sperm-producing system, such as gonorrhea or other sexually transmitted illnesses. 

• Testicular tumours. 

• Undescendent testis. 

• Side effects of certain medications and street substances. These include sulfasalazine, nitrofurantoin, tetracyclines, cimetidine, colchicine, allopurinol, some chemotherapy medications, cannabis, cocaine, and anabolic steroids. 

• Scarring from earlier operations, such as inguinal hernia surgery, might clog sperm ducts, affecting fertility. 

• Varicoceles may impact male fertility. 

• Hormonal issues, such as pituitary gland dysfunction, can cause Cushing's syndrome or hyperprolactinaemia. 

• Genetic conditions such as cystic fibrosis. 

• Certain inherited diseases, caused by faulty genes, can impact testicular development and function. Examples include Klinefelter's and Kallman's syndromes. 

• Men who are overweight may experience reduced fertility. 

Unknown 

Approximately one in every four infertile couples has no known cause. 

Tests for infertility 

• A Semen analysis for the male spouse to check sperm quality. 

The test findings are often classified into one of three categories: 

            • Normal. 

            • Absolutely abnormal. 

There are different terminology depending on : 

Oligospermia and azoospermia are charecterised by  few or no sperm respectively . 

Teratozoospermia is characterized by abnormal sperm shape and size ('morphology'). 

Asthenozoospermia occurs when just a small percentage of sperm move properly. 

Abnormal results may be caused by a combination of the factors listed above.  

Some general recommendations 

The success rate of conception gradually decreases with time. However 

• Take folic acid, zinc, and multivitamins daily to prevent spinal cord problems in babies. 

Folic acid is a vitamin found naturally in foods including spinach, sprouts, broccoli, green beans, and potatoes. 

• Refrain from exposing intimate regions to excessive temperatures, such as using a laptop on the thigh or taking a hot bath. 

Smoking 

Stop if they smoke. 

Alcohol in excess 

This may have an effect on fertility in both men and women. This is why it is recommended not to drink at all. If you decide to drink while trying to conceive, limit your intake to one or two units once or twice a week. 

Medication 

Some medications can harm a developing fetus and should be adjusted before becoming pregnant. Medicines used to treat epilepsy are a good example. These include sulfasalazine, nitrofurantoin, tetracyclines, cimetidine, colchicine, allopurinol, and several chemotherapy medications. 

Stop using recreational drugs. 

- marijuana, cocaine, and anabolic steroids. 

Diabetes 

If you have a medical condition that requires frequent monitoring, such as diabetes, you should start planning before you get pregnant. 

Weight control 

If you are extremely overweight or underweight, your chances of becoming pregnant may be lowered. To increase your chances of conceiving, keep your body mass index (BMI) between 20 and 30. 

Sex and Fertility 

It is recommended not to try to time your sexual activity to coincide with expected ovulation. This might induce anxiety, which can occasionally lead to sexual or relationship issues. 

Sperm can persist for up to seven days after unprotected sex between a couple. As a result, even though an egg (ovum) only lives for 12-24 hours, having sex two or three times per week is enough if you're trying to conceive. Studies have revealed that having sex every two to three days increases your chances of becoming pregnant. 

Infertility therapy. 

Treatments for infertility depends on underlying cause. Treatments, such as medicines may include 
Some Medication can improve sperm count in some men with infertility. Your doctor may prescribe an estrogen receptor blocker, such as clomiphene citrate, which stimulates the hypothalamus and pituitary gland in the brain. This generates hormone production and the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH), which can increase sperm production.

Medication.

Men with low testosterone levels may be prescribed human chorionic gonadotropin (HCG) or HMG to adjust FSH and LH levels and increase sperm production. This medication is injected three times per week for as long as six months. Your doctor uses regular blood tests to monitor testosterone levels, adjusting the medication dosage accordingly.
There are several more medication which may be advised by your treating Doctor

Surgical procedures for  Male Infertility 

Varicocele are bloated veins in the testes, which may decrease fertility. This disorder can be cured by surgery. 

The tubes within the male reproductive system which transport sperm may become obstructed, due to injury or vasectomy. In some cases, the blockage can be surgically removed and the tubes can be repaired. 

If surgery does not work, surgical procedure called Percutaneous epididymal sperm aspiration (PESA) are very helpful in retrical of sperm directlt from site of storage. A short needle is placed into the epididymis while undergoing local anaesthesia. Sperm is extracted and either utilized immediately for ICSI or frozen for future use. 

Artificial insemination to treat male infertility ( IUI ) 

The man's sperm is collected which is then cleansed, and concentrated before being inserted in partner's uterus via the cervix using thin tube . 

This option is used when: 

• There is poor sperm concentration in their semen. 

• There are functional issues, including impotence. 

• Antibodies against sperm can be seen in  seminal fluid. 

• Cervical mucus block sperm transport due to several reasons. 

In-vitro fertilization (IVF) for male infertility. 

In-vitro fertilisation (IVF) involves collecting sperm from a male and placing it in a specially designed incubator. Egg is retrived by a process called Ovum Pickup.  

The eggs are combined with sperm and fertilized by placing in a specialized incubator. The fertilized eggs mature into embryos, which are subsequently placed in the woman's uterus via a tiny tube introduced through the cervix. 

Male infertility treatment with intracytoplasmic sperm injection (ICSI) 

In cases where there are very few sperm intracytoplasmic sperm injection (ICSI) is an option. 

ICSI involves injecting a single sperm into each egg under ICSI manipulator. The fertilized eggs develop into embryos, which are then transported to the uterus at the right time.