Infertility is defined as the inability of a couple to conceive even after 12 months of unprotected, frequent sexual intercourse. It affects about 180 million couples worldwide, and has traditionally been thought of as a woman’s problem. However, now it is well established that men are also a major contributor to infertility – about one out of every three cases of infertility is due to men alone!
Male infertility is defined as the inability of a male to make a fertile female pregnant. The male is responsible for about 20% and contributes to another 30-40% of all infertility cases. Overall, in about 50% of the cases, the male factor is the cause of infertility. Dr Rakesh Patel, Poojan IVF Center, says, “Nowadays, male infertility is responsible for about 40% of all infertility cases, so understanding the causes and treatment options is more important in this era.”
Causes Of Male Infertility
Dr Rakesh Patel
Male infertility has many causes – a from hormonal imbalances to physical problems, to psychological and/or behavioural problems. Moreover, fertility reflects the overall health of a man. Men who live a healthy lifestyle are more likely to produce healthy sperm. Most often, the problem lies in the process of either making or moving the sperm. Dr Rakesh highlights some lifestyle choices that have a negative impact on male fertility. “Modifying these lifestyle choices can improve a man’s fertility and should be considered when a couple is trying to achieve pregnancy.”
- Smoking: Significantly decreases both sperm count and sperm cell motility
- Prolonged use of marijuana and other recreational drugs
- Chronic alcohol abuse
- Anabolic steroid use: Causes testicular shrinkage and infertility
- Overly intense exercise: Produces high levels of adrenal steroid hormones which cause a testosterone deficiency resulting in infertility
- Inadequate vitamin C and Zinc in the diet
- Tight underwear: Increases scrotal temperature which results in decreased sperm production
- Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive substances, mercury, benzene, boron, and heavy metals
- Malnutrition and anaemia
- Excessive stress
Sometimes, making sperm is not the main problem, rather moving the sperm where they need to go is an issue. Sperms in the semen are either abnormal, very low in number, or not there at all. Causes of this kind of infertility include:
- Retrograde ejaculation: In this condition, semen ejaculates backwards into the bladder instead of out the penis
- Absence of the main sperm pipeline known as the vas deferens: This is a genetic problem
- Obstruction: Obstruction can occur anywhere in the plumbing between the testicles and the penis
- Anti-sperm antibodies: Antibodies can abnormally attack a man’s own sperm on their way to the egg
Psychological Impact Of Male Infertility
Dr Rajni Jindal
Psychological aspects of infertility in men have been insignificantly researched as compared to that in women. However, it is now noticed that men do suffer the psychological toll of infertility, but it can present differently than in women. Dr Rajni Jindal, Consultant Assisted Reproductive Techniques, Jindal Heart Institute & Fertility Centre, Bhatinda, Punjab, says, “Men may initially feel shocked and overwhelmed by the diagnosis of infertility and start seeing themselves as imperfect. Additionally, men often develop a sense of failure and feel they will miss out on an important life experience. Often, men feel uncomfortable expressing depression and sadness; thus, their reactions may come out as verbal anger.”
Emotional effects of male infertility are common, but professional and group support can help navigate infertility treatment. The emotional effects of infertility may include:
- Feelings of inadequacy
- Loss of control
- Thoughts of failure
- Physical reactions
- Relationships fallout
Some couples may need counselling, as infertility is associated with psychological distress. This is particularly important if genetic abnormalities are found.
Treatment And Counselling
Dr Meenakshi Dua
A diagnosis of male infertility can be one of the hardest challenges for a man. Unfortunately, some men have to accept the reality that nothing can be done about their infertility. However, for other men, advances in male infertility treatment offer real help. Dr Meenakshi Dua, Senior Consultant, ART Fertility Clinic, Gurgaon, says, “Don’t hesitate to ask for help. Timely help can make you fulfil your dreams.”
The ultimate goal of male infertility treatment is to achieve pregnancy. Ideally, the causes of male infertility are reversible with appropriate treatment and then conception can result from natural sex. Dr Dr Meenakshi shares common treatments for male infertility.
The doctor may suggest surgery to fix problems with creation, maturation, or ejaculation of sperm. Surgery performed to remove twisted, swollen veins in the scrotum can sometimes improve the quality of sperm. Obstructions in the sperm transport plumbing can be surgically corrected.
Hormone treatment may help if the cause of infertility is a hormone disorder. Hormone imbalances can affect sperm development. They can be caused by a problem in the hypothalamus, pituitary gland, and testes interaction. Treatment may include gonadotropin therapy or antibiotics.
- Assisted Reproductive Techniques
Nowadays, assisted reproductive techniques (ART) offer powerful new options. These high-tech and costly male infertility treatments give sperm an artificial boost to get into an egg. ARTs allow conception for men with very low or even abnormal sperm. Initially, sperm are collected either from ejaculated semen or by a needle from the testicle. Then they are processed and introduced to eggs by various methods such as:
Intrauterine Insemination (IUI) – Sperm are injected directly into the uterus at the time of ovulation. Women are given medicines to increase the number of eggs released.
In-Vitro Fertilisation (IVF) – Sperm are mixed with multiple eggs collected from the woman for fertilisation and then placed in the uterus. IVF requires at least some viable sperm.
Intracytoplasmic Sperm Injection (ICSI) – A single sperm is injected using a tiny needle directly into an egg. The fertilised egg is then implanted in the uterus. This technique is used when sperm counts are extremely low or abnormal.
Counselling For Male Infertility
Males are less likely to ask for help and may refuse psychological counselling for infertility despite the potential benefits. Counselling is found to be promising in cases of psychological infertility. Men who accept the reality regarding their infertility and try to understand the situation well have higher chances of achieving pregnancy. Counselling also decreases stress and anxiety and redefines the approach to treating the condition.
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