Male Infertility

General Facts

More than one third of couples meeting a doctor due to not being able to become pregnant are due to male infertility. Infertility is often questioned when failing to conceive after around a year of having unprotected intercourse. Most couples are able to conceive during this time frame. So if a pregnancy hasn’t occurred, some tests are required to determine a diagnosis of infertility in either one or both of the partners.

Causes and risk factors

Some men might not show any kind of symptoms while other men can be confronted with difficulties in their sexual life or hormonal changes that can affect them.

There are a number of functional changes that stand behind male infertility. Some of them are of a physical nature and they prevent normal ejaculation of spermatozoids with the semen, while others affect the quantity and/ or quality of semen. Most common causes of male infertility are listed below:

  • Sexual transmitted diseases: infections in the male genital area may result in infertility that are usually be reversed with appropriate treatment
  • Blockage or trauma in the testicles, prostate or urethra: men can either be born with or acquire such over time, in these cases a surgical approach is often recommended.
  • Retrograde ejaculation: spermatozoids are not ejaculated outside the penis but they end up in the bladder. This condition usually occurs in diabetics, while administering certain medication or post-surgery
  • Genetic diseases: rarely encountered, genetic conditions like chromosomal anomalies or cystic fibrosis may be the cause of infertility
  • Hormonal dysfunctions – at the level of the pituitary or thyroid gland
  • Sexual dysfunctions – impotence or erectile dysfunction due to the anxiety and stress – Varicocele: varicose dilation of the veins inside the scrotum which blocks normal blood flow.

Other risk factors that might influence fertility:

  • Excessive physical exercise or movement
  • Stress & anxiety
  • Obesity
  • Drug and alcohol abuse
  • Extended exposure to toxins: lead, radiations, pesticides, mercury, radioactive substances etc.
  • Heat on the scrotum might also reduce the spermatozoids production. This can be caused by wearing underwear that is too tight, excessive use of saunas, riding a bike.

Diagnosis and treatment

The doctor will generally ask about the medical history of the patient and assess what tests are required to be done in order to establish diagnosis.

A sperm analysis might be required. After the test results arrive, the doctor will advise whether the condition can be reversible with medication, therapy or surgery and if there are options for sampling sperm in vitro fertilization.

Depending on the cause of infertility the doctor shall advise on adopting lifestyle habits that can increase fertility.

There are also procedures today that allow harvesting of sperm directly from the testicles:

  • TSA stands for testicular sperm aspiration
  • MESA is testicular biopsy (microsurgical epididymal sperm aspiration.) Both can be performed by a small scrotal incision