Male infertility: Causes, treatment, what men should know about their fertility

When a couple is unable to conceive, the female has been always unfairly blamed and it is one of the most widespread fallacies to date, which stems from the fact that women are at the centre of the whole process - from conception through full-term pregnancy to nursing and caring for their children. However, infertility has been medically confirmed to be caused by underlying disorders in both sexes and it has been found that more than one-third cases of infertility can be traced to male infertility.

Male fertility is quite dependent on the body mass index (BMI) and extra body weight can cause many fertility struggles since a study has suggested that obesity can reduce the quality of men's sperm. It is a lesser known fact that overweight men have significantly lower sperm counts than men of normal weight but male reproductive health is rarely discussed in India or anywhere in the globe and even when infertility is recognised, it is met with disappointment and humiliation since the capacity to reproduce is assumed.

What is male infertility?

In an interview with HT Lifestyle, Dr Sumit Mehta, Consultant Urology at Fortis Hiranandani Hospital in Vashi, explained, “'Infertility' is a broad term that implies the inability to procreate. In men, it encompasses Erectile Dysfunction (ED) too, as it also contributes to procreation. Infertile men have defects in their semen, the fluid needed for procreation. Semen carries sperms and fluids that nourish it; any factor affecting these can affect fertility.”

Causes of male infertility:

As per Dr Sumit Mehta, the most common finding in infertile men is a low sperm count. A count of 20 million to 40 million is considered normal and this parameter has to be considered with other factors when assessing a man for infertility. He said, “This includes the motility, anatomy, and fragility of the sperm. Falling sperm counts have been a concern over the last century as the normal ranges have been revised to meet with the falling sperm counts of men over the world. Most infertile males have low sperm count due to low or defective production.”

Adding to the list of causes behind male infertility, Dr Sumit Mehta shared, “Other factors include - poor quality of seminal fluid or obstruction in the pathway of ejaculation, low production due to stress, nutritional deficiency, underlying health issues like diabetes, thyroid disease, obesity, advanced heart disease, and cancers. Treatment for cancers like chemotherapy and radiation also affects sperm count. A bad lifestyle, mental stress, tobacco & alcohol consumption, and working in a hot humid environment at the workplace like a factory (boiler/machinery) also contributes to low sperm count. Absent fructose in the semen contributes to this, as does obstruction in the pathway of ejaculation.”

Treatment and what men should know about their fertility?

Dr Amolkumar Patil, Consultant - Urology and Kidney Transplant Surgery at Apollo Hospitals in Navi Mumbai, revealed, “Pre-conception health for men is important for fertility as they have a crucial role in conception. To conceive, a man must have a good erection and normal ejaculation, sperm count must be good, and sperm must be healthy to reach and penetrate the egg. These factors can affect your partner’s chances of getting pregnant and also the health of offspring.”

One study in the Journal of Human Reproductive Sciences has found that the awareness pertaining to male infertility is extremely low; they were able to identify only 51% of risk factors and 45% of health issues associated with male infertility. Urging upon the need to enlighten men with more information on the subject, Dr Kshitiz Murdia, CEO and Co-Founder of Indira IVF, shared, “The first thing to be kept in mind is that men need to produce enough healthy sperms with good motility (ability to swim), morphology (shape) and genetic robustness. This can be ensured by maintaining a healthy lifestyle and mental health, prevention of sexually transmitted diseases and quitting substance abuse, smoking and alcohol intake."

According to him, “The next step in pre-conception is to achieve erection and ejaculation – any complications related to this such as erectile dysfunction and premature ejaculation can act as a barrier. Male infertility can be a result of congenital and medical ailments as well as environmental factors. Congenital ailments that include blocked sperm ducts, hormonal issues and undescended testes can impact one’s fertility. Medical conditions such as varicocele that can be treated with surgery can lead to less sperm count and decreased quality of the same. Additionally, health conditions such as diabetes, thyroid disease, hypertension, cardiovascular diseases and obesity must also be looked into.”

Highlighting that in the environment, exposure to certain hazardous chemicals, increased temperature in the pelvic area and even pollution can affect male fertility, Dr Kshitiz Murdia added, "Cancers of the male genital organs and treatment of cancers in the pelvic area can impact sperm production and its quality. In such cases, men can freeze their sperms to be used later in their lives; this procedure can also be utilised later in life in case of other fertility complications. It is imperative to understand that infertility can be due to different constitutive conditions in the body. Thus, it becomes essential to conduct regular check-ups and undertake any preventative measures to ensure a good reproductive health."

Echoing the same, Dr Sumit Mehta suggested, “Treatment of infertility involves treating the cause, like stopping consumption of tobacco and alcohol, destressing, correcting underlying risks like Endocrinal Diseases (Diabetes), heart disease and blood pressure. A general preventive health check-up yearly helps in detecting silent diseases early. Early detection means early treatment and lesser damage with early cure. Preventive regular semen analysis has no place as a screening test in healthy males, hence it is not advisable to do semen tests like other routine laboratory tests. Cryopreservation of semen is advised in men who undergo treatment for cancers or are likely to undergo treatments/ suffer from diseases which will contribute to low sperm counts. Impotence or Erectile Dysfunction (ED) needs to be addressed separately but modification of lifestyle and de-stressing are common to both.”