Male Fertility: When You Should Seek Help?

Infertility problems affect 8–12% of couples. Up to 50% of infertile couples are the result of male factor infertility, whether in part or solely. Many men do not seek treatment or even investigate the role they may play in infertility. It is essential to consider the role of male infertility.

Unfortunately, the evidence for male infertility is more limited than the studies on female infertility. Many factors, both modifiable and non-modifiable, should be considered if you are struggling to grow your family.

Is it all about semen?

Male infertility, or the inability to cause pregnancy in a fertile female, is most often due to deficiencies in semen. Deficiency issues include sperm concentration or count, the motility of the sperm — their ability to move — or the morphology of sperm-the physical structure. A combination of these deficiencies can also exist. Approximately 7% of all males have some degree of semen abnormality.

Sperm abnormalities

A sperm count or concentration is the number of microscopic sperm present in the ejaculatory fluid. Male sperm counts have rapidly and significantly decreased since the 1940s — and the numbers are concerning. In the 1940s, the average sperm count was 113 million sperm per milliliter. In the 1990s, the average sperm count was 66 million sperm per milliliter. Astonishingly, the average male sperm count after 2000 has continued to decrease by 2.64% annually.

Some medical conditions affecting sperm count include the following:

• Azoospermia. Lack of sperm in the ejaculatory fluid.
• Oligozoospermia. Low sperm count, less than 15 million sperm per milliliter, is clinically significant.
• Asthenozoospermia. This is sperm that have a motility deficiency. Sperm need to move quickly and effectively through the cervical mucous to find their target egg. Poor motility of sperm can result in infertility.
• Teratozoospermia. This is sperm with an abnormal structure. Problematic sperm cause problems with fertility.

The cause of the significant drop in sperm concentration is largely unknown, but there are risk factors, modifiable and non-modifiable, that can impact sperm health.

Modifiable risk factors of male infertility

Most male infertility has no definite cause. Yet, as in female infertility, lifestyle changes can impact fertility. The regulation of male sex hormones is complex, and disruption can affect fertility. Modifiable risk factors can include:

• Exposure to environmental toxins. Toxins include pesticides/herbicides, heavy metals, air and noise pollution, non-ionizing radiation, radiofrequency electromagnetic radiation from laptops and cellphones, and natural gas/oil exposure. Smoking, alcohol consumption, illicit drug use, and medications can also be toxic. Endocrine-disrupting compounds (EDC) include bisphenol A (BPA) and phthalates — a chemical found in many plastics, solvents, personal care products, and even fast food.
• Oxidative damage. An imbalance between free radicals and antioxidants within the body. These free radicals can cause damage by reacting with other molecules within the body. Free radicals easily damage sperm. Smoking and alcohol, especially together, can change semen quality due to oxidative damage.
• Dietary exposure to isoflavones. Isoflavones are found in soy. Some studies have shown that increased soy food intake is related to lower sperm count concentration. Soy is an additive in many foods.
• Obesity. Obesity can result in decreased sperm motility and altered structure, most likely due to hormonal changes. Obesity can have co-occurring conditions such as diabetes and heart disease that can have consequences on fertility as well.

Healthy lifestyle changes such as reducing environmental toxin exposure, adopting a nutritious diet, beginning a moderate exercise program, reducing alcohol intake, and smoking cessation should all be recommended if you and your partner are struggling with infertility.

Other causes of male infertility

Additional causes of male infertility are broad. Any medication, tumor, disease, or disorder that impacts the glands that secrete sex hormones can alter male fertility. Age is also an important factor. A few examples are explained below.

• Medications. Many medications can alter male fertility, but the most common are antidepressants, anti-inflammatories, chemotherapy medication, and hormone replacements.
• Structural disorders. Any structural defect or obstruction of the male urogenital system, including the epididymis, vas deferens, or testes.
• Klinefelter syndrome. Men with this genetic mutation have an XXY chromosome instead of the normal XY chromosome. These men are generally infertile with hypogonadism — too little or no sex hormone production. Many are not diagnosed until adulthood.
• Undescended testes. This condition is generally repaired at a young age, but an undescended teste/s is sometimes indicative of a testicular defect. Men with a history of undescended teste/s have poorer quality sperm.
• Viral mumps orchitis. Recently, the reduction in receiving the MMR vaccine has led to more mumps infections. About 25% of males infected with mumps may suffer some degree of infertility due to damage to the seminiferous tubules — the birthplace of sperm.
• Age. Age decreases the concentration and efficient motility of sperm. For example, a study showed that 90% of seminiferous tubules contained sperm in 20-to-30-year old’s while only 50% contained sperm in 40-to-50-year olds. Sperm motility and structure also decreased among these age categories.

Artificial reproductive technology (ART) such as IVF may be necessary to achieve pregnancy in these and similar disorders and diseases.

When to seek help?

Clinically, infertility is the inability to conceive a baby within 12 months with unprotected and frequent intercourse. From the male perspective, successful conception begins with healthy sperm that have found their way from the vagina through the cervix and can make the journey up the fallopian tube to an awaiting female egg. Infertility testing will target this conception pathway.

A physician will perform a general physical exam, including an examination of the genitals and a health history. Questions concerning lifestyle choices, certain risk factors, and sexual history, current and past, may also be discussed. Specific fertility tests may include:

• Semen testing. A lab will provide an analysis of your sperm that has evaluated the total sperm count, the structure of the sperm, and how they move. Semen testing is the simplest and most valuable test.
• Hormonal testing. This blood test will evaluate your testosterone and other male hormone levels.
• Genetic testing. Occasionally, genetic defects can cause infertility.
• Imaging and biopsy. Sometimes an MRI, ultrasound, and even biopsy can help determine if there are any structural defects of the reproductive organs that may be causing infertility.

Unfortunately, even with these statistics and risk factors, 40% of male infertility is ultimately considered idiopathic, meaning the cause is unknown. Regardless, it is crucial to evaluate all risk factors and perform testing to see if any reason can be identified.