What increases a man’s risk of infertility?

There are many reasons why a man may have fertility problems. Fortunately, once diagnosed, some of these causes may be treatable.

Couples are considered infertile after they have tried for one year or more to get pregnant without success. Many couples automatically assume that the problem is a female issue, but up to forty percent of fertility issues are male-related problems. It is important that both couples have testing to identify what factors are contributing or causing infertility. In men, there are many different causes of infertility, including trauma or sports related injuries, hormonal disorders, illness, medications, or anatomical problems.

Dr Azadeh our health adviser, a senior lecturer at the Medical School of the University of the Gambia and a senior consultant in Obstetrics & Gynaecology is this week focusing on the causes of men infertility and giving advice on following the questions:

What is Male Infertility?

Diagnosing Male Infertility

What Causes Male Infertility?

What is Male Infertility?

Men are often astounded to discover that they have reproduction problems which may be affecting their ability to father a child. Reproductive problems in men such as the poor quality or quantity of sperm being produced, hormone disorders, reproductive anatomy trauma, obstruction and sexual dysfunction can all prevent conception from taking place.

Infertility is defined as the inability to achieve a pregnancy (impregnating a woman) after one year of well-timed, unprotected intercourse. It is estimated that male infertility is involved in about 40% of the 2.6 million married couples in the United States who cannot conceive.

As many as one-half of these men experience irreversible infertility and cannot father children at all, while a small number of these cases are caused by a treatable medical condition. A combination of both male and female factors is responsible in about one-third of cases.

The signs and symptoms of male infertility are not always obvious. In most instances, intercourse, erections and ejaculation will usually happen without difficulty.  The appearance and quantity of the ejaculated semen would also appear normal to the naked eye. Some signs of hormonal problems such as changes in hair growth or sexual function may indicate infertility.

Coping with male infertility is extremely difficult. Men often see infertility as a failure which brings about a number of negative emotions such as guilt, depression, anger, stress and frustration. Today, however there are various treatment options that can help infertile men become fathers.

Diagnosing Male Infertility
A couple who have had well-timed, unprotected intercourse for a year should consult their doctor for a fertility evaluation. In the case of men, a thorough physical examination will be performed. Certain tests such as semen testing will determine the number, movement and shape of the sperm in the ejaculate.

Blood tests will be able to check if hormone levels that control sperm production are normal or if there may be a genetic problem. In addition, urine is also tested to check for retrograde ejaculation in men who produce low volumes of ejaculate. A testicular biopsy may be performed to ascertain whether there is an obstruction in the testicular reproductive tract or a sperm production problem is present.

What Causes Male Infertility?
The most common causes of male infertility involve abnormal sperm production, the way in which sperm is delivered, lifestyle and health issues. These causes may include:

Abnormal sperm production - One of the most common causes of infertility in men is as a result of the sperm production process in testes. If the shape and structure of sperm is hampered, sperm may not be able to reach the egg.

Low sperm concentration - Low sperm concentration, known as sub-fertility, is defined as 10 million or less sperm per millilitre of semen. The count for normal sperm concentration is greater than or equal to 20 million sperm per millilitre of semen.

Blockage of sperm delivery - Obstructions that occur in the tubes leading sperm away from the testes to the penis can cause a total lack of sperm in the ejaculated semen.

Testicular Varicocele - A varicocele is a dilated or varicose vein and when it occurs in the scrotum it may prevent normal cooling of the testicle. This leads to reduced sperm count and motility

Undecided testicle or testes - Undecided testicle or testes is the term used when one or both testicles fail to descend from the abdomen into the scrotum during fatal development. Because the testicles are exposed to the higher internal body temperature, compared with the temperature in the scrotum, sperm production may be affected.

Hormonal problems - If the pituitary gland, which is situated at the base of the brain, does not send the correct signals to stimulate the testes, low testosterone levels may be caused. Because of this sperm cannot be produced.

Sexual problems - Sexual problems such as erectile dysfunction, ejaculation difficulties, low libido or lack of sex drive can prevent a couple from conceiving.

Underlying medical conditions - An existing medical condition such as thyroid disease, diabetes or Cushing’s syndrome may also affect fertility.

Genetic defects - In the genetic defect a man has two X chromosomes and one Y chromosome instead of one X and one Y. This causes abnormal development of the testicles, resulting in low or absent sperm production.

Risk factors that affect male infertility - There are several risk factors that may affect male infertility - some of which can be avoided.

Age - A man’s fertility declines as he ages. It has been estimated that the amount of semen ejaculated and sperm motility begins to slowly decrease in men or from the age of 37 years.

Tobacco smoking - Smoking tobacco is believed to affect the quality of semen. Not only does smoking pose a health risk to the smoker but a larger number of birth defects have been found in the children of men who smoke.

Alcohol - Drinking large amounts of alcohol can have negative effects on the reproductive system. It is also detrimental to your liver and general health.

Recreational drugs - Drugs such as anabolic steroids, generally used by athletes, reduce sperm production by stopping the hormones made by the pituitary gland. Other drugs such as cocaine or heroin also affect sexual performance and health.

Sexually transmitted diseases (STDs) - Sexually transmitted diseases such as gonorrhoea and genital herpes can affect sperm production and damage the important tissues, preventing sperm from passing from the testes to ejaculate. If you have an STD, seek immediate treatment from your health practitioner. Practice safe sex and make sure that you are tested for STD’s before planning a family.

Tight underwear - Research has suggested that tight underwear can decrease sperm counts. Wear loose boxer shorts to reduce the chances of heat stress on sperm production.

Hot baths, saunas and spas - Men should avoid hot baths, saunas and spas because the body temperature, especially around the testes, can reduce sperm production. Sperm require a cool environment to develop.

What are some treatment options?

Your treatment options will depend entirely on the factors causing your infertility. The good news is that few medical fields have changed as dramatically during the past decades as reproductive medicine, particularly as it pertains to men.

Today, many conditions can be corrected with drugs or surgery thus enabling conception to occur through normal intercourse.

Surgical Therapies for Male Infertility

Among the most exciting treatment developments are microsurgical approaches to repair dilated varicose scrotal veins to improve semen quality.

You should consider treatment if you meet the following criteria:

•you and your partner are trying to conceive a child, but thus far have been unsuccessful

•you have been diagnosed with a varicocele that can be felt

•your semen analysis or sperm function tests are abnormal

•your partner has normal fertility or treatable infertility

•you are contending with a varicocele and abnormal semen

•you are an adolescent male with a varicocele and reduced testicle size

•The most of treatments are available in the Gambia

For further information visit the Governments hospitals and clinics RVTH, number of NGO and private clinics, The Point Health Section, E-Mail azadehhassan@yahoo.co.uk and call Dr Azadeh on 7774469 during working days from 3-6pm.