Infertility in men
Infertility is a multidimensional global health issue that affects both developed and developing countries. There are so many different factors that influence fertility: from being born with reproductive dysfunctions to modern life and social context. The diagnosis of infertility impacts patients on a psychological level likewise, increasing the risk of developing depression and anxiety.
Last week we talked about female infertility and shared stories of women struggling with it. Today we will be focusing on male infertility. What is infertility, what causes it and how can it be treated? Let’s find out!
What is infertility?
Infertility is characterized by the inability to conceive after 12 months or more of regular unprotected intercourse. Infertility can be classified as first infertility (difficulty to conceive) or second infertility (difficult to conceive the desired number of children).
Based on a study performed by the WHO (World Health Organization), female infertility is estimated to account for 37% in infertile couples, male infertility for 8%, and male and female infertility in the same couple for 35%.
Percentages and causes of infertility can differ by region and economical situation. 15% of the population in developed countries is struggling with infertility, while in developing countries the number can go as high as 30%. In developing countries, second infertility has a higher prevalence then primary infertility as a result of a high number of young pregnancies and later infections with STDs.
Infertility in men
Infertility affects 7% of all men, with the highest rate being in Africa and Eastern Europe.
The highest number of infertile individuals (where men represent 43%) occurs in an African region, known as the “African Infertility Belt” (from East to West across central Africa). In this region the spread of STDs is high as well.
15% of infertile male cases are due to genetic factors, while 50% of them do not have a known cause (idiopathic infertility). Unfortunately, male infertility is not well reported (the numbers might be higher) because of stigma and cultural preconceptions. This happens especially in Africa and the Middle East, where men are considered the dominant figures in communities and families, therefore infertility is considered as emasculating. As a consequence, infertile men do not report their condition and even blame it on their spouses.
In order to not let infertility impact the formation of a family, some cultures use various methods to increase the chance of having children. For example, in some cultures polygamy is common to overcome infertility and to increase chances of having children. In some African countries, males follow the tradition of “Chiramu”, where an infertile man can bring a male relative to impregnate his wife. Like this, the infertile man keeps his problems hidden and his status is not affected.
Difficulty in conceiving can be caused by low quality of semen, which can have one or more of the following characteristics:
Azoospermia: semen (ejaculate) without sperm cells
Aspermia: no semen (ejaculate)
Oligozoospermia: semen with low concentration of sperm cells => low sperm count
Asthenozoospermia: reduced sperm motility => sperm cells travel with low speed
Factors that affect fertility in men
Advanced paternal age is considered to be between 35 and 50 years
For men older than 45 the time to conceive is longer than for men under 45
Increasing age in male has a negative influence on the male fertility, though not as much as for women
Increasing in age is associated with decline in semen volume but not in density
With age, testicular function deteriorates
With increasing age, men can develop hormonal changes and various conditions (testicular trauma, cancer, varicocele, genital inflammation)
Smoking affects sperm production, the motility and the morphology (structure) of sperm cells
Studies show that smoking is associated with increased risk of sperm DNA damage
Maternal smoking during pregnancy (when the mother smokes while pregnant) and lactation is thought to affect the sperm of the male offspring
Paternal smoking (the male partner of the couple trying to conceive) may affect the success of IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection). If you want to learn more about the use of IVF in infertile couples, check out our last post.
Underweight has been linked with low sperm quality
Obese men are 3x more likely than normal weight men to develop low sperm count and low sperm motility
Excess of fat tissue has effects on testosterone secretion and on spermatogenesis (the process of producing sperm cells)
5. Intensive exercises
Intensive exercises decrease sex hormones levels and seminal function
Long term abuse of alcohol affects libido, hormones and sperm production in the testes (testicles)
7. Environmental pollutants
Exposure to pesticides and other chemical substances affects fertility in men, increasing the risk of oligozoospermia
8. Recreational drugs
Marijuana, cocaine, narcotics (opiates), methamphetamines and anabolic-androgenic steroids/AAS (used by athletes to increase their performance and personal appearance) influence fertility negatively, by affecting the sperm function and hormones
Marijuana is the most abused illicit drug globally and it is usually used by males. Regular intake of marijuana (more than once/week for 3 months) decreases the sperm concentration and the number of sperm cells in semen
Long term abuse of cocaine results in low sperm concentration and motility
Prolonged use of AAS results in loss of libido and erectile dysfunctions, altered spermatogenesis, testicular atrophy (damage) and infertility
9. Unhealthy diets
Processed meat, full-fat dairy products, beverages with sugar are associated with low quality of semen and lower chances of conceiving
10. Maternal caffeine consumption
Studies show that males born from women that consumed caffeine in large doses during pregnancy, show a tendency of lower levels of testosterone and volume of semen
11. Genital heat
Prolonged time of sitting, some sports like cycling and medical conditions such as varicocele and cryptorchidism increase the temperature of testicles. High temperatures around this area result in sperm DNA damage
12. Sleep disturbances
Studies suggest that patients with sleeping difficulties encounter lower levels of semen volume
13. Psychological stress
Decreases semen quality: low sperm count, low sperm motility, low percentage of normal functioning sperm
Decreases the secretion of testosterone
Infertility can increase the level of stress as well. In a study conducted on 274 men, 32% of them reported symptoms of depressions and 61% of them reported anxiety
14. Sexually transmitted diseases (STDs)
Sexually transmitted infections with Neisseria gonorrhoeae (gives Gonorrhea) produce further medical complications that can end in infertility if not treated in time
Congenital factors (born with it)
Anorchia: when a man is born without testicles.Cryptorchidism: when one or both of the testicles fail to descend from the abdomen into the scrotum (the skin that contains testicles)
Congenital absence of vas deferens: vas deferens is a muscular tube of the male reproductive system that is in charge of transporting the semen for the ejaculation to happen
Genetic abnormalities: affect the production and the quality of sperm
Acquired factors over time
Testicular torsion: when a testicle rotates and the blood supply is interrupted
Obstruction of the urogenital tract
Recurrent urogenital infections
Varicocele: abnormal dilation of the veins inside of the scrotum. 15% of male population develops it and 40% of them are infertile. This condition increases the temperature of the scrotum, affecting sperm production
Sexual dysfunctions: erectile dysfunction, ejaculatory disorders such as premature ejaculation and retrograde ejaculation (the semen enters the bladder instead of ejaculating through the penis during orgasm)
Hormonal disturbances: hypergonadotropic hypogonadism (insufficient production of testosterone)
Infertility treatments should start only after two years of unprotected intercourse. Exception: medical conditions that clearly diagnose infertility
Sexual dysfunctions: psychosexual therapy (for the individual or as a couple), medical treatment
ART (assisted reproductive technology): all methods used for conceiving, that cannot be achieved through sexual intercourse: IVF (in vitro fertilization), ICSI (intracytoplasmic sperm injection)
Drug treatment: even though many drug products have been tried in studies, there is no clear evidence that they work. When it comes to supplements, studies show that antioxidant supplementation may increase the chances of pregnancy for couples undergoing ART (assisted reproduction techniques)
Surgical treatment: for conditions such as varicocele or obstructions of the urogenital tract
Unfortunately, over 50% of cases of male infertility are of unknown cause. As infertility is a global health concern that affects the future of humankind, the need for further research is imperious.
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