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

Lifestyle factors

1. Age

  • 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