Demystifying male+ infertility: learn the causes and treatment options

Male+ infertility is often an overlooked aspect of family planning, with many causes and consequences, all involving a small cell… To understand male+ fertility issues, it’s first worth learning how sperm gets made and where it travels to meet its final destination – a female+ egg.

The sperm’s journey

The male+ reproductive system is an intricate assembly line, where sperm is created, nurtured, mixed with nourishing fluids and then propelled out during ejaculation. The process is controlled and managed by several hormones, primarily follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. ¹

The entire process starts in the testes, two oval-shaped organs, safely nested inside the scrotum, which holds and protects the pair. Testes are responsible for producing sperm as well as testosterone. After sperm is made, it then moves into the epididymis, a coiled tube behind each testicle where it fully matures. It typically takes more than 70 days for the body to create new sperm. ^2 3

When ejaculation occurs, sperm leaves the epididymis and enters another set of tubes called vas deferens, which transport sperm towards the urethra. Along this journey, it mixes with seminal fluid from the seminal vesicles, prostate gland and bulbourethral glands, located under the prostate. This cocktail, a couple of percent sperm and the rest fluids, forms what we know as semen. The fluid nourishes the sperm and provides the space for them to swim. It also contains a clearer secretion, which helps to lubricate the urethra and neutralise any acidity from the vagina that might damage sperm. ^4 5

During intercourse, sperm travels through the cervix into the uterus and fallopian tubes. There, the sperm cosies up, surviving for up to five days. ⁶ If the timing is right and the sperm and an egg meet in the fallopian tubes, the rendezvous can lead to fertilization and eventually conception.

But the reproductive dance is a delicate interplay and sometimes things don’t fall into place as they ought to. Genetics, hormone levels and exposure to environmental conditions can all affect male+ fertility.

What causes male+ infertility

Natural male+ reproduction depends on two key factors – healthy sperm and having an erection with the ability to ejaculate. Issues can emerge anywhere in the process.

Problems with making healthy sperm are one of the most common reasons for male+ infertility. Some men+ may face infertility issues because they don’t produce enough sperm or no sperm at all.

Low sperm count can be caused by sperm obstruction which occurs when there’s a blockage in the tubes that carry sperm from the testes to the urethra. Some men+ are born without the vas deferens tube, others may experience obstruction because of infection, injury or past surgeries in the pelvic area. ^7 8 In any case, the sperm can’t make its way into the semen, leading to male+ infertility.

Sperm obstruction is quite common and is responsible for around one in three cases of male+ infertility. ⁹ However, signs may not be obvious until partners struggle to conceive. ¹⁰

Other causes of male+ infertility involve an underdeveloped sperm that may be immature or unable to swim. This means the sperm can’t reach its destination even if there’s enough of the material. Sometimes, an abnormal sperm’s shape such as a misshapen head or double tail will make it hard for the little fella to swim around. ¹¹

Meanwhile, retrograde ejaculation is a condition that affects the way semen moves during ejaculation. Instead of being propelled forward out of the penis, it goes back into the bladder. Hence the name ‘retrograde’, meaning reversed. Retrograde ejaculation is not harmful or painful, but can lead to male+ infertility since sperm doesn’t end up where it needs to be for natural conception.

Although less frequently, varicoceles can also lead to fertility problems. The condition is characterised by enlarged, swollen veins in the scrotum. The exact reason varicoceles form is not entirely understood, but they tend to develop slowly and are most common in young men+. Most varicoceles are harmless and often don’t require treatment, but one of their side effects is that they increase temperature which affects sperm production.

In addition, genital exposure to high temperatures, such as in hot tubs or saunas, is another risk factor, as well as some prescription medicines. These include medicines for ulcers, psoriasis, depression and high blood pressure.

What are the signs of male+ infertility

The main sign of male+ infertility is the inability to conceive. Sometimes, there are no other symptoms; however, male+ infertility may come with ejaculation issues, reduced sexual desire or difficulties maintaining an erection. In certain cases, men+ may also feel pain, swelling or a lump in the testicle area. If the underlying reason is chromosomal or hormonal in nature, some may also notice abnormal breast growth or decreased body hair. ^12 13

Diagnosing male+ infertility

When trying to determine male+ infertility, doctors will start the diagnosis with a conversation about any past illnesses and sexual development during puberty, followed by a physical examination of the genitals. The process is then followed by semen analysis which examines a sample for sperm count, shape and movement. Typically, at least two semen samples are taken on separate days.

Further testing may include hormone and genetic testing and an ultrasound. Blood tests are used to check hormone levels and rule out other problems. When a blockage is suspected, the doctor performs a testicular biopsy to check sperm production.

What can you do to combat male+ infertility

Treatment of male+ infertility depends on the underlying causes. For example, if the culprit is a low testosterone level, medicines might be prescribed to correct imbalances.

On the other hand, surgery can be an effective treatment in cases of physical issues like blocked sperm ducts or varicoceles. A procedure called varicocelectomy, for example, is used to remove enlarged veins in the scrotum that might be causing a low sperm count.

In cases where blockage can’t be surgically treated, sperm can be retrieved directly from the testes for use in assisted reproductive techniques (ART). For example, extracted sperm can be injected directly into an egg to facilitate fertilization.

Finally, in overcoming male+ infertility, lifestyle changes shouldn’t be underestimated. Research shows that cutting down on alcohol, quitting smoking, eating a healthy diet and exercising regularly can improve men’s+ chances to become fathers. Read more about these lifestyle changes in our recent article, where you can also learn what other environmental factors are contributing to a decline in male+ fertility.

When to see a doctor

Generally, if you and your partner have been trying to conceive for a year or more without success, it’s a good time to seek medical advice. This timeframe is typically used as a guideline because around 85 percent of couples will conceive within a year of regular unprotected sex. ¹⁴

If you’re over the age of 35, you might want to check in with your doctor even sooner, perhaps after six months of trying, just because fertility potential tends to decrease with age.

Also, if you’re experiencing symptoms like difficulty with ejaculation, reduced sexual desire or discomfort in the testicle area, it’s worth setting up a doctor’s appointment. These symptoms could be indicators of potential fertility issues. ¹⁵

REFERENCES

1. https://my.clevelandclinic.org/health/articles/9117-male-reproductive-system
2. https://www.medicalnewstoday.com/articles/325906#_noHeaderPrefixedContent
3. https://www.hopkinsmedicine.org/health/wellness-and-prevention/overview-of-the-male-anatomy
4. https://www2.nau.edu/gaud/bio301/content/spmtz.htm
5. https://www.sciencedirect.com/topics/medicine-and-dentistry/bulbourethral-gland
6. https://crh.ucsf.edu/about-fertility/conception
7. https://pubmed.ncbi.nlm.nih.gov/15367371/
8. https://www.hopkinsmedicine.org/health/conditions-and-diseases/male-infertility
9. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/infertility-in-men
10. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/infertility-in-men
11. https://www.mayoclinic.org/diseases-conditions/male-infertility/expert-answers/sperm-morphology/faq-20057760
12. https://www.ncbi.nlm.nih.gov/books/NBK562258/
13. https://www.yalemedicine.org/conditions/male-infertility
14. https://www.nhs.uk/conditions/infertility/
15. https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773

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