How does male infertility contribute to conception problems?

In India, when we speak of infertility, very rarely does the conversation revolve around the topic of male infertility. According to the Indian Society of Assisted Reproduction, out of approximately 27.5 million infertile individuals in India, men make up about 40-50%.

But why does it happen, and can you do anything to prevent or treat it? Let's understand more.

Male infertility is classified into two categories:

• Primary Infertility: If a man is unsuccessful at impregnating his partner despite regular intercourse.
• Secondary Infertility: If a man faces difficulty impregnating his partner after having at least one child.

If you are unable to conceive even after frequent unprotected sexual intercourse for more than a year, you should consult a fertility specialist. While this could be a sign of male infertility, it's not irreversible. With modern science, it's still possible to conceive.

Here are some of the most common causes of infertility in men: 

• Oligospermia: A condition of low sperm count in the semen that can happen due to various lifestyle and medical factors.
• Teratozoospermia: A defect that causes 96% of the man’s sperm to be deformed or abnormally shaped. Habits like smoking, genetic issues, and alcohol or drug consumption contribute to the problem.
• Asthenospermia: It is a condition of low sperm motility. Infections, genetic defects, and anti-sperm antibodies may delay the sperm from travelling to and fertilising the egg in this condition.
• Varicoceles: A condition similar to varicose veins, varicoceles occur when veins in the scrotum are enlarged. It causes an increase in scrotal temperature, which impacts sperm production.
• Hormonal Imbalance: Hormones are vital for the proper functioning of the male reproductive system. Inadequate production of hormones such as testosterone or gonadotropins can lead to infertility.
• Infections: Cases of prostate or testicular inflammation due to infections can result in low-quality sperm production.
• Ejaculation Issues: Retrograde ejaculation can cause the sperm to enter the bladder instead of the penis. Without any sperm entering the vagina of a woman, conception is not possible.
• Lifestyle: Apart from a poor diet, habits like smoking and drinking can reduce sperm quality. It is especially seen in older men, where age plays a contributing factor in infertility. 

A sign of infertility in men, low sperm quality and production, has increased alarmingly in the last 40 years. One in 20 men faces issues of reduced fertility, increasing the percentage of assisted reproductive technologies (ART) to 10% yearly. Every one out of three IVF cycles is due to male infertility issues. 

Other contributing factors like obesity and delayed parenthood lead to hormonal imbalances like low testosterone, ultimately causing male infertility.

Male infertility goes beyond sperm production and quality and may be the result of structural abnormalities and blockages as well. Some causes include:

• Genetic and birth defects: These account for almost 20% of infertility cases in men. It can be an infection or inflammation from a sexually transmitted disease that blocks the flow of semen. Swollen veins in the scrotum or previous surgery can cause structural abnormalities.
• Sperm morphology: This is a condition where the shape and structure of the sperm impact its ability to fertilise an egg. For instance, a healthy head of the sperm contains genetic material and DNA. In Globozoospermia (round-headed sperm) or Microcephaly (small-headed), the sperm cannot help the egg fertilise.
• Chromosomal defects: Disorders like Klinefelter syndrome, where the man has an extra X chromosome (XXY), cause infertility due to testicular failure. These defects can also cause cystic fibrosis, a condition that blocks tubes, leading to low or absent sperm production. 

Another common cause of male infertility is hormonal imbalance, which can affect your libido, erections, and sperm quality. 

• Low testosterone: A failure of your gonads to produce adequate testosterone leads to testosterone deficiency, which is called hypogonadism. This impacts sperm production.
• High testosterone: Hypergonadism occurs when the gonads are hyperfunctioning, leading to abnormally high testosterone levels. It affects sperm quality and production.

Imbalances affect glands like the pituitary gland, prostate, hypothalamus, thyroid, and testicles, making your infertility journey feel like a roller-coaster of emotions. However, remember that male infertility is not the end of your parenthood journey but a roadblock. 

Today, lifestyle choices like smoking, drinking, and late-night shifts lead to serious health problems and negatively affect sperm quality. 

• Junk food: Processed food is low in nutrients, leading to obesity at a younger age and affecting sperm quality and production.
• Sedentary Lifestyle: Lack of physical activity leads to weight gain, poor circulation, and hormonal disturbances, which can reduce sperm count and motility.
• Stress: Stress and obesity trigger high oxidative stress (cortisol) levels, damaging sperm production and motility.
• Chemical stressors: Sometimes, factors like the environment you live in also affect fertility. Chemicals like Bisphenol A and Phthalates found in plastics, pesticides, and air affect sperm quality and count.
• Water pollutants: Heavy toxic metals like lead and mercury are now more commonly found in water and soil. These significantly affect male fertility, sperm DNA, and quality. 
   

Finding out you are infertile is disheartening for men and women alike. However, it is also important to understand male infertility does not label your masculinity. If you are facing any of the below symptoms, there are effective treatments to help:

• Low Libido: Reduced libido or sex drive is a sign of hormonal imbalance and infertility in men.
• Scrotum Pain: Any pain or discomfort in the scrotum or even testicles can be due to an infection. If left untreated, it can lead to infertility.
• Ejaculation Issues: Conditions like premature or retrograde ejaculation are a sign of male infertility.
• Erectile Dysfunction: A condition where getting an erection is difficult, also known as impotence, is one of the most obvious signs of infertility in men

If you have been trying to impregnate your partner for over a year unsuccessfully, here are some medical tests you can consider. 

• Semen analysis: Helps you understand the count, abnormalities, mortality, and liquefaction time.
• Sperm DNA Fragmentation Index (DFI): It helps identify genetic issues and DNA damage in the sperm.
• Post-ejaculation urinalysis (PEU): Helps understand the condition of retrograde ejaculation. It also helps determine the cause behind the backflow of the sperm to the bladder using the semen present in the urine.
• Physical examination: A genital examination can help see exterior damage or inflammation of the scrotum or testicles.
• Medical checkup: A thorough checkup using your medical history can shed light on any surgeries or health issues causing symptoms of infertility. 

Additional tests include: 

• Scrotal ultrasound to help identify issues like varicocele and blockages.
• Hormonal testing of glands to check for sperm production, sexual development, and fertility.
• A testicular biopsy identifies the causes of low sperm motility and production.

If you are suffering from male infertility issues, know that there are options. It can seem like there is no hope, but all you need is to get an expert opinion about your infertility to find the right course of action. 

• Lifestyle Changes: Sometimes, the simple act of changing your habits can reverse infertility issues. These include a healthy diet, quitting smoking, exercising regularly, and managing stress.
• Medication: Using doctor-prescribed medications can help improve your chances of fertility. If you have a hormone imbalance affecting sperm quality, Tricyclic antidepressants, calcium channel blockers, and anti-androgens are administered. Other hormone therapies are also recommended depending on the cause of infertility.
• Surgery: Often, minimally invasive surgeries can treat a variety of male infertility issues. It is the first line of treatment for signs like reproductive tract blockages and varicoceles.
• Sperm Donor: In extreme cases of male infertility, using a donor sperm is also advised. It is prevalent and legal in India. 

• In vitro fertilisation (IVF) helps you realise your dream of having a child. Your partner will be injected with fertility medication to increase the chances of multiple egg maturities. Once ready, the eggs are collected and fertilised with sperm in a lab. After successful fertilisation, the embryo is placed within your partner’s uterus.
• Intracytoplasmic sperm injection (ICSI) involves physically injecting sperm into a mature egg to help speed up the fertilisation process.
• Microsurgical testicular sperm extraction (TESE) increases the chances of successful sperm release if there is an ejaculation disorder. 

Dealing with male infertility is a challenging task for couples who are trying to conceive. However you decide to deal with it, it is necessary to remember you are not alone. If you observe the symptoms mentioned above or have difficulty conceiving a child, speak to your doctor. There are plenty of male infertility treatment options that have shown positive outcomes in the past.