Understanding Male Infertility

Infertility can be a deeply challenging and emotional experience for many couples, but it is more common than most people realize. Approximately one in six couples globally faces difficulty conceiving¹. In 40% of infertility cases, both partners may have contributing factors, while sole male factors contribute to 30% and sole female factors account for another 30%. ²

What is male infertility

Infertility refers to the inability to achieve a pregnancy after 12 months or more of consistent, unprotected intercourse. For men, common challenges include oligozoospermia, which is a low sperm count affecting about 25% of men in sub-fertile couples, and azoospermia, the complete absence of sperm, which affects approximately 10%.³ Understanding these conditions is the first step toward addressing them, offering hope and potential solutions for those navigating this sensitive and personal issue.

What causes male infertility

The major causes of male infertility can be obstruction to the passage of sperm or the inability to produce enough healthy sperm. Problems such as a low sperm count, malformed sperm, and the absence of sperm in the semen are the leading causes. Several factors can affect the quantity and quality of sperm:

• Varicocele: This condition involves dilated veins within the scrotum, which may cause discomfort or pain. Varicoceles are present in 15% of the normal male population, and found in up to 40% of patients with male infertility^{^4}. In some men, it can lead to poor development of a testicle, low sperm production, or other issues that may result in infertility. Surgery may be recommended to address these complications.
• History of Undescended Testis: Cryptorchidism, where one or both testicles fail to descend into the scrotum, commonly affects infants, especially those born prematurely. If untreated, it can increase infertility risks and typically requires surgical correction. 
• Erectile Dysfunction: This condition involves the inability to achieve or maintain an erection. It can be caused by health issues, psychological stress, or lifestyle factors. 
• Ejaculatory Disorder: This condition affects a man's ability to ejaculate properly. It can manifest as delayed ejaculation, premature ejaculation, or an inability to ejaculate.
• Genetic Disorders: Conditions such as Klinefelter’s syndrome and Y-chromosome microdeletion are associated with a low or absent sperm count.
• Infections: Previous mumps, urinary tract infections and sexually transmitted infections can interfere with the quality of sperm.
• Medications: Some drugs, especially cancer medications, can impair sperm production or even cause the complete absence of sperm production by destroying the stem cells.
•  Hormonal Imbalances: Conditions like pituitary tumours can lead to issues with sperm production and quality.
•  Antisperm Antibodies: These antibodies can damage or kill sperm.  Smoking is one of the factors that could increase antisperm antibodies.
• Previous history of scrotal or inguinal surgery: The vas deferens (tube bringing the sperm from the testicle to the prostate) may have been injured or obstructed due to the previous surgery.

How is male infertility diagnosed

If you suspect you have an infertility problem, seek medical advice. The causes of male infertility can be difficult to diagnose, and it might take several tests to determine the cause of infertility. Diagnosing male infertility typically involves a physical examination, medical history, and semen analysis. Additional tests such as hormone testing, genetic tests, and a testicular biopsy might also be recommended.

What are the treatment options

Many different treatments can help reverse male infertility. Before starting any treatments, it’s important to adopt a healthy lifestyle, which includes quitting smoking, stopping or reducing alcohol use, maintaining a healthy weight, eating well, and exercising regularly.

Depending on the cause or male infertility, medical treatments or assisted reproductive technology may include:

• Surgical treatment for conditions such as varicocele.  
• Hormone treatment.
• Treatments for erectile and ejaculation problems.
• Assisted reproductive technology such as intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF).

Facing male infertility can be overwhelming, but it’s important to remember that many couples do go on to conceive with the right diagnosis, support, and treatment. Advances in medical science, together with lifestyle changes and emotional resilience, offer a path forward. If you or your partner are struggling to conceive, don’t hesitate to seek professional guidance. Early intervention can make a significant difference, not only in improving your chances of conception but also in understanding your overall reproductive health.

1. World Health Organisation- 1 in 6 people globally affected by infertility: WHO (https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility)
2. National Library of Medicine -  Male Infertility (https://www.ncbi.nlm.nih.gov/books/NBK562258/)
3. National Library of Medicine -  Azoospermia (https://www.ncbi.nlm.nih.gov/books/NBK578191/)
4. National Library of Medicine - StatPearls (https://www.ncbi.nlm.nih.gov/books/NBK448113/)