Infertility affects nearly 15% of couples worldwide, with male infertility contributing to approximately 50% of cases. Despite its high prevalence, male infertility remains a lesser-discussed topic compared to female infertility. Understanding the causes, diagnostic approaches, and available treatment options is crucial for better reproductive health outcomes.
Causes of Male Infertility
Male infertility can be caused by a variety of factors, which can be broadly categorized into pre-testicular, testicular, and post-testicular causes.
1. Pre-Testicular Causes
These are conditions that affect sperm production due to hormonal or systemic issues:
• Hypogonadotropic hypogonadism – Low gonadotropins (FSH & LH) leading to reduced testosterone production.
• Obesity – Disrupts hormonal balance, leading to reduced sperm production.
• Chronic illnesses – Diabetes, liver, and kidney diseases impact sperm production and function.
• Medication & drug use – Anabolic steroids, chemotherapy, and certain antibiotics can reduce sperm count.
2. Testicular Causes
Conditions affecting the testes directly result in impaired sperm production or function:
• Varicocele – Enlarged testicular veins leading to increased scrotal temperature, reducing sperm quality.
• Genetic disorders – Klinefelter syndrome, Y-chromosome microdeletions affect spermatogenesis.
• Infections – Orchitis (e.g., mumps), sexually transmitted infections (STIs) can damage testicular tissue.
• Testicular trauma or surgery – Injury to the testes can impact sperm production.
3. Post-Testicular Causes
These conditions affect sperm transport and delivery:
• Obstructive azoospermia – Blockage in the vas deferens or epididymis, often due to infections or congenital absence of vas deferens (seen in cystic fibrosis).
• Retrograde ejaculation – Semen enters the bladder instead of being expelled.
• Ejaculatory dysfunction – Caused by neurological disorders, prostate surgery, or spinal cord injuries.
Diagnosis of Male Infertility
A thorough evaluation includes:
1. Medical & Sexual History – Past illnesses, surgeries, medication use, and sexual health are assessed.
2. Physical Examination – Testicular size, varicocele, and any structural abnormalities are checked.
3. Semen Analysis – Key parameters assessed:
o Sperm count (>15 million/ml is normal)
o Motility (>42% motile sperm is normal)
o Morphology (>4% normal forms are ideal)
4. Hormonal Profile – FSH, LH, testosterone, prolactin levels help assess endocrine function.
5. Genetic Testing – Karyotyping, Y-chromosome microdeletion testing in severe cases.
6. Scrotal Ultrasound – Detects varicocele, testicular abnormalities.
7. Post-Ejaculatory Urinalysis – Checks for retrograde ejaculation.
Treatment Options
Treatment depends on the underlying cause and may include medical, surgical, or assisted reproductive techniques.
1. Medical Treatment
• Hormonal Therapy – Used in hypogonadotropic hypogonadism.
• Antioxidants – Vitamin C, E, Coenzyme Q10 improve sperm quality.
• Antibiotics – Treat infections affecting sperm health.
2. Surgical Treatment
• Varicocele Repair – Microsurgical varicocelectomy improves sperm parameters.
• Vasectomy Reversal – Restores sperm flow in men with a history of vasectomy.
• Sperm Retrieval Techniques – TESE (Testicular Sperm Extraction) and PESA (Percutaneous Epididymal Sperm Aspiration) for azoospermia cases.
3. Assisted Reproductive Technologies (ART)
• Intrauterine Insemination (IUI) – Used in mild male factor infertility.
• In Vitro Fertilization (IVF) – Fertilization occurs in a lab with sperm injection into the egg.
• Intracytoplasmic Sperm Injection (ICSI) – Direct injection of a single sperm into an egg, used in severe male infertility cases.
• Sperm Donation – For non-retrievable sperm cases.
Lifestyle and Preventive Measures
• Maintain a Healthy Weight – Obesity impairs sperm production.
• Avoid Smoking and Alcohol – Reduces oxidative stress on sperm.
• Limit Exposure to Environmental Toxins – Pesticides, radiation, and heavy metals impact fertility.
• Manage Stress – Psychological stress affects hormonal balance.
• Regular Exercise – Improves testosterone levels and sperm motility.
Conclusion
Male infertility is a significant contributor to reproductive challenges but can be effectively managed with proper diagnosis and treatment. Advances in ART, genetic testing, and hormonal therapies have improved fertility outcomes for men. Early intervention, lifestyle modifications, and medical advancements can help many couples achieve parenthood successfully. If you or someone you know is facing infertility issues, seeking a specialist’s advice is the first step toward a solution.
Author : Dr.Chandana
