It is estimated that approximately 1 in 6 couples worldwide are faced with infertility. While female factors are considered to be mainly responsible, the truth is that in over 50% of cases, male infertility is a contributing factor and in 25% of cases it is the sole associated factor. In view of the above we shall explain below many aspects of male infertility and offer advice to men wishing to start a family.
WHEN SHOULD I GET WORRIED?
A common phenomenon amongst couples trying to conceive is that they are quick to panic when they are having difficulties. Most fertile couples conceive on average within 4 months of trying (frequent intercourse during the woman’s fertile window), with longer time required in a significant number of cases. However, after 12 months of natural conception efforts, there should be a clinical suspicion of infertility, associated with female factor, male factor or both. For a more general guide to infertility and available courses of action, as well as advice, kindly also look into our article: “DIFFICULTY GETTING PREGNANT: WHY, WHAT TO DO AND WHEN TO SEEK FERTILITY CARE”.
WHAT CAUSES MALE INFERTILITY?
Multiple factors may be associated with male infertility such as:
Medical factors: a number of medical conditions and treatments for certain conditions may impact male fertility such as:
Varicocoele: an abnormal swelling of testicular veins, a common and potentially treatable condition.
Metabolic disorders eg Diabetes, obesity.
Anatomical anomalies:
obstruction of sperm flow (at any level, from the testis to the urethra).
Undescended testicles.
Small transport tubule defects (associated with injury, inflammation etc).
Infections: infection of any of the male reproductive organs (epididymitis, orchitis etc), Sexually Transmitted Infections (HIV, gonorrhoea, chlamydia etc) and SARS CoV 2 (COVID-19) infection.
Sexual intercourse issues:
Retrograde ejaculation
Erectile dysfunction
Premature ejaculation
Painful intercourse
Psychosexual disorders
Immunological disorders, such as anti-sperm antibodies, coeliac disease etc.
Hormonal disorders: such as decreased Testosterone, endocrine organ dysfunction, such as hypothalamus, pituitary, adrenal and/or thyroid gland dysfunctions.
Genetic abnormalities: Klinefelter’s Syndrome, Kallmann’s Syndrome, Cystic Fibrosis, Chromosomal anomalies etc may negatively affect male fertility.
Tumours, either of the male reproductive system or male fertility associated organs eg hypothalamus, pituitary, adrenal and/or thyroid gland.
Medications: chemotherapy, testosterone replacement therapy, anabolic steroids, certain drugs eg arthritis drugs may impair male fertility.
History of pelvic surgery (eg testicular surgery, prostatectomy) and major abdominal surgery.
Environmental factors
Exposure to chemicals (eg herbicides, benzole-based solvents, paints).
Exposure to heavy metals (eg lead).
Exposure to radiation and/or radiotherapy.
Increased testicular temperature and/or pressure (sitting for long periods, tight clothes etc) may affect male fertility.
In most cases, the only warning sign is infertility itself. However, depending on the underlying cause, there may be warning signs, which combined with the difficulty to conceive, should raise awareness:
Sexual intercourse disorders, such as ejaculation difficulties, small sperm ejaculate volume, reduced libido and/or erectile dysfunction.
Pain, swelling and/or a palpable lump in the testicular area.
Recurrent respiratory infections (possibly associated with cystic fibrosis).
Anosmia (inability to smell).
Gynaecomastia (breast growth).
Decreased facial and/or body hair.
HOW IS MALE INFERTILITY DIAGNOSED?
Diagnosis of male infertility is performed via semen analysis, a test during which multiple sperm parameters may be assessed such as:
Parameter
Normal value
Volume
> 1.5 ml
pH
>7.2
Total sperm number
> 39 million sperm per ejaculate >15 million sperm per ml
Morphology
>4% normal forms (Tygerberg method)
Vitality
> 58% live sperm
Motility
>40%
Sperm agglutination
none
An abnormal semen analysis confirms the diagnosis of male factor infertility in most cases. Additional tests, such as semen culture, DNA Fragmentation Index (DFI) calculation, sample oxidative stress (assessment with MiOXSYS®), genetic testing eg peripheral blood karyotype, cystic fibrosis mutation testing, Y chromosome microdeletion testing, ultrasound, post-ejaculation urinalysis and/or testicular biopsy may be performed on individual cases.
ARE THERE ANY TIPS TO IMPROVE SPERM QUALITY?
In most cases, dietary supplementation, lifestyle changes, awareness of environmental hazards and improved mental health may enhance male fertility. Namely, beneficial changes may include:
Smoking cessation.
Reducing / ceasing alcohol intake.
Maintenance of a normal weight (BMI: 18.5-25).
Avoidance of having a vasectomy, prefer alternative contraception strategies.
Avoid exposure to environmental health hazards (radiation, industrial chemicals, heavy metals etc).
Psychological stress reduction.
Acupuncture: stress reduction and sperm quality improvement.
Exercise.
Avoidance of substance abuse.
Balanced diet and dietary supplements, most importantly:
Vitamin C
Vitamin E
Selenium
Zinc
Folic acid
Avoidance of continuous sitting at work and cycling.
WHAT IF I STILL HAVE ISSUES?
Some cases can be resolved with such measures alone. However, there are many methods that facilitate selection of the healthiest sperms and increase your chances during Assisted Reproduction Techniques (ART), such as sperm centrifugation and the more advanced sperm separation technique (Zymōt). It is important to remember that >10% of males who wish to father children are facing difficulties, you are not alone in your struggle. Thanks to modern Fertility Medicine, >90% of males with infertility manage to produce offspring of their own genetic material.
Semen analysis constitutes the first examination in assessing male fertility. The sample should be collected after a minimum of 2 days and a maximum of 5 days of sexual abstinence. The whole sample should be collected in a clean, wide-mouthed container, in a private room near the laboratory. The sample may be collected at home under exceptional circumstances, must be delivered to the laboratory within 1 hour, and maintained at body temperature during transfer.
Semen analysis includes macroscopic and microscopic analysis of the sample by recording the following parameters:
The volume of the sample,
The pH of the sample,
The number of spermatozoa in the sample (semen concentration),
The movement of the cells (sperm motility),
The morphology of the cells and
The presence of other round cells in the sample
The test results will be ready within one day. A normal result indicates that there is a sufficient number of spermatozoa with good motility enabling it to travel towards an egg and normal morphology to fertilize it. Nevertheless, a normal result does not guarantee fertility. Moreover, variance from the reference values does not necessarily indicate infertility. It is worth mentioning that the volume and quality of sperm is not always the same with each ejaculation.
Semen analysis is performed in accordance with internationally accepted principles of the World Health Organization (World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen, in 5th ed. 2010.).
Finally, the treating physician should be informed regarding medications, illness, etc, as it may have negative effects on semen quality.
For further information or if you wish to arrange an appointment you can contact us to +30 2310-420020 or via e-mail at info@embryoclinic.eu.
A common phenomenon amongst couples trying to conceive is that they are quick to panic when they are having difficulties. Most fertile couples conceive on average within 4 months of trying (frequent intercourse during the woman’s fertile window), with longer time required in a significant number of cases. However, after 12 months of natural conception efforts, there should be a clinical suspicion of infertility, associated with female factor, male factor or both. For a more general guide to infertility and available courses of action, as well as advice, kindly also look into our article: “DIFFICULTY GETTING PREGNANT: WHY, WHAT TO DO AND WHEN TO SEEK FERTILITY CARE”.