Male infertility

Infertility is defined as the inability to conceive a child despite trying for a year or more, and affects 10 to 15% of the adult reproductive population.

Infertility differs from sterility. Being sterile means you're unable to conceive a child. With sterility, you or your partner has a physical problem that precludes the ability to conceive. A diagnosis of infertility simply means that becoming pregnant may be a challenge rather than an impossibility.
 
To become pregnant, a couple must have intercourse during the woman's fertile time of the month, which is right before and during ovulation. Because its tough to pinpoint the exact day of ovulation, having intercourse often during the approximate time maximises the chances of conception.
 
Whilst age can be a significant factor for women, a man's age affects fertility to a much lesser degree and 20 or 30 years later than in a woman. Even though there is a decrease in sperm production after age 25, some men remain fertile into their 70’s.
 
Fertility problems are a major psychological stressor within a relationship, and it is best to see a medical practitioner a year or so after unsuccessfully trying to become pregnant. About 50% of couples that seek fertility treatment will be able to have a child.
 

The Man or the Woman?

For a woman to become pregnant, her partner's sperm must be healthy so that at least one can swim into her fallopian tubes. An egg, released by the woman's ovaries, must be in the fallopian tube ready to be fertilized. Next, the fertilized egg, called an embryo, must make its way through an open-ended fallopian tube into the uterus, implant in the uterine lining, and be sustained there while it grows.
 
It is a myth that infertility is always a "woman's problem." Half of all cases are based, at least partially, on male factors.
 

What Causes Male Infertility?

A number of causes exist for male infertility that may result in impaired sperm count or mobility, or impaired ability to fertilize the egg. The most common causes of male infertility include abnormal sperm production or function, impaired delivery of sperm, conditions related to a man's general health and lifestyle, and overexposure to certain environmental elements.
 
Male factors include:
  • No sperm are produced (azoospermia)
  • Too few sperm are produced (oligospermia)
Also lifestyle  factors can influence the number and quality of a man's sperm:
  • Alcohol
  • Smoking (nicotine)
  • Drugs such as marijuana (dagga), and certain medications
  • Environmental toxins such as pesticides and lead
  • Tight-fitting underwear and hot baths and saunas are not recommended. This is because it may raise testicular temperature and interfere with sperm production
A sperm production problem can exist from birth or develop later as consequence of medical illnesses like:
  • Mumps
  • Sexually transmitted diseases
  • Injury to the testis
  • Testicular tumours
If a man cannot maintain an erection or ejaculate normally, infertility problems are likely. Causes of such erectile dysfunction include:
  • Diabetes
  • Prostate surgery
  • High blood pressure

The Medical Evaluation

For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman's vagina. A medical evaluation is necessary to determine the cause of a couples infertility. Initially a medical and sexual history is taken and, if no obvious problem is revealed, tests may be needed. The process involves:
  1. A general physical examination: this includes examination of your genitals and questions concerning your medical history, illnesses and disabilities, medications and sexual habits.
  2. Semen analysis: your doctor may ask for a specimen of ejaculated semen. This is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. Your doctor will provide instructions. Such a specimen may be required more than once. A laboratory analyzes your semen specimen for quantity, color and presence of infections or blood. Detailed analysis of the sperm also is done. The laboratory will determine the number of sperm present and any abnormalities in the shape and movement (motility) of the sperm. Often sperm counts fluctuate from one specimen to the next. Further tests may be needed to look for infection, hormonal imbalance, or other problems.
  3. Hormone testing: a blood test to determine the level of testosterone and other male hormones is common.

Treatment options for infertility

Depending on the results of the examination and laboratory tests, different treatments may be recommended. Eighty to 90 percent of infertility cases are treated with fertility drugs or surgery. In the man, one infertility problem often treated surgically is damage to the vas deferens (the tube that carries sperm from the testis), commonly caused by a sexually transmitted disease, other infection, or vasectomy (male sterilization). Other important tools in the battle against infertility include artificial insemination (AI) and other assisted reproductive technologies (ART).
 

Artificial insemination (AI)

In some cases, a woman may not be able to become pregnant with her partner because his sexual problems make it impossible for him to ejaculate normally during sex, or because the vaginal environment cannot support sperm, or for other reasons. In these cases, through artificial insemination, the semen is placed into the womans uterus or vaginal canal using a hollow, flexible tube called a catheter.
 

Assisted reproductive technology (ART)

ART has revolutionized the treatment of infertility.  ART procedures, which include in vitro fertilization (IVF), have been available for nearly twenty years since the birth of Louise Brown, the world's first "test tube baby." Medical advances have enabled many couples to have their own biological child. An ART health team includes physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.
The most common forms of ART include:
  • In vitro fertilization (IVF): this is the most effective ART technique. IVF involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization. IVF often is recommended as a first-line therapy and is the treatment of choice if both fallopian tubes are blocked. It's also widely used for a number of other conditions, such as endometriosis, unexplained infertility, cervical factor infertility, male factor infertility and ovulation disorders.
  • Electroejaculation: electric stimulus brings about ejaculation to obtain semen. This procedure can be used in men with a spinal cord injury who can't otherwise achieve ejaculation.
  • Surgical sperm aspiration: this technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if blockage is present.
  • Intracytoplasmic sperm injection (ICSI): this technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure. ICSI has been especially helpful in couples who have previously failed to achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically improves the likelihood of fertilization.
  • Assisted hatching: this technique attempts to assist the implantation of the embryo into the lining of the uterus.
ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or uses donor eggs. The man should have healthy sperm, or donor sperm should be available. The success rate of ART gradually diminishes after age 32.
 
In conclusion, few couples become pregnant at the first attempt. If after a year you’ve had no success, consult your doctor. If an underlying cause is found, with modern medical advances most couples can still have a baby one way, or the other.