Understanding male infertility

What you need to know:

  • A couple is normally declared infertile if they are not able to conceive after a year of trying for a baby.
  • In about a third of these couples, male infertility plays a role.
  • For this reason, testing for fertility in men is just as crucial as assessing it in women.

For many years, people thought that issues related to fertility were solely a ‘woman’s problem’. Although some people still hold this view, modern medicine has proven that this is not true.

Approximately 10 per cent of couples worldwide are infertile. This means they aren’t able to conceive a child even though they’ve had frequent, unprotected sexual intercourse for a year or longer.

In about a third of these couples, male infertility plays a role. For this reason, testing for fertility in men is just as crucial as assessing it in women.

Generally speaking, it is best that men get checked for infertility before their partners as the initial tests are easier and less invasive than those for women.

WHAT CAUSES MALE INFERTILITY

Sperm disorders: This is the most common cause of male infertility. A man can find himself producing sperm that is underdeveloped, abnormally shaped or unable to move properly.

Alternatively, the man may not produce any sperm at all (azoospermia) or have them in abnormally low numbers (oligospermia).

A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.

Infections: Sexually-transmitted diseases such as chlamydia and gonorrhea can cause infertility in men (especially if they are left untreated). In Kenya, tuberculosis affecting the reproductive system has also been found to hamper fertility.

Obstruction: Sometimes there is nothing wrong with the sperm but the tubes that allow for them to come out are blocked.

This can be as a result of repeated infections (especially if they are poorly treated) or previous surgery to the reproductive system. In a few cases, some men are born with these obstructions.

Genetics: One of the leading causes of early miscarriages and failure to conceive are chromosomal/genetic abnormalities. Since half of a child’s genetics come from the father, any genetic abnormalities on his part may make it difficult to get a healthy baby. (It is important to note that you can have genetic abnormalities even though you do not have any obvious physical defects/problems).

Varicoceles: These are dilated veins in the scrotum (usually can be felt on the scrotal sac and have been described as a ‘bag of worms’). In some men, these can impair sperm development.

Sexual dysfunction: Erectile dysfunction and premature ejaculation can contribute to reduced fertility in a man.

Retrograde (backwards) ejaculation Retrograde ejaculation occurs when semen pushes backwards into the bladder instead of out of the penis during sexual intercourse.

This is caused by the failure of nerves and muscles in the bladder outlet to close during orgasm.

AFFECTS DIABETIC MEN

It is a problem that can affect diabetics and men who have had previous surgery around their reproductive area. Men with this problem report passing cloudy urine after sex or ‘dry’ ejaculations during orgasm.

Hormones: A functional male reproductive system is largely dependent on hormonal control. These hormones control sperm production and sexual drive and if in low levels, can affect a man’s fertility.

Undescended testicles: Some male babies fail to have one or both testes descend into the scrotum while they are in their mother’s wombs. This can lead to fertility issues later on as testes that are lodged in other parts of the lower abdomen may not function appropriately.

For this reason, all baby boys must have their scrotums examined to make sure both testes are descended. If you find one or both are undescended, take him to a paediatric surgeon who can easily correct this problem.

Immunity issues: In certain circumstances a man’s immune system may attack his own sperm (the same way it would attack an infection). This can occur after a groin injury, surgery to that area or infection.

Illicit drugs, alcohol and smoking: Use of drugs such as marijuana, cocaine and heroin can affect fertility. Excessive use of alcohol may have indirect negative effects on your fertility. Men with fertility issues are also adviced to stop smoking before trying for a baby.

Medication: Certain medications used to treat depression, arthritis, infections, high blood pressure and cancer can affect sperm production, function and ejaculation. You should, however, never discontinue your medication without consulting your doctor.

Cancer: Cancers affecting the male reproductive organs or the brain can reduce a man’s fertility. In addition, sometimes the treatment for these cancers (radiation, chemotherapy and surgery) can also have negative effects on a man’s fertility.

Excessive exercise: Studies have shown that exercising too much may lead to the release of too many steroid hormones in the body.

This can affect fertility. Use of anabolic steroid tablets to increase muscle strength and growth can cause the testicles to shrink and sperm production to decrease.

(Anabolic steroids are sometimes used by sportsmen and weight lifters but due to their side-effects have been banned in those taking part in competitions. This has not, however, stopped them from reaching our market. Most of them are packaged as ‘natural muscle builders’ and marketed to us through the classified pages of our print media with images of extremely muscular men).

Obesity: Inasmuch as too much exercise is not healthy, obesity can also affect your fertility. Too much body fat can cause hormonal changes that reduce male fertility.

Toxins: Exposure to toxins and environmental hazards such as pesticides, radiation and heavy metals such as mercury and lead may affect fertility.