Shying away from a routine fertility evaluation is something to avoid. Like many inherited conditions, infertility is in most cases beyond the control of the individual.
For couples trying to conceive and seeing no success after at least a year of unprotected sexual intercourse, evaluating their fertility and scope for pregnancy can help to understand what is causing the delay. These days we need not make assumptions as to who is infertile and whether there is hope at all for a couple to conceive. The best fertility clinic comes equipped with state-of-the-art lab facilities that can test for male and female fertility issues immediately.
For young couples, where the woman is in her early to mid-20s, there is no clock ticking and they can continue to try to conceive without medical intervention if neither of them is infertile. However, for women in their late 20s and early 30s, it is best to talk to the doctor and find out what options are available. This age-factor impacts the health and stability of the female reproductive system and is hence a point to consider for couples interested in having a child. While it might seem like the onus is on the woman, in reality male infertility like low sperm count is also a cause for delayed pregnancy, which brings us back to where we started: evaluating the fertility of the couple.
HOW IS MALE FERTILITY TESTED?
Fertility evaluation started with detailed history taking and a simple physical examination. The physical examination might reveal varicoceles which is an abnormal growth of veins above the testicles – this can be corrected by surgery and it could end infertility issues. Other visible abnormal growths or physical anomalies may also be revealed in a physical exam. The medical history helps the doctor understand what past medical conditions and surgeries you have been through that might be affecting your sperm quality or count. Other tests that delve into the specifics are:
A semen sample is taken, and a fertility expert analyses the sperm in terms of shape, quantity, and motility. If the sample has a higher amount of normal shaped and active sperm, then the person does not have any significant fertility issues. Of course, there might be other issues to consider. If the test shows any abnormalities, then the doctor will prescribe other tests to zero in on the issue. A lower sperm counts, or slower moving sperms are also bound to reduce chances for conception. A complete lack of semen is definitely a red flag that might be caused by a blockage in the reproductive system or in rare cases it could be due to an absent vas deferens, which is a genetic problem.
This is an imaging test that helps identify a varicocele or other structural problems in the testicles.
A tissue sample from the testicles is taken for testing. If this comes back normal, then the problem is most likely some sort of obstruction during sperm transport.
This imaging test is performed to check the prostate for blockages of the tubes that carry semen.
This involves a blood test that measures the level of testosterone and other hormones that impact sexual development and sperm production.
This is done to check is there is sperm in the urine which is indicative of retrograde ejaculation – where the sperm is being ejaculated into the bladder.
While the jury is still out on when genetic testing is required, especially in the case of low sperm count and in absence of sperm, it would help understand the cause for infertility.
WHAT ARE THE CAUSE FOR MALE INFERTILITY?
This could refer to a sperm count of less than 15 million sperm per millilitre of semen or to abnormal movement that slows down their progress to the egg.
In rare conditions it has been found that some men produce antibodies that obstruct and attack the sperm as they move towards the egg. This is definitely going to cause problems in getting their partner pregnant.
In this condition the semen ejaculates backwards and into the bladder. This could be a genetic issue or the result of a surgery.
A varicocele is a swelling of the veins above the testicle, and this leads to lower sperm count and poor-quality sperms. It is one of the most common causes for male infertility and it can be treated.
Inflammation in the testicles and some sexually transmitted infections (gonorrhoea or HIV) can reduce sperm production.
Tumours can impact the male reproductive organs. Treating the tumours through surgery, radiation or chemotherapy can affect quantity and quality of sperms.
This is a congenital condition in some men were at the time of foetal development one or both testicles fail to descend from the abdomen into the scrotum. While the condition can be treated, having had it decreases fertility.
Klinefelter’s syndrome causes abnormal development of the male reproductive organs because he is born with two X chromosomes and one Y chromosome instead of one each. Kallmann’s syndrome results from a lack of production of certain hormones that direct sexual development which delays puberty and consequently impacts fertility. Cystic fibrosis in men causes the vas deferens to atrophy in its very early stage of development – which means men with this disorder are born without the vas deferens which is essentially the tube that transports the sperm to the urethra.
These can include: erectile dysfunction, premature ejaculation, painful intercourse, anatomical abnormalities or even psychological problems that interfere with sex-drive.
Medications taken for other chronic conditions or even for cosmetic benefits can impact male fertility. Testosterone replacement therapy, certain steroids, chemotherapy, radiotherapy, some ulcer drugs, and some arthritis drugs impair sperm production.
The testicles that contain the sperms, maintain a certain temperature that helps the production of healthy sperm. Elevated temperatures are believed to affect sperm production and function. Avoiding tight clothes, spending lesser time in hot environments, and reducing visits to the sauna can help.
All of these habits can decrease sperm count and reduce fertility.
From impacting the health and production of the sperm, obesity can also cause hormonal changes that reduce male fertility.
The cause for male fertility can be any of the above reasons. In order to treat infertility issues, it is important to find out where the problem lies and if it is rectifiable. Given that modern medicine offers treatment for infertility increasing the possibility for conceiving a child, shying away from a routine fertility evaluation is something we must learn to avoid. Like many inherited conditions, infertility is in most cases beyond the control of the individual. And when infertility is induced by poor lifestyle habits and environmental causes, it can be reversed. Start with a consultation at a fertility hospital and take it one step at a time.
CONSULTANT – FERTILITY SPECIALIST
MS(OG),Fellowship in Andrology & Reproductive Medicine