Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. Infertility implies the failure to conceive. It is termed as :
when conception has never occured and
when the patient fails to conceive after
having a child.
How Conception Occurs?
Conception results from the fertilisation of the ovum (female gamete)
by the spermatozoa or sperm (male gamete). After ejaculation the sperms
migrate towards the fallopian tubes and fertilisation takes place in the
fallopian tubes. The usual life span of a sperm is estimated to be about
24 hours; while the life span of ovum is estimated at 12 hours. So a
coitus to be capable of fertilisation, must take place within twelve
hours of ovulation (release of ovum from the ovary). That certainly
explains why some married couples fail to conceive, though they are
potentially fertile. The intercourse should be able to coincide with the
short time after ovulation, when the ovum is viable, so that chances of
fertilisation are there. And even then there are numerous factors like
sperm motility, viability of sperms, etc. before fertilisation can
Is it Always the Females Fault if Conception is Not
This is a misconception because conception depends upon the fertility
of both the partners. Any fault in either partner can lead to
inferetility. Studies have shown that 40% of infertility is due to the
Male Infertility Causes
The commonest reason, is a low sperm count, which can be attributed to
It is when the exact cause is not known.
It is a swollen varicose vein in the scrotum, most commonly on the left side. Blood accumulated in the swollen testicular veins leads to increased temperature in the
testis & damages sperm production.
It can be diagnosed, by asking the patient to stand erect and cough. The cord like structure from which the testis hangs i.e., the spermatic cord, feels like a "bunch of worms", on palpation.
Infection like gonorrohea, TB, filariasis; on surgery for hernia/hydrocele may lead to blockage of the passage between the testes and the penis. In this case sperms
will be absent from the semen(azoospermia).
Hormonal imbalance due to pituitary or adrenal gland can lead to infertility.
Exessive intake of alcohol and/or drugs leads to decrease in liver function and
increase in levels of the hormone Estrogen which in turn suppresses sperm production.
Like twisting of testis leading to compromised blood supply; undescended testes when the testes lie in the abdomen; and damage due to exercise or heat can decrease sperm production. Testes lie outside the body in the scortum because they can produce sperms in a cooler environment. So clothes like tight jeans, nylon briefs, and hot baths/saunas, lead to damage to sperm production.
Effect of Long Term Medication
Certain drugs have an adverse effect on the sperm production. Some of these are Antihypertensives- like reserpine, methyldopa, guanethidine & propranolol, corticosteroids, anabolic steroids, antipsychotics, certain anti-cancer drugs etc.
People working with harmful chemicals like lead, nickel, mercury, anaesthetic gases, insecticides & pesticides and x-rays, are at increased risk of suffering from decreased sperm count.
Another common reason for male infertility are infections like tuberculosis, chlamydia, gonorrhoea and syphilis. Mumps can lead to complications like testicular inflammation. Infections can damage the male reproductive tract leading to duct obstruction in some cases and decreased sperm production in others.
Problems with Ejaculation in Men
Certain men have problems with ejaculation like problem having an erection (impotence) or
inadequate erection for vaginal penetration. Problems with erection can be due to psychological factors like performance anxiety, inhibitions against sex and due to physical factors like neurologic defects, diabetes, inadequate blood flow to the penis,
and also to certain hormonal problems. Another problem with ejaculation that some men face is that the semen goes backwards into the urinary bladder instead of being ejaculated
through the penis. This can occur in men who have had spinal injury or
the ones suffering from diabetes, causing improper contraction of
urinary bladder sphincter muscle.
Male Infertility Tests
Male infertility is usually known by a semen analysis. This is a simple test where the man provides his semen sample to evaluate. The lab uses this sample to measure the amount of semen and the number of sperms. The lab also evaluate sperm shape and movement. The pre-requisites for semen analysis are
» Abstinence from sex or masturbation for 4-5 days prior to the day of
» The sample given should not be more than half hour old
» It should be collected in a wide-mouthed, clean jar by masturbation.
» The sample is to be kept at room temperature.
Ideally, the test should be performed at least twice to confirm results. For ejaculation problems, certain tests like monitoring for nocturnal erections and measuring the blood flow through the penis may need to be carried out. A successful alternative that has come up is collections of sperms by masturbation which later be used for artificial insemination. Other sophisticated tests like sperm viability test, sperm penetration assay, antisperm antibodies test may be required in certain cases. Testicular function can be assessed by male hormone levels in blood of
the male, or by testicular biopsy.
Can Something be Done to Enhance Fertility: Male Infertility Treatments
With advanced medical technology, male infertility can be treated. Some male infertility causes can be treated through surgery. The other treatments may include:
» Incase of infections, treatment with antibiotics is possible.
» Surgical operations which help to remove a varicocele, reverse a vasectomy, or repair a duct obstruction
» Medications or fertility drugs to improve sperm production
» In extreme cases, when there is no success in the above treatments or the male infertility caise is untreatable or not known, IUI treatment or IVF treatment may be suggested.
Other Methods for Infertility Treatment
» Smoking & excessive alcohol intake is associated with low sperm counts. These habits should be discontinued.
» Stop using drugs such as body-building steroids & illicit drugs. Other medication such as antihypertensives should also be reviewed in the light of effect on sperm count.
» Most importantly the frequency of intercourse should be increased, so that chances of conception increase.
» Men should wear loose fitting underwear and cool clothes and avoid high temperature baths like saunas etc.
» It is advisable that when the couple is planning pregnancy, intercourse is done in a proper position and using proper technique.
» Lubricants such petroleum jelly etc. should be avoided.