Male Infertility
- eleniana6
- Oct 24, 2023
- 0 min read
What is male infertility? What is the scale of the issue?
The definition of “infertility” is based on the inability of a “couple” to achieve spontaneous pregnancy within a year of trying to conceive. It is estimated that about 15% of couples may fall into this definition, and in about 50% of cases male factor infertility is implicated (1).
What are the causes and who is at risk?
There are a multitude of factors that may be involved with male factor infertility. These include non-treatable conditions (such as a genetic or congenital disorder, undescended testicle(s), previous treatments for cancer such as chemotherapy, malignancy etc) and treatable reversible conditions (for example, hormone problems, infections, increased scrotal temperature, varicoceles etc). Genetic factors include men diagnosed with Klinefelter Syndrome and cystic fibrosis (congenital bilateral absence of the vas) (1).
Men at risk might include the following: previously undescended testicle(s) at birth (whether it has been corrected or not), previous surgery to the testicle(s), previous cancer, and cancer treatments (including but not limited men with previous testicular cancer), previous infections of the testicles (e.g. mumps), high scrotal temperatures (chefs, competitive cycling etc), varicoceles, sperm auto-antibodies, systemic diseases such as sarcoma, previous vasectomy or injury, and of course medications for chronic conditions such as hypertension.
Increasing age of the man has emerged as a risk factor for male subfertility. This is an important consideration as increasingly couples choose to delay childbearing for various reasons. Studies in multiple nations have shown the trend in increasing paternal age. There is no consensus for the definition of “advanced paternal age” however most professionals in this area accept advanced paternal age as greater than 40 years. Studies have suggested reduced rates of natural conception in these older men, as well as increased rates of miscarriage. Despite these observations the risks associated with increasing paternal age remain poorly characterised (1,2).
Another important factor that many men might overlook is the impact of lifestyle factors on sperm quality. Oxidative stress is considered important to male infertility, which may lead to sperm DNA damage and poorer DNA integrity. This is often associated with poor lifestyle (e.g., smoking, diet, and environmental exposures). Improving diet, fertility multivitamins etc are often advocated as these factors may improve sperm quality (1,3).
Unfortunately, in about 30-40% of male infertility cases, no factors are found to explain the abnormal sperm parameters (termed idiopathic male infertility). It should also be borne in mind that any attempts at conception involve both the male and female partner – although this may seem like an obvious statement, especially in men with mildly abnormal sperm parameters, it may be that the female partner is also subfertile resulting in a subfertile couple.
Therefore, it is so important for men with subfertility to seek advice from a urologist with a specialist interest in fertility, to try work out reversible causes and provide ways to optimise sperm quality.
What are the signs and symptoms?
Signs and symptoms for male subfertility can vary greatly and will largely depend on the underlying condition or cause for the infertility. Often men only find out about their infertility when they are unable to conceive with their partner resulting in the finding of an abnormal semen test result.
However, the following signs or symptoms should prompt a review by a urologist for further assessment:
- Symptoms of reduced testosterone levels (reduced libido, erectile dysfunction, fatigue, low mood etc).
- Small testicles on examination (either self-examination of by a healthcare professional).
- An abnormal testicular lump or growth.
- Varicoceles (pain or “bag or worms” above the testicle, often asymptomatic though).
- Characteristics that might suggest an underlying genetic disorder such as Klinefelter Syndrome (taller than average height, decreased facial and body hair etc).
- Medications for chronic conditions that may impact sperm quality.
What impact can these issues have?
The impact of these issues can be massive for that individual man and the couple. Of course, the impact will largely depend on the severity of the male infertility and the underlying cause. In men with azoospermia (no sperm seen in ejaculate) the news of having no sperm can be devastating and may result in mental health issues and significant relationship difficulties. In addition, the diagnosis of an underlying genetic disorder might have equally complex and life changing impact. The impact of infertility on the couple may also create a lot of anxiety and stress in the couple and individuals, and in some cases, men may have difficulties in achieving erections.
How is male infertility treated?
This will depend on the underlying cause and the severity. Treatment might range from lifestyle factor modifications, stopping of medications, to surgical intervention for varicoceles for example. In men with azoospermia, with no sperm seen in the ejaculate, surgery can be done to retrieve sperm from the epididymis or testicle depending on the underlying cause. These surgeries are termed “Surgical Sperm Retrieval (SSR)” and include microTESE for example.
Can Ms Anastasiadis advice me on male infertility?
Ms Anastasiadis has a specialist interest in male infertility. She is also the Lead for Andrology and Male Fertility at Croydon University Hospital. As such she sees many patients with male factor infertility every week and therefore is well placed to assess and treat this condition, which can often be complex. Ms Anastasiadis also appreciates how difficult these issues can be for a couple, and as such will endeavour to streamline all diagnostics and treatments so as to avoid unnecessary delays.
Are there any weblinks to useful resources and support?
References
1) Sexual and Reproductive Health in EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023. ISBN 978-94-92671-19-6.
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility.
2) Brandt JS, Cruz Ithier MA, Rosen T, Ashkinadze E. Advanced paternal age, infertility, and reproductive risks: A review of the literature. Prenat Diagn. 2019 Jan;39(2):81-87. doi: 10.1002/pd.5402. Epub 2019 Jan 10. PMID: 30520056.
3) Bisht S, Faiq M, Tolahunase M, Dada R. Oxidative stress and male infertility. Nat Rev Urol. 2017 Aug;14(8):470-485. doi: 10.1038/nrurol.2017.69. Epub 2017 May 16. PMID: 28508879.
