What is Male Infertility, Causes and Treatment

What is infertility?

Infertility is defined as an inability to achieve a pregnancy after one year of unprotected intercourse.  Infertility also defines as the failure of the couple to conceive after trying to do so for at least one full year.[1]

Infertility in Modern Societies

 Infertility is the global health issue and it takes a huge personal importance in the modern world.  Childbearing and start the family is one of the most important and natural event of human being. It also relates to happy life and family integration. However, it is reported that infertility affects approximately 15 % percent of couples globally.[2] According to Sharlip, “50% of infertility cases are due to a solely female factor, pure male factor accounts 20-30 percent, and the remaining 20-30% is due to a combination of both male and female factors”.[3]

 Infertility is one of the burn global health issues in all parts of the world, especially in USA and Europe. 

How Infertility affects quality of life

Infertility is itself stressful subject that has negative effects on quality of life. Life without children is associated with physical, psychological and social problems. It may also negatively affect the overall health of men and women.

Major Causes of Male Infertility

 There are several causes of male infertility that relate to anatomical abnormalities, psychological and social implications such as varicoceles, ejaculatory  duct obstruction or ejaculatory disorders, low sperm counts or  deficient sperm production.[4]  Most common causes of infertility are:

• Low Sperm Count

The scientific Studies confirm that mostly male infertility associated with low sperm counts. It is reported that 40-90 % of cases are due to low sperm counts, poor sperm quality or both and sperm abnormality.[5]  The normal semen level should have a volume of 1.5-5.0 ml, with greater than 20 million sperm/ml and Level of abnormal sperm should be less than 40 %, with greater than 30 % of the sperm motility.

• Hypogonadotropic hypogonadism

 Hypogonadotropic hypogonadism is defined as a deficiency of the pituitary secretion of follicle-stimulating hormone (FHS) and luteinizing hormone (LH).[6] Hypogonadotropic hypogonadism negatively effects on FSH and LH production (both are sex hormones). This deficiency of hormones affects on decrease normal puberty, fertility, and reproductive health.  It may also lead to the decrease of sex drive.

• Immunologic Infertility

Immunologic factors are co

• Disorders of Ejaculation

nsidered as an important cause of male infertility.  Immunologic infertility is defined as the presence of anti-sperm antibodies in blood plasma. ASA (anti-sperm antibodies) contribute to decreasing the male fertility by inhibiting sperm functions that play the significant part for fertilization.[7] 

 Ejaculation disorder is one of the common male sexual problems. Ejaculation is used for the fluid of semen (sperm) from its storage location, through ejaculatory duct and out into the urethra and after that the sperm is ejected into the vagina. Ejaculatory disorders can lead to infertility and sexual dysfunction.

• Age Factor on Infertility

  It is well documented that age factor is one of the important factors of   male infertility. Fertility naturally starts to decline with age. Many couples want to delay childbearing during the perfect and reasonable age. This delay can be harmful to their fertility. It is important to remember that fertility, testosterone level, and semen parameters begin to decrease from age 35 in men.  Furthermore, it is reported that more DNA damage was found in sperm after age 40.

•  Obesity

Obesity has become the serious issue in recent time. Recent studies have proved that high BMI (Body mass index)   can affect fertility.  The risk of infertility in obese men is more than men who have with normal weight.  In addition, it is reported that a fat man with 25% BMI is associated with 25 percent decrease in sperm count and motility. [8]

  

• Underweight

Underweight is one of the effective parts which can affect fertility in men and women. It is determined that man with underweight has low sperm contestation than those who are at normal weight. [9]

• Psychological Factors

  Psychological factors such as stress and depression have many negative effects on fertility.  There is strong association between stress, depression and infertility. Depression and stress can affect on decrease testosterone level and luteinizing hormone (LH). Low Testosterone and LH effect on gonadal functions [10]which significantly   impact on reducing spermatogenesis and sperm parameters. Decreasing stress levels have positive effects on the improvements of fertility.

• Environmental Risk Factors

Latest studies suggest that several environmental factors such as heat, chemicals dust, silicones, physical agents and chemicals are implicated in infertility[11] and they heave can negative effect on sperm quality. [12] 

•  Cigarette Smoking

 There is also an association between Cigarette smoking and sperm count.  Cigarette smoking can negative effect on sperm count and motility. It also increases the number of abnormal sperm.[13]

• Hyperprolactinemia

Hyperprolactinemia is defined as the persistent elevation of serum prolactin levels. The normal high limit serum prolactin level is 20nglmL in women and slightly lower in men. Hyperprolactinemia is a common cause of    infertility in men and women.[14]

Treatment of Infertility

 There are many treatments options of male infertility in recent time. Medical science also has increased the chances of treatment of infertility. Reproductive health treatment remains a successful option for an infertile man.  I will discuss the effective therapeutic options in next post.

 

---

[1] Benyamini Y, Gozlan M, Kokia E. Variability in the difficulties experienced by women undergoing infertility

treatments. Fertil Steril. 2005;83(2):275-83.

[2] A unique view on male infertility around the globem, Ashok Agarwal, Aditi Mulgund, Alaa Hamada, and Michelle Renee Chyatte, Reprod Biol Endocrinol. 2015; 13: 37. Published online 2015 Apr 26. doi: 10.1186/s12958-015-0032-1.

[3] Sharlip ID, Jarow JP, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al. Best practice policies for male infertility. Fertil Steril. 2002;77:873–82. doi: 10.1016/S0015-0282(02)03105-9. [PubMed] [Cross Ref]

[4]

[5] E. U. Etuk  and A. A. Muhammad, Fertility enhancing effects of aqueous stem bark extract  of Lophira lanceolatain male Spargue dawley rats, nternational Journal of Plant Physiology and Biochemistry Vol. 1(1) pp. 001-004, October 2009.

[6]  Early postnatal treatment of hypogonadotropic hypogonadism

with recombinant human FSH and LH, Katharina M Main, Ida M Schmidt, Jorma Toppari1 and Niels E Skakkebæk, European Journal of Endocrinology (2002) 146 75–79 ISSN 0804-4643

[7] Immune infertility: towards a better understanding of sperm (auto)‐immunity, Claudia Bohring and Walter Krause1, Oxford Journals   Medicine & Health  Human Reproduction Volume 18, Issue 5 Pp. 915-924.

[8] Martini AC, Tissera A, Estofán D, Molina RI, Mangeaud A, de Cuneo MF, Ruiz RD. Overweight and seminal quality: a study of 794 patients. Fertil Steril. 2010;94:1739–1743. doi: 10.1016/j.fertnstert.2009.11.017. [PubMed] [Cross Ref]

[9] Chavarro JE, Toth TL, Wright DL, Meeker JD, Hauser R. Body mass index in relation to semen quality, sperm      DNA integrity, and serum reproductive hormone levels among men attending an infertility clinic. Fertil Steril. 2010;93:2222–22231. doi: 10.1016/j.fertnstert.2009.01.100. [PMC free article] [PubMed] [Cross Ref]

[10] Schweiger U, Deuschle M, Weber B, Körner A, Lammers C, Schmider J, Gotthardt U, Heuser I. Testosterone, gonadotropin, and cortisol secretion in male patients with major depression. Psychosom Med. 1999;61:292–296. [PubMed]

[11] Weller DP, Zaneweld JD, Farnsworth NR.Gossypol: pharmacology and current status asa male contraceptive. Econ Med Plant Res1985;1:87-112.

 [12] Thonneau P, Bujan L, Multigner L, Mieusset R. Occupational heat exposure and male fertility: a review. Hum Reprod 1998;13:2122- 2125.

[13] Kulikauskas V, Blaustein D, Ablin RJ. Cigarette  smoking and its possible effects on sperm. Fertil Steril 1985;44:526-528.

[14] Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8:3–6. [PubMed]