Male Factor Infertility

“From the cold shoulder treatment downright to open and unabated rebuke, I have witnessed my fair share of men chastise their wives for the inability to conceive.”

– Dr Navdeep Singh Pannu

Dr Navdeep knows from his experience that men are as culpable to be the reason behind why a couple is unable to conceive. In this interview, he explains the reasons for infertility in men and the possible treatment for the condition.

The odds

It is not uncommon for the burden and blame of infertility to fall squarely on the shoulders of the female gender. The fact is, about half the time, men contribute to the problem. According to Dr Navdeep, male factor infertility is responsible in about 30 percent of couples with infertility, and male and female factors together contribute to the problem in another 30 percent.

The right conditions

Differing from women who are born with a reserve of eggs in their ovaries, a man’s testicles, through a process called spermatogenesis, produce millions of new sperm every day. Consequently, male fertility depends on the body making normal sperm and delivering them. However, producing mature and healthy sperm that can travel depends on many things. The following are the main causes for male infertility:

(i) Sperm disorders
Sperm disorders can arise from the genetic makeup that one is born with. Chromosomal abnormalities may interfere with spermatogenesis. When this happens, it leads to deficiencies in semen and semen quality. The most significant of these are low sperm concentration or count (oligozoospermia), poor sperm motility or movement (asthenozoospermia) and abnormal sperm morphology or shape (teratozoospermia). As high as 90% of male infertility problems are related to count, and there is a close association between abnormal semen parameters and sperm count.

(ii) Hormonal problems
Hormones produced by the pituitary gland tell the testicles to make sperm. The follicle stimulating hormone (FSH) stimulates the production of sperm and the luteinizing hormone (LH) stimulates the testes to secrete the male sex hormone, testosterone. High levels of FSH and LH can indicate a failure of testicular function, whilst inadequate levels may indicate that the testes may not be receiving adequate stimulation. Testosterone produced by the testes stimulates sperm production and is required for sperm motility; while elevated levels of the hormone prolactin may result in abnormal semen production.

(iii) Varicoceles
A varicocele happens when veins become enlarged inside the scrotum. Out of 100 infertile men, 40 may be affected. The condition causes low sperm numbers because blood flows back into the scrotum from the belly, making the testicles too warm for making sperm.

(iv) Other causes
Other causes of male infertility may include male reproductive tract blockages from repeated infections, surgery (such as vasectomy), swelling or developmental defects. Certain medications given to treat health problems may change sperm production, function and delivery. The presence of antisperm antibodies may cause ‘Immunologic Infertility’ where a man’s body makes antibodies that attack his own sperm. Erectile disfunction (ED) and decreased libido may also affect male fertility, as will disorders that upset ejaculation.

In some cases, male infertility can be caused by environmental factors which are less obvious such as exposure to excessive heat due to one’s occupation, as the case with truck drivers, welders, or firefighters, or habits, such as excessive use of the hot tub or tight clothing. Infertility in men can also be triggered by stress, obesity or an obsession with certain exercise regimes.

Tests and treatment

Male fertility diagnosis starts with a full history and physical exam in addition to blood work and semen tests. A full history-taking will include childhood illnesses, current health problems or medications that might harm sperm production. You will also be asked about your lifestyle habits and preferences which may have an effect on male fertility. The physical exam will look for problems within the male reproductive tract.

Semen analysis is a routine lab test. This test will reveal sperm volume, count, concentration, movement and structure. A blood sampling will provide information on hormone levels to learn how well the testicles are producing sperm. Other tests and procedures that involve ultrasound and/or a biopsy may also be conducted.

The treatment for infertility is dependent on the cause of the infertility. Many problems can be rectified with lifestyle tweaks, drugs or surgery, and this would allow conception through normal sex. In instances where the sperm count is too low to enable natural conception, Assisted Reproductive Technique (ART) such as Intrauterine Insemination (IUI) and In Vitro Fertilisation (IVF) could be viable options. In conditions where there is no viable sperm, options that involve the use of donor sperm could be considered.

Egos aside

Not all male infertility is permanent or untreatable; it is not uncommon to treat infertility in men through one or a combination of actions. The pervasive issue though, according to Dr Navdeep, is the denial on the part of the male partner. He emphasised, “Having a baby is a couple effort and therefore it is important for both partners to assume equal responsibility from conception right through to child-rearing.”

You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call 03-8076 7111 (TMC Fertility & Women’s Specialist Centre, Puchong) or 03-62871209/03-62871000 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.

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