#HEALTHTALK 20: Infertility in men

Before now, most men ignored their reproductive health as a norm. It was generally believed that for a man, the ability to have and sustain an erection meant that all was well. Most men often consider going through fertility tests as demeaning and disgraceful. In fact, some still do. 

So, until recent times, women were blamed for the inability to conceive in most marriages. But, this is not always true because the possible for men to be infertile sexually is now known and established. 

Infertility in men is any health issue in a man that has lowered the chances of getting his female partner pregnant.

Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problem and other factors can play a role in causing male infertility.

Sperm problems can be associated with lifestyle choices which can lower sperm numbers. Smoking, drinking alcohol and taking certain medications can lower sperm numbers. Other causes of low sperm numbers are sickness (such as kidney failure), mumps, chromosome or hormonal disorder.

Self Examination

Check your shorts: The size of your testicles should be about the same size as an apricot and should be firm. 80% of the testicles is devoted to sperm production; so the bigger the size of your testicles, the larger your sperm production. However not just the number but the quality of the sperm and the morphology is of great importance; so you might still want to get yourself checked by a doctor.

Signs of infertility in men

Although most men with male infertility do not notice symptoms other than the inability to conceive a child, signs and symptoms associated with male infertility include:

1.   Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction). 

If you have erectile dysfunction there would be difficulty in penetration as stiff enough erection is needed. A normal ejaculation should be about ½ to 1 teaspoon at least, containing about 20million sperms of which at least 50% should be quality sperm cells. The quality of the sperm in terms of motility (fast swimmers and twitchers) is important for fertility.

2.   Pain, swelling or a lump in the testicle area. 

3.   Recurrent respiratory infections. 

4.   Inability to smell. 

5.   Abnormal breast growth (gynecomastia). 

6.   Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality. 

7.   A lower-than-normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate).

Causes of infertility in men varies from medical/biological to environmental factors, and lifestyle choices. 

Prevention

Many types of male infertility aren't preventable. However, you can avoid some known causes of male infertility.

Don't smoke. Limit or abstain from alcohol. Steer clear of illicit drugs. Keep the weight off. Don't get a vasectomy, avoid things that lead to prolonged heat for the testicle. Reduce stress. Avoid exposure to pesticides, heavy metals and other toxins. 

Lifestyle choices to improve fertility

1.   Eat dark green vegetables and fruits: In arranging your meals and meal plans, make sure you add fruits and vegetables. It is advisable to eat 60% fruits/vegetables in all meals.

2.   Your diet should be high in protein, not carbs. 

3.   Eat Nuts. 

4.   Reduce your weight: Obesity causes decreased testosterone and increased scrotal temperature.

5.   Move about for at least 30mins per day. Exercise increases testosterone levels. Studies show that active men have higher testosterone levels than inactive men. However the reverse is the case when too much exercise is done.

6.   Anything that improves blood flow, improves metabolism, and improves your cardiovascular/heartrate is most probably going to result in better sperm production.

7.   Sleep for over 6 hours: This might sound unreal but sleeping helps in sperm production. When you sleep, you recharge your pituitary gland which controls sperm production. So, a recharged pituitary gland would effectively carry out its tasks.

8.   Keep your reactive oxygen level in check. Adequate intake of antioxidants like Vitamin-C can help.

Infertility treatment in women

Treatment of infertility depends on the cause and your age. It falls into two main categories: one helps fertility through medications or surgery, and the other uses assisted reproductive technologies.

Fertility drugs 

Clomiphene, taken as a pill, and FSH and LH hormone injections are the main treatment drugs for women with ovulation disorders. Women with no clear cause of their infertility might also use these drugs. Pills like clomiphene or aromatase inhibitors (letrozole, used off-label) increases LH to induce ovulation. Injections of GnRH, LH, or FSH help mature eggs and induce ovulation. Sometimes, doctors use drug treatment with intrauterine insemination (IUI), when sperm are released into the uterus through a catheter (a thin flexible tube) inserted through the vagina. IUI is done at the time of ovulation.

Surgery 

Surgery may help women with fibroids, uterine polyps, scarring, or endometriosis. Surgery may also be an option for some women with blocked fallopian tubes, but it depends on your age and the type of blockage. Any surgery to unblock a fallopian tube may increase the risk of ectopic (tubal) pregnancy.

Assisted Reproductive Technology (ART) 

Assisted reproductive technology uses techniques such as mixing sperm with an egg outside the body (in vitro fertilization or IVF), or injecting a single sperm into an egg (intracyctoplasmic sperm injection (ICSI), then transferring the resulting embryo back into the uterus. Some women with very few remaining eggs in their ovaries choose IVF using a donor egg.

Treatment of infertility in men

Medical Attention:

Seeking professional medical help from your doctor is of utmost importance. Self-help measures and recommendations from non-medical personnel should be taken with a pinch of salt. 

Surgery

Surgical method is often used to correct the varicocele, or an obstructed vas deferens repaired, and prior vasectomies can be reversed. Sperm can be retrieved directly from the testicles or epididymis using sperm-retrieval techniques in cases when sperm cannot be ejaculated. 

Treating Infections like STIs

Antibiotic treatment might cure an infection of the reproductive tract, but doesn't always restore fertility.

Treatments for sexual intercourse problem

Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.

Hormone Treatment

In cases where the hormones high or low levels of certain hormones are the cause of infertility your doctor might recommend hormone replacement or medications.

Asssisted Reproductive Technology (ART) 

ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.

Whichever may be the case, it is crucial that couples should jointly seek professional medical help by talking to a doctor. 

Chisom Deborah Ogbonna, a Biologist, writes from Lagos, Nigeria where she is a lead content developer for the #HealthTalk series.

Disclaimer: The #HealthTalk series is aimed at informing the public in a general sense that is not necessarily professional. Hence, the information provided herein is not meant to replace the appropriate medical guidance of a trained and licensed physician. Doctor's counsels are to be taken in preference.

~ The Paul Anunaso Blog Team