Male Infertility: Your Questions Answered
Let’s get some common male infertility questions answered! And what better way than to get them right from the source from an Embryologist who works first hand with sperm and eggs every day. We asked Christiana from nurture.hf to answer some of the most common male infertility questions out there. Here they are.
How common is male infertility?
Infertility has traditionally been thought of as a woman's problem. But this cannot be further from the truth. About one out of every three cases of infertility is due to the man alone, and males are involved in infertility about half the time. So overall, around 30% of infertility is attributed to female factors, around 30% to male, 20% combined male and female and 20% is unexplained.
About one in 20 men have low numbers of sperm, causing infertility. However, only about one in every 100 men has no sperm at all.
What are some of the causes of male infertility?
Sperm are made in the testicles and are then stored inside tubes called the epididymis, which lie on top of each testicle. Sperm are nourished by seminal fluid, which is made by glands along the way. The processes of sperm production and ejaculation depend on there being proper levels of testosterone and other hormones, as well as correct signaling from the nervous system.
The most common causes of infertility in men involve the following:
Abnormal or inadequate sperm: A low sperm count, poor sperm motility or abnormally shaped sperm can reduce your ability to fertilise an egg. Low sperm count is evident in cases where a man has fewer than 15 million sperm per millilitre of semen. Sperm motility is the ability of the sperm to move (or swim) progressively forward to fertilise an egg. Abnormally sized or shaped sperm can affect the ability of the sperm to reach and fertilise an egg. Increased Sperm DNA fragmentation may also cause fertility issues.
Abnormal sperm production or function can be due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.
Sperm delivery issues: Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
Hormonal Causes: If you have a condition which has lowered your Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, this can result in low or no sperm production and low blood testosterone levels.
Genetic Causes: Many inherited (genetic) diseases can cause low or no sperm production e.g. Klinefelter’s Syndrome.
Medication and drugs: Some prescription drugs can reduce your chances of conceiving, so if you are taking regular medication, speak to your doctor about suitable alternatives. The use of recreational drugs should be completely avoided. Drugs such as marijuana, anabolic steroids, and taking medications to treat bacterial infections, can also affect fertility.
Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.
Age: To a lesser extent than female fertility, male fertility can also decline with age and this may impact time to pregnancy, risk of miscarriage and the overall health of your child.
Lifestyle factors:
Weight: For men, being severely overweight can lead to a general decrease in libido and ultimately is known to impact the quality of semen produced.
Smoking: For men, toxins in cigarettes are widely known to have an adverse effect on the quality of their sperm as smoking can increase DNA damage.
Alcohol: drinking excessive alcohol can lower testosterone levels, sperm quality and quantity as well as possibly reducing libido and causing impotence.
Frequent exposure to heat, such as in saunas or hot tubs, can raise body temperature and may affect sperm production.
Environmental issues: Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation can affect your ability to conceive and in extreme cases, may also lead to sterility.
Stress: extremely stressed or anxious can reduce sperm count in men and lower libido.
STDs: Sexually transmitted diseases are known to impact both female and male reproductive organs and cause problems with fertility. Whilst some can be treated, an undiagnosed STI may have a long-term impact on your ability to conceive.
How is male infertility diagnosed?
The first step is a general physical examination and medical history. This includes examining the genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and about your sexual development during puberty.
The second step is a routine semen analysis. Semen samples can be obtained in a couple of different ways. You can provide a sample by ejaculating into a special container at your fertility clinic. In some cases, semen can also be collected by using a special condom during intercourse. The semen sample is then examined in a specialized lab. Sperm counts can fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are performed over a period of time in order to ensure accurate results. If a sperm analysis is normal, it is likely that the female partner will be referred for fertility assessment before conducting any more male infertility tests.
In order to identify the cause of infertility the following tests may be advised:
Scrotal ultrasound: a scrotal ultrasound can help your doctor see if there is a varicocele or other problems in the testicles and supporting structures.
Hormone testing: hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems also might contribute to infertility. A blood test measures the level of testosterone and other hormones.
Post-ejaculation urinalysis: sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
Genetic tests: when sperm concentration is extremely low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might be ordered to diagnose various congenital or inherited syndromes.
Testicular biopsy: this test involves removing small biopsies from the testicle with a needle. If the results of the testicular biopsy show that sperm production is normal, your problem is likely caused by a blockage or another problem with sperm transport.
Specialized sperm function tests: a number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there's any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change recommendations for treatment.
Transrectal ultrasound: a small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate and look for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
How is the health of semen evaluated?
A routine semen analysis test measures a number of parameters but we typically focus on the following:
Semen Volume: The number of milliliters of semen produced per sample.
pH value: an acidic ejaculate (lower ph value) may indicate one or both of the seminal vesicles are blocked. A basic ejaculate (higher ph value) may indicate an infection.
Sperm Concentration: The amount of sperm produced within a milliliter of semen.
Total Sperm Count: The total amount of sperm produced in a sample (concentration x volume)
Total Motility: The percentage of the sperm that can swim forward
Morphology: The percentage of sperm that have the proper shape
The results of the semen analysis are then compared with the following World Health Organization reference values:
semen volume: 1.5 ml or more
pH: 7.2 or more
sperm concentration: 15 million spermatozoa per ml or more
total sperm count: 39 million spermatozoa per ejaculate or more
total motility (percentage of progressive motility and non‑progressive motility): 40% or more motile or 32% or more with progressive motility
Vitality: 58% or more live spermatozoa
sperm morphology (percentage of normal forms): 4% or more.
Do my chances of infertility increase as I get older?
In short, yes they do! Healthy men in their 70s and beyond can still father children, although if you are middle-aged or older, it usually takes longer for your partner to become pregnant. This might be because of less sexual activity, lower semen volume, changes to sperm movement, possibly lower sperm function and DNA quality. The chance of the child with a genetic or chromosomal problem also increases as you get older. The ability of sperm to move and the proportion of normal sperm tend to decrease with age, affecting fertility, especially after age 50.
Can drinking alcohol or smoking tobacco affect my semen analysis?
Yes it can. Heavy smoking has been associated with decreased sperm counts and alcohol consumption has been associated with increased numbers of morphologically abnormal sperm. Both these parameters are crucial for normal fertilization.
Smoking can:
reduce the quality of sperm
cause a lower sperm count
affect the sperm’s ability to swim (motility)
cause male sexual impotence (inability to get or maintain an erection).
The good news is that stopping smoking can reverse the damage.
What can I do to boost my fertility? Are there supplements I can take to increase my sperm quality?
Maintain a healthy weight. Some research suggests that increasing body mass index (BMI) is linked with decreasing sperm count and sperm movement.
Eat a healthy diet. Choose plenty of fruits and vegetables, which are rich in antioxidants and might help improve sperm health. The following antioxidants have been linked to improved sperm health:
- Zinc: found in oysters, crab, red meat, poultry, and beans.
- Vitamin C: found in many fruits and vegetables, with the highest levels found in red peppers, kiwi, oranges, and grapefruit.
- Selenium: found in high amounts in Brazil nuts. Also found in tuna, cod, beef, turkey, and chicken.
- Vitamin E: found in nuts, seeds, oils, and leafy greens.
- Folic acid (or folate): found in beef liver, leafy green vegetables, fruits, beans, and peas, and often in fortified grains.
- Lycopene: found in tomatoes, apricots, pink grapefruit, and watermelon.
Manage stress. Stress can decrease sexual function and interfere with the hormones needed to produce sperm.
Exercise. Moderate physical activity can increase levels of powerful antioxidant enzymes, which can help protect sperm
What lifestyle factors can negatively affect sperm?
There are a wide variety of lifestyle risk factors that could potentially negatively affect sperm quality. These include cigarette smoking, alcohol intake, use of illicit drugs, obesity, psychological stress, APA, diet, and caffeine intake. The adverse effects of these factors can sometimes become intensified from one generation to the next, and then get passed on to the resulting offspring. However, it is important to note that their negative effects can be overcome to a large extent by behaviour modification and better lifestyle choices.
Lifestyle factors:
Weight: For men, being severely overweight can lead to a general decrease in libido and ultimately is known to impact the quality of semen produced.
Smoking: For men, toxins in cigarettes are widely known to have an adverse effect on the quality of their sperm as smoking can increase DNA damage.
Alcohol: drinking excessive alcohol can lower testosterone levels, sperm quality and quantity as well as possibly reducing libido and causing impotence.
Frequent exposure to heat, such as in saunas or hot tubs, can raise body temperature and may affect sperm production.
Environmental issues: Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation can affect your ability to conceive and in extreme cases, may also lead to sterility.
Stress: extremely stressed or anxious can reduce sperm count in men and lower libido.
STDs: Sexually transmitted diseases are known to impact both female and male reproductive organs and cause problems with fertility. Whilst some can be treated, an undiagnosed STI may have a long-term impact on your ability to conceive.
I’ve been told I have an abnormal semen analysis. What is the next step? Is there anything else that can be done?
The most important thing to know is that one abnormal semen analysis result doe not necessarily mean you are infertile. Sperm quality tends to fluctuate over time so a follow up semen analysis may in fact show normal results. At least two consecutive semen analysis should be abnormal in order to establish a true issue with sperm quality. Semen quality can be affected by illness, anxiety, medication (such as antibiotics) and many other factors. Not abstaining from ejaculation for three to four days before your test can also alter the results. If a part of the ejaculate is missed this can also significantly affect the semen analysis outcome.
So if you have one abnormal semen analysis you should definitely consider a second follow-up test. If a second follow-up also shows an abnormal result, then it is time to see a reproductive urologist and reproductive endocrinologist to discuss options for treatment. Men with extremely poor semen quality are at an increased risk for testicular disease as well. In some cases, the solution may be a course of supplements or sometimes a testicular biopsy may be recommended.
For more information you can follow Christiana @nurture.hf.