In the last few months, the focus of many of the articles on this page has been on female health. This week, in order to redress some of this imbalance, I will focus on male infertility.
Male infertility is a term which has gained currency particularly because of the increasing frequency with which the male factor alone is now found to be responsible for causing issues of infertility. By some estimates, it is responsible for some 40 to 50 per cent of all cases. This finding is said to affect up to seven percent of all males. In other words, out of every 100 men, seven are estimated to have some form of infertility.
Male infertility is declared when a man is unable to cause pregnancy in a healthy, fertile woman after one entire year of active cohabitation. Sometimes, it is the only reason a woman is unable to conceive. Some other times, it is part of a spectrum of causes that make this difficult or impossible. The causes of this inability vary greatly. In many cases, the nature of the sperm produced by the man is principally responsible for the problem. This is brought about by the number of sperms, their level of activity, the energy with which they swim and their physical composition.
Causes of infertility in the male are divided into three broad categories. There are factors which are prevalent within the body but essentially present before the level of the testes. Then, there are those factors which occur just because the testes are involved and finally, there are those factors which are blamed by virtue of occurring because of events happening after exiting the testes. It is a large, unwieldy list, but we shall try hard to make sense of it all. What is important here then is to appreciate that male infertility is caused by low sperm production, abnormal sperm function or blockages that prevent the transportation of the sperm to the site where its action is desired.
The pre-testicular factors refer to those factors which make the adequate support of the testes impossible or impaired. These are due to factors like inadequate support of the hormones that are most important for this supporting role and situations of poor general health such as obesity and diabetes. The case of the obese man is particularly instructive because it makes such men insensitive to leptin within the small part of the brain called the hypothalamus where all these functions are regulated and mediated. The net effect of this deficiency is to reduce the release of the master hormone that controls the secretion of the male hormones.
The next common factor is alcohol use which, if done in large amounts over a long period of time, changes the volume of semen, as well as the quality of sperms produced in each ejaculation. This helps ensure there is a reduced sperm cell count. There is also an increase in the presence of abnormal sperms, which are sperm cells that either have two heads or have two tails or are otherwise deformed; so that they are unable to swim in a useful direction within the vagina and uterus. As alcohol causes such damage, the use of tobacco through heavy cigarette smoking increases the likelihood of male infertility by as much as 30 per cent. The products of cigarette smoking progressively damage the sperm cells and lead to their death. This is the singular reason some governments around the world now require tobacco manufacturers to place the relevant warnings on the packets.
The next factor may be due to aging. As men get older, there is a steady decline in the quality of semen. This may have a lot to do with the fact that as men age, they progressively lose their ability to repair damaged cells. The loss of this ability affects the quality of the sperms they produce and it is thus a major factor in causing male infertility. Besides, the spectre of irregular intercourse is a major contributor to male infertility because of the stress now associated with life in urban environments and the pressure of the workplace itself.
Factors within the testes causing low sperm quality or absent sperm production despite adequate support from the relevant male hormones is a major contributor to this problem. Some of these factors are things that are relatively easy to diagnose with a good clinical examination. These include varicoceles, a situation in which a man develops enlarged and tortuous veins that feel like a bag of worms when examined. These veins transmit heat into the scrotum and therefore inhibit adequate sperm production. The same is true for hydroceles, for infections such as mumps and malaria, and also for injuries resulting from accidents of any sort which affect that part of the body. Undescended testis is also a major cause of this problem particularly when it is unrecognised or left unattended. This is also true of physical abnormalities like hypospadias, a problem in which the urethra is abnormally situated under the penis.
Less commonly, cancers such as seminomas and testicular cancers will also be responsible for this impairment. That is why the now disgraced cyclist, Lance Armstrong, was idolised around the world when he recovered from testicular cancer to become a cycling maestro and even managed to have children along the way, until it emerged that his performance on the racing track was drug-enhanced. In the same way, people on radiation therapy for any purpose are similarly inhibited in the production of normal sperms. Worse are those individuals in whom a cause cannot be established for their inadequate sperm production. This is the case in as many as 30 per cent of all males that suffer from infertility.
Also, previous operations carried out in that part of the body that have caused some damage to the vital structures there, such as the spermatic cord, also contribute to some of these problems. This particular event is not common but forms a part of what is recognised as the post testicular factors. These are the factors which hinder the release of sperm after normal production in the testes. So, obstruction of the spermatic cord as seen above, infection within the testes known as orchiditis, people who suffer from cystic fibrosis and those who have Katergener’s syndrome are some of the individuals who will suffer this kind of problem.
The other factors retrograde ejaculation as seen in people who have had operations like prostatectomy or use drugs like Aldomet for blood pressure control will also have these kinds of problems. Men who have erectile dysfunction may also similarly suffer but they can have the hope they can be treated often successfully. However, the worst of these is frank impotence. Sometimes, impotence is the result of some other disease within the individual such as a problem with the spinal cord as a result of an injury or a structural abnormality.
There are often some signs of male infertility. Sometimes, these features are ignored because the people who experience them do not appreciate that there is a problem and they should therefore seek some help. Some of these factors are changes in hair growth which should gradually become obvious over a period of time. There will also be changes in sexual desire. There would be changes in the normal pattern of erections and ejaculation. Early morning erection may be lost, as will the presence of erection at the site of an erotic scene. Ejaculation may also become premature or may not even occur at all. There may be a pain or a lump or a swelling in the testicles but sometimes also, the testicles may be small and firm.
For many of these problems, treatment remains possible. In some centres around the world, injuries to the spermatic cord can be reversed by microvascular surgical techniques. Many of the other causes are treatable and such treatment is dependent on the causes. The doctors most skilled in this area are called urologists and it is in the interest of all men who have been diagnosed like this to seek the expert opinion of one of these people in the course of their treatment.
Male infertility is a term which has gained currency particularly because of the increasing frequency with which the male factor alone is now found to be responsible for causing issues of infertility. By some estimates, it is responsible for some 40 to 50 per cent of all cases. This finding is said to affect up to seven percent of all males. In other words, out of every 100 men, seven are estimated to have some form of infertility.
Male infertility is declared when a man is unable to cause pregnancy in a healthy, fertile woman after one entire year of active cohabitation. Sometimes, it is the only reason a woman is unable to conceive. Some other times, it is part of a spectrum of causes that make this difficult or impossible. The causes of this inability vary greatly. In many cases, the nature of the sperm produced by the man is principally responsible for the problem. This is brought about by the number of sperms, their level of activity, the energy with which they swim and their physical composition.
Causes of infertility in the male are divided into three broad categories. There are factors which are prevalent within the body but essentially present before the level of the testes. Then, there are those factors which occur just because the testes are involved and finally, there are those factors which are blamed by virtue of occurring because of events happening after exiting the testes. It is a large, unwieldy list, but we shall try hard to make sense of it all. What is important here then is to appreciate that male infertility is caused by low sperm production, abnormal sperm function or blockages that prevent the transportation of the sperm to the site where its action is desired.
The pre-testicular factors refer to those factors which make the adequate support of the testes impossible or impaired. These are due to factors like inadequate support of the hormones that are most important for this supporting role and situations of poor general health such as obesity and diabetes. The case of the obese man is particularly instructive because it makes such men insensitive to leptin within the small part of the brain called the hypothalamus where all these functions are regulated and mediated. The net effect of this deficiency is to reduce the release of the master hormone that controls the secretion of the male hormones.
The next common factor is alcohol use which, if done in large amounts over a long period of time, changes the volume of semen, as well as the quality of sperms produced in each ejaculation. This helps ensure there is a reduced sperm cell count. There is also an increase in the presence of abnormal sperms, which are sperm cells that either have two heads or have two tails or are otherwise deformed; so that they are unable to swim in a useful direction within the vagina and uterus. As alcohol causes such damage, the use of tobacco through heavy cigarette smoking increases the likelihood of male infertility by as much as 30 per cent. The products of cigarette smoking progressively damage the sperm cells and lead to their death. This is the singular reason some governments around the world now require tobacco manufacturers to place the relevant warnings on the packets.
The next factor may be due to aging. As men get older, there is a steady decline in the quality of semen. This may have a lot to do with the fact that as men age, they progressively lose their ability to repair damaged cells. The loss of this ability affects the quality of the sperms they produce and it is thus a major factor in causing male infertility. Besides, the spectre of irregular intercourse is a major contributor to male infertility because of the stress now associated with life in urban environments and the pressure of the workplace itself.
Factors within the testes causing low sperm quality or absent sperm production despite adequate support from the relevant male hormones is a major contributor to this problem. Some of these factors are things that are relatively easy to diagnose with a good clinical examination. These include varicoceles, a situation in which a man develops enlarged and tortuous veins that feel like a bag of worms when examined. These veins transmit heat into the scrotum and therefore inhibit adequate sperm production. The same is true for hydroceles, for infections such as mumps and malaria, and also for injuries resulting from accidents of any sort which affect that part of the body. Undescended testis is also a major cause of this problem particularly when it is unrecognised or left unattended. This is also true of physical abnormalities like hypospadias, a problem in which the urethra is abnormally situated under the penis.
Less commonly, cancers such as seminomas and testicular cancers will also be responsible for this impairment. That is why the now disgraced cyclist, Lance Armstrong, was idolised around the world when he recovered from testicular cancer to become a cycling maestro and even managed to have children along the way, until it emerged that his performance on the racing track was drug-enhanced. In the same way, people on radiation therapy for any purpose are similarly inhibited in the production of normal sperms. Worse are those individuals in whom a cause cannot be established for their inadequate sperm production. This is the case in as many as 30 per cent of all males that suffer from infertility.
Also, previous operations carried out in that part of the body that have caused some damage to the vital structures there, such as the spermatic cord, also contribute to some of these problems. This particular event is not common but forms a part of what is recognised as the post testicular factors. These are the factors which hinder the release of sperm after normal production in the testes. So, obstruction of the spermatic cord as seen above, infection within the testes known as orchiditis, people who suffer from cystic fibrosis and those who have Katergener’s syndrome are some of the individuals who will suffer this kind of problem.
The other factors retrograde ejaculation as seen in people who have had operations like prostatectomy or use drugs like Aldomet for blood pressure control will also have these kinds of problems. Men who have erectile dysfunction may also similarly suffer but they can have the hope they can be treated often successfully. However, the worst of these is frank impotence. Sometimes, impotence is the result of some other disease within the individual such as a problem with the spinal cord as a result of an injury or a structural abnormality.
There are often some signs of male infertility. Sometimes, these features are ignored because the people who experience them do not appreciate that there is a problem and they should therefore seek some help. Some of these factors are changes in hair growth which should gradually become obvious over a period of time. There will also be changes in sexual desire. There would be changes in the normal pattern of erections and ejaculation. Early morning erection may be lost, as will the presence of erection at the site of an erotic scene. Ejaculation may also become premature or may not even occur at all. There may be a pain or a lump or a swelling in the testicles but sometimes also, the testicles may be small and firm.
For many of these problems, treatment remains possible. In some centres around the world, injuries to the spermatic cord can be reversed by microvascular surgical techniques. Many of the other causes are treatable and such treatment is dependent on the causes. The doctors most skilled in this area are called urologists and it is in the interest of all men who have been diagnosed like this to seek the expert opinion of one of these people in the course of their treatment.