Male subfertility or infertility is a condition which reduces the chances of a man’s ability to cause his fertile female partner to become pregnant. It can be caused by many possible reasons, which must be properly identified in order to formulate an appropriate and effective treatment. It is thought that around half of infertility cases can be attributed to male factors. Fortunately, many of these can be treated.
There are several factors that can impact male fertility, and these can be broadly categorised into lifestyle, environmental, medical, and genetic factors:
While men can produce sperm throughout their lives, sperm quality can decline with age.
Tobacco use is linked to decreased sperm quality and lower sperm counts.
Excessive alcohol consumption can lead to reduced testosterone levels and impaired sperm production.
Poor nutrition lacking in certain essential vitamins and minerals can affect overall health and sperm quality.
Both excessive exercise and a sedentary lifestyle can negatively impact sperm quality.
Certain sexually transmitted infections and other infections can cause inflammation or scarring that blocks sperm passage.
Conditions like hypogonadism can lead to insufficient production of testosterone and other hormones that are critical for sperm production.
Diabetes, hypertension, and other chronic conditions can impact overall health and sperm quality.
Excessive exposure to industrial chemicals, heavy metals, and pesticides can damage sperm.
Frequent use of saunas, hot tubs, or laptops on the lap can raise scrotal temperature and potentially reduce one’s sperm count.
Used for muscle building, anabolic steroids can significantly impair sperm production when misused.
Certain antibiotics, anti-hypertensives, and psychiatric medications can impair one’s fertility.
Exposure to high levels of radiation can affect sperm production.
Chemotherapy can lower or stop sperm production for a while. Sometimes, the drugs may also reduce the sperms’ ability to move or even change their genetic make-up.
Male subfertility is usually more common than one realises. It is responsible for about half of all infertility cases, highlighting the importance of addressing male reproductive health in fertility assessments and tailoring the right treatment for the couple.
The doctor will perform a comprehensive evaluation in order to identify possible causes that may be impairing the patient’s fertility. These assessments include:
A detailed review of the patient's medical, surgical, and sexual history may be requested. This includes previous illnesses, surgeries, lifestyle habits, and any known exposure to toxins or radiation.
A thorough physical exam that focuses on the reproductive organs can identify issues such as varicoceles, testicular atrophy, or other physical abnormalities.
This is the crucial part of male fertility testing. A sample of the patient’s semen will be collected and examined to assess:
Blood tests to measure levels of important hormones such as testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin.
This helps to identify any genetic abnormalities or mutations that may be contributing to infertility.
Ultrasound or other imaging tests may be used to visualise the structure of the reproductive organs and identify issues like blockages, tumours, or varicoceles.
Treatment is tailored to the causes identified from the diagnosis. Possible treatments include:
Eating a balanced diet can improve sperm quality. Foods like leafy greens, nuts, seeds, and fish are beneficial.
Maintaining a healthy weight through regular, moderate exercise can improve one’s fertility.
Reducing exposure to environmental toxins, quitting smoking, and moderating alcohol intake are important.
To address hormonal imbalances, treatments might include certain hormone medications, injections, or testosterone therapy.
If an infection is causing infertility, antibiotics can help treat the underlying infection.
Supplements such as vitamin C and vitamin E may improve sperm quality by reducing oxidative stress.
Surgical correction of varicoceles can improve sperm quality and count.
Microsurgical procedures can remove blockages in the epididymis, allowing sperm to enter the vas deferens and get into the ejaculate.
Reversal of vasectomy or repair of obstructions can help to restore malefertility.
In this process, the sperm and eggs are combined in a laboratory, with the resulting embryos being implanted into the woman’s uterus.
A single sperm is injected directly into an egg to facilitate fertilisation.
For men with no sperm in their ejaculate, techniques such as testicular sperm extraction or percutaneous epididymal sperm aspiration can be used to retrieve sperm directly from the reproductive tract.
