Male Infertility

When a couple has trouble having a baby, there’s about a 50-50 chance that the man has a problem contributing to the pregnancy…

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What is infertility?

Infertility is “the inability to conceive after 12 months of unprotected intercourse.” This means that a couple is not able to become pregnant after a year of trying. Most (85%) couples with normal fertility will conceive within a year of trying.

The chance of a normal couple conceiving is 20% to 37% by three months, 75% by six months, and 90% at one year. Of those couples that do not conceive in the first year, as many as 50% will conceive in the next year. Couples that have tried without success to conceive should see a fertility specialist.

How often should a couple have intercourse?

Surprisingly, long periods of abstinence can decrease the quality of sperm. Couples should have intercourse (sex) at least two to three times a week during the fertile period. A couple has more chances for pregnancy if they have intercourse every one to two days during the fertile window, and a pregnancy is most likely if a couple has intercourse within the six-day time frame that ends on the day that an egg is released (ovulation).

Fertility in the aging male

Sperm quality deteriorates somewhat as men get older, but it generally does not become a problem before a man is in his 60s. Despite these changes, there is no maximum age at which a man cannot father a child. As men age, their testes tend to get smaller and softer, and sperm morphology (shape) and motility (movement) tend to decline. Aging men may develop medical illnesses that adversely affect their sexual and reproductive function.

Male factor

When a couple has trouble having a baby, there’s about a 50-50 chance that the man has a problem contributing to the pregnancy. He might:

  • Produce too few sperm to fertilize an egg
  • Make sperm that are not shaped properly or that do not move the way they should
  • Have a blockage in his reproductive tract that keeps sperm from getting out

If you might have a fertility problem, your doctor will want to perform a complete history and physical, as well as several tests to find out what may be causing your infertility.

infertility_male_causes_1

Semen analysis

Semen analysis is probably the first test you will be asked to perform. Semen is the fluid that is released when a man has an orgasm. Semen carries the sperm in fluids that should nourish and protect it. You will typically be asked to provide a semen sample by masturbating into a sterile glass jar. The semen analysis provides a lot of information about the quantity and quality of both semen and the sperm it contains. Some of the things that are measured are:

  • How much semen a man produces (volume)
  • The total number of sperm in the semen sample (total count)
  • The number of sperm in each milliliter of semen (concentration)
  • The percentage of sperm that are moving (motility)
  • If the sperm are the right shape or not (morphology)

The analysis can also suggest if you have an infection in your reproductive system.

Hormone levels and reproduction

Important chemicals in your body, called hormones, control sperm production. They also affect your interest in sex and your ability to have sex. Too much or too little of these hormones can cause problems with sperm production or trouble having sex. Two important hormones for reproduction are follicle-stimulating hormone (FSH) and testosterone (T). Your doctor may do blood work to check to see if you have the right amount of these hormones. If indicated, your doctor may check other hormone levels, including luteinizing hormone (LH), estradiol, and prolactin.

Counseling

Infertility is a medical condition that touches all aspects of your life. It may affect your relationships with others, your perspective on life, and how you feel about yourself. How you deal with these feelings will depend on your personality and life experiences. Most people can benefit from the support of family, friends, medical caregivers, and mental health professionals.

Are boxers shorts or briefs better?

Some studies suggest that wearing brief underwear may raise the temperature around the scrotum and cause a decrease in sperm quality. Choosing boxer underwear is one way to avoid this. The evidence from these studies is inconclusive. Regardless, avoiding situations that raise scrotal temperature (like hot tubs or using laptops on your lap) might improve sperm quantity and quality. Some medications, along with chronic medical conditions and high fevers, may impair the body’s ability to make sperm. Ask your doctor how your medications or conditions affect your fertility potential.

How can I improve our chances of conceiving naturally?

Like many aspects of our health, a man’s fertility is improved by adopting a healthy lifestyle. Maintaining an ideal weight, a diet rich in antioxidants (found in fruits and vegetables), as well as multi-vitamins may improve the quality of sperm. Reducing stress and controlling chronic medical conditions such as high blood pressure and diabetes may also improve a man’s chances of impregnating his partner. Remember that any such changes in the man’s lifestyle will take almost three months to show an improvement in sperm. Couples with underlying medical or genetic conditions should see a doctor so that they can increase their overall health before conceiving.

When Do I Need To See An Infertility Counselor?

Consider counseling if you are feeling depressed, anxious, or so preoccupied with your infertility that you feel it is hard to live your life productively. You also may want to seek the assistance of a counselor if you are feeling “stuck” and need to explore your options. Signs that you might benefit from counseling include:

  • persistent feelings of sadness, guilt, or worthlessness
  • social isolation
  • loss of interest in usual activities and relationships
  • depression
  • agitation and/or anxiety
  • mood swings
  • constant preoccupation with infertility
  • marital problems
  • difficulty with “scheduled” intercourse
  • difficulty concentrating and/or remembering
  • increased use of alcohol or drugs
  • a change in appetite, weight, or sleep patterns
  • thoughts about suicide or death

Male Infertility Specialist

An Urologist and a Reproductive Endocrinologist are trained to evaluate infertility in men. Their services may be offered in a fertility clinic depending on the specific challenge affecting the man. Also, although Gynecologists and Obstetricians are readily equipped to manage female infertility, they can also be involved in the fertility management of men. After evaluation, they will decide on the best way to assist you.

 

 

Information from American Society for Reproductive Medicine was used in this article.

Author: Dr Ahmad Abdullah, MBBS, MSc Clinical Pathology

Ahmad is a father, a husband and a poet. He was born and raised in Lagos, Nigeria. He earned his medical degree from the University of Juba, currently in South Sudan. He is interested in medical research and currently practicing in Lagos, Nigeria.

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