Male Infertility

Behind the Diagnosis: Exploring the Causes of Male Infertility

Male infertility is often considered taboo because of traditional standards and expectations of men. But it’s a real issue. Around 13 out of 100 couples are unable to get pregnant even with regular unprotected sex, and in more than one-third of cases, the issue is with the man—usually due to problems with sperm delivery and sperm production. Thankfully, modern science and doctors are now able to address the causes of male infertility more effectively than before.

If you and your partner have consulted a doctor and you found out that your sperm has problems, it’s best to approach a specialist to talk about and understand your condition and find the best treatment. The earlier you address infertility, the sooner you can improve your condition and increase your chances of helping your partner conceive.

What are the causes of male infertility, and what can you do about them? This blog has all the answers to help you make informed choices with your partner and physician.

How sperm works

To understand the causes of male infertility, it’s important to know how sperm is produced and delivered.

Under normal conditions, a man’s body makes sperm, which is delivered into the woman’s body when he ejaculates during sex. The male reproductive system creates, keeps, and transports sperm while hormones control these processes. The testicles make both the sperm and testosterone, the male sex hormone, and these are in the scrotum, the sac of skin beneath the penis. When sperm exits the testicles, they should be in the epididymis or the tube behind each testicle.

Before ejaculation, sperm enters the vas deferens, another set of tubes leading from the epididymis to behind the bladder in the pelvis. Each tube joins the seminal vesicle with the ejaculatory duct, so sperm mixes with fluid from the seminal vesicles and prostate during ejaculation, creating semen. Then, semen goes through the urethra to exit the penis.

The causes of male infertility depend on your body’s ability to make and deliver normal sperm. However, it can also depend on the health of your sperm.

When sperm is in your female partner’s vagina, it goes through her cervix, then to her uterus and fallopian tubes, where it meets the egg for fertilisation. However, this only happens under appropriate environmental conditions, hormone levels, and genes.

Reasons for male infertility

Making healthy, mature, and potent sperm can depend on many factors. Some involve issues that prevent cells from becoming sperm or keep them from reaching the egg. Even the scrotum’s temperature can make a difference in a man’s fertility. 

The most common causes of male infertility are:

  • Hormonal imbalance:

Usually attributed to an imbalance in the pituitary, thyroid, and adrenal glands and the hypothalamus.

  • Infections:

Inflamed testicles or the epididymis can result in blockages that prevent sperm production and delivery.

  • Physical causes:

Injuries can occur on the urethra or bladder after surgery or an accident and cause a blockage in the ejaculatory pathways. However, they can also be due to medication, spinal conditions, or diabetes.

  • Sexual issues:

Some men have erectile dysfunction, experience early ejaculation, painful intercourse, or cannot ejaculate at all.

  • Varicocele:

This is a reversible condition where veins swell and drain the testicle, resulting in poor sperm quantity and quality.

  • Anti-sperm antibodies:

Sometimes, the body makes antibodies that identify sperm as foreign substances, so they attack and eliminate them.

  • Genetics:

Single gene mutations and chromosomal abnormalities, cystic fibrosis, Klinefelter’s syndrome, and Kalman’s syndrome are among the genetic causes of male infertility.

  • Retrograde ejaculation:

This occurs when the semen goes to the bladder instead of exiting through the urethra and penis during orgasm, resulting in minimal to no semen.

  • Surgeries or medication:

Medications for arthritis and cancer, long-term anabolic drugs, and medicines for ulcers may impair sperm production and lead to male infertility.

  • Lifestyle factors:

Obesity, smoking, alcohol consumption, repeated use of cannabinoids, cocaine, and other drugs can damage sperm DNA and negatively impact sperm quality.

  • Environmental factors:

Men exposed to hazardous chemicals, silicones, adhesives, insecticides, radiation, and other substances in the workplace could be at risk of male infertility. Likewise, those required to sit over prolonged periods (e.g. driving) and exposed to high temperatures (e.g. bakeries) can have problems with sperm production.

Apart from these major causes of male infertility, other medical conditions could be culprits, such as azoospermia. This means the semen doesn’t have any sperm, and it affects around 1% of men. Additionally, it’s evident in up to 20% of male infertility cases.

How azoospermia happens

A lack of sperm during ejaculation can be due to a blockage in the male genital system, even when the system normally generates sperm. This phenomenon is called obstructive azoospermia. However, non-obstructive azoospermia can also occur, meaning sperm production is completely poor.

Azoospermia is often identified as among the causes of male infertility during an evaluation. A test involves two semen analyses at separate instances when the specimen shows no sperm after centrifugation under the microscope. In addition, hormonal tests like Prolactin, Total Testosterone, LH, FHS, Karyotype, scrotum ultrasound, and semen test for fructose levels can help doctors diagnose the condition properly.

Here is a more in-depth look at azoospermia and why it’s one of the causes of male infertility:

  • Obstructive azoospermia

    This type means something is preventing the sperm from leaving the penis, even when the testes normally make them. It can be due to a congenital blockage or absence of the vas deferens, a previous vasectomy, epididymal blockage, or other acquired obstructions, like scarring and infections from previous traumas or surgeries.
  • Non-obstructive azoospermia

    This condition happens when the testes have sperm production issues. Even with regular sperm transport pathways, sperm generation becomes absent or severely impaired due to Sertoli cell-only syndrome, testicular failure, hypogonadotropic hypogonadism, or genetic abnormalities.

There’s hope in overcoming male infertility.

Let seasoned fertility doctors like Dr Kaberi Banerjee help address the causes of male infertility and provide the right treatment in India. Book an appointment at Advance Fertility & Gyne Centre online or call +91-9871250235.

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