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Male Fertility and Sexual Wellness

Infertility poses a prevalent challenge for individuals designated male at birth (DMAB). Conception is intricately layered with hurdles. Yet, for those grappling with male infertility, there's hope of still experiencing biological parenthood alongside a partner. Various treatments exist to enhance the likelihood of conception.

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What is male infertility?

Infertility can affect individuals of any gender. Male infertility specifically refers to a condition that impacts those males, hindering their reproductive system's ability to conceive with individuals assigned female at birth (AFAB).

What occurs when a man is infertile?

Male infertility signifies engaging in unprotected sexual intercourse for over a year without conception with your AFAB partner.

How common is male infertility?

Around 186 million people globally grapple with infertility, with men being responsible for roughly half of these cases. Studies indicate that male infertility impacts approximately 10% to 15% of men in the United States aiming to start a family.

Is it easy to conceive?

No, it's quite challenging to conceive. The human species is known for its relatively low reproductive capacity. Even for a young and fertile couple engaging in regular intercourse, the chances of conceiving each month are only about 20-25%.

Conception involves a complex interplay of various factors within both the male and female reproductive systems, including:

 

  • Production of healthy male reproductive cells (sperm) and a viable female reproductive cell (egg).

  • Unobstructed fallopian tubes facilitating sperm-egg encounters.

  • Successful fertilization between sperm and egg.

  • Implantation of the fertilized egg (embryo) in the uterus.

  • Sustaining a healthy pregnancy to full term (approximately 39 to 40 weeks), reliant on the embryo's health and the female's hormonal balance. Any disruption to these factors can lead to infertility.

Symptoms and Causes

What are the signs of poor sperm health?
The main indication of male infertility is the inability to conceive a child naturally. However, male infertility can also manifest through various psychological and emotional symptoms, including:

- Depression
- Loss
- Grief
- Feelings of inadequacy
- Sense of failure

If you or your partner are grappling with any of these emotions, seeking support from a therapist or psychiatrist is recommended.

Additionally, male infertility might be linked to low testosterone production from the testicles. In such cases, symptoms such as fatigue, erectile dysfunction, depression, weight gain, and lack of interest may arise. Consulting a urologist specializing in male infertility or a reproductive endocrinologist is advisable if you or your partner experience these symptoms.

What factors causes male infertility?
Male infertility can arise from various biological and environmental influences, such as:

1. Sperm abnormalities, encompassing malformed sperm, low sperm count (oligospermia), and the absence of sperm in semen (azoospermia).
2. Genetic conditions like Klinefelter syndrome and myotonic dystrophy.
3. Certain medical ailments, including diabetes, autoimmune disorders targeting sperm, and cystic fibrosis.
4. Infections like epididymitis, orchitis, and sexually transmitted infections such as gonorrhea or HIV.
5. Varicoceles, which are swollen veins in the testicles.
6. Cancer treatments like chemotherapy, radiation therapy, or surgical removal of the testicles (orchiectomy).
7. Testicular trauma.
8. Hormonal imbalances affecting the hypothalamus or pituitary glands.

Who does male infertility affect?
Any individual males may experience infertility. However, the likelihood of male infertility increases if you:

- Possess a body mass index (BMI) exceeding 25 (indicating overweight or obesity).
- Are aged 40 or above.
- Have encountered radiation exposure.
- Have been subjected to environmental toxins, such as lead, cadmium, pesticides, or mercury.
- Engage in tobacco, marijuana, or alcohol consumption.
- Take specific medications like flutamide, spironolactone, or bicalutamide.
- Regularly endure elevated testicular temperatures from prolonged exposure to heat sources like saunas, hot tubs, or prolonged wheelchair use.
- Have a history of undescended testicles.
- Have experienced varicoceles in the past.
- Utilize testosterone therapy for low testosterone levels.
- Use anabolic-androgenic steroids (AAS) or supplements containing hormone traces to augment muscle mass.

What consistency characterizes healthy sperm: thick or runny?

Semen, the whitish-gray fluid discharged from the penis during orgasm (ejaculation), comprises sperm, fluids facilitating sperm deposition in the vagina, and nutrients like proteins, vitamins, and minerals vital for sperm nourishment. Normally, semen is thick and adhesive.

 

However, a runny or watery consistency could suggest a low sperm count, potentially leading to male infertility.

Diagnosis and Tests

How is male infertility diagnosed?

Male infertility can be diagnosed by a primary care physician (PCP) or by referral to a specialist such as a urologist or a reproductive endocrinologist.

During the examination, the PCP will conduct a thorough physical assessment to gauge overall health and to pinpoint any physical issues that might impact fertility. They'll also delve into your sexual history and habits, inquiring about:

- The duration of attempts to conceive with your partner
- Past instances of impregnating a partner
- History of sexually transmitted infections (STIs), including testing and treatment
- Usage of contraceptives and types employed
- Family history of male infertility
- Lifestyle factors such as smoking, alcohol consumption, or recreational drug use
- Current medication regimen

If the physical examination and health history review yield no apparent causes, further tests may be ordered to delve deeper into potential male infertility issues.

Which examinations are utilized in diagnosing male infertility?
One of the primary diagnostic tools employed by healthcare providers is a semen analysis, which assesses the volume and quality of sperm within a semen sample.

Additional tests that a provider may recommend to pinpoint or exclude potential causes of male infertility encompass:

- Imaging examinations: These may involve noninvasive techniques like ultrasound or magnetic resonance imaging (MRI), or more invasive procedures such as venography.
- Blood tests: These assessments can gauge hormone levels and detect any abnormalities in genes or chromosomes.
- Urinalysis: This urine test aids in diagnosing sexually transmitted infections (STIs) and diabetes.
- Testicular biopsy: Here, a small sample of testicular tissue is extracted to evaluate sperm production capability.

Management and Treatment

Is it possible to address male infertility?
Certainly. There are various treatment options available to tackle male infertility. Your treatment plan might incorporate the following, depending on the underlying cause:

Lifestyle adjustments:
   - Maintaining a healthy weight suitable for your body.
   - Incorporating more fruits and vegetables into your diet.
   - Engaging in regular physical activities like walking, jogging, cycling, dancing, or weightlifting.
   - Managing stress levels effectively.
   - Quitting smoking, alcohol consumption, and the use of recreational or nonprescription drugs.
   - Avoiding the use of sexual lubricants during intercourse.

Surgery

Surgical interventions may encompass:

1. Vasectomy reversal: This procedure reconnects the vas deferens, allowing for the possibility of pregnancy by restoring the flow of sperm into the semen, typically after a previous vasectomy.

2. Vasoepididymostomy: This surgery addresses blockages within the epididymis, the tube adjacent to the testicle where sperm matures, thus enabling sperm to enter the semen.

3. Sperm retrieval: Through a biopsy, healthcare professionals extract sperm from either the testicles or the epididymis.

4. Varicocelectomy: This procedure treats varicocele, a condition characterized by the pooling of blood in the testicles due to varicose veins in the scrotum, which can impair sperm quality. By removing these varicose veins, the surgery may enhance the likelihood of pregnancy in certain cases.

Prevention

Is it possible to prevent male infertility?

Decreasing the likelihood of male infertility involves:

1. Refraining from or quitting smoking, alcohol consumption, and nonprescription drug use.
2. Minimizing exposure to harmful chemicals.
3. Keeping current with vaccinations against viruses that could impact fertility.
4. Avoiding prolonged exposure of the testicles to heat.
5. Adopting a diet low in fats and maintaining a healthy weight.
6. Consult with Dr. Paul Naveen about additional risk factors and strategies to mitigate them.

If diagnosed with cancer, discuss sperm banking with a healthcare provider before beginning treatment.

Which foods and beverages should be avoided if dealing with male infertility?

There are indications from research that the following items could potentially impact sperm quality:

1. Processed meats
2. Sweets
3. Soy
4. Dairy products
5. Canned fish
6. Sugary sodas and similar beverages
7. Alcohol
8. Caffeine

Opting for a well-rounded diet that includes the following could be advantageous:

1. Fresh fruits and vegetables
2. Dried fruits
3. Legumes
4. Lean fish
5. Low-fat milk

When Should I Consult a Doctor?

It's advisable to seek guidance from Dr. Paul Naveen if you and your partner have been unsuccessful in conceiving after a year of attempts. Additionally, if you're experiencing emotions like depression, grief, or feelings of inadequacy, consider scheduling an appointment with a therapist.

A Message from NU Urology and Andrology Clinics

Dealing with male infertility presents significant hurdles. It impacts approximately 15% of men in India striving to conceive a biological child. Fortunately, advancements in technology offer hope for many couples in achieving their goal of parenthood. If your partner is unable to conceive after a year of trying, consulting Dr. Paul Naveen is advisable. Lifestyle adjustments can potentially mitigate infertility risks, while various surgical and procedural interventions exist to address underlying causes.

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