Addressing The Facts About Male Infertility
Infertility, as we know is the inability of a couple to have a child, despite having unprotected sexual intercourse for more than one year. Of the many causes leading to infertility, malefactors are responsible in about one-third of the cases, female factors in one-third and both, male and female factors, or unknown reasons comprise of what’s left.
Male infertility can be the result of either insufficient or absent production of sperms, which are microscopic cells secreted in the semen, leading to the fertilization of the female ovum (egg), resulting in a pregnancy.
Causes Of Male Infertility
Insufficient or absence of the production of sperms occurs due to an interruption of the normal processes of production in the testes.
Sperm production requires temperatures of around two degrees below the normal body temperature, which is why nature designed a sac to hold the testis away from the warmer parts of the body.
A constant increase in temperature around the scrotum (which is the sac containing the testes) is known to decrease sperm production.
Hormonal abnormalities are also known to decrease sperm production. These can occur due to abnormalities in the thyroid, the pituitary (a small gland in the brain), or can result from local defects in the testes, which is unable to recognize the hormones and thus, do not produce sperms.
Fortunately, most of these conditions can be treated with ‘exogenous’ hormones which mean hormones are administered to the affected patients, which in turn enhances the chances of sperm production.
Genetic diseases meaning the patient has been born with defects in hormonal production or action are more difficult to treat – an obvious reason for which causes are not known until it is too late. Sperm production starts in the testes around puberty (11-15 years) and most males do not marry until their 20’s – by then the defects’ set in and it is almost impossible to reverse the errors.
Any disruption to the testis can also adversely affect sperm production. An example of this is a massive injury to the testes, such as with a football, or cricket ball, resulting in swelling and internal bleeding, or mumps in a teenager, which can involve the testes.
After sperm production, comes the need to transport the sperms to an organ from where they can be delivered to the female vagina. A collection of multiple tubes, namely the epididymis, vas deferens, ejaculatory ducts, and seminal vesicles, all of which are paired, transport and prepare the sperm for their eventual function – fertilizing the egg (ovum). A disruption at any level of this pathway can result in absent sperm in the semen and though the male will still have semen, the semen will have no sperm.
It must be noted that both the pathways should be disrupted at the same time, for infertility to occur – so even one functioning testis with an intact pathway, is enough to make a male fertile.
In most cases, the interruption of the pathway is not a certificate of disaster – there are methods to bypass the need for the pathway, such as directly extracting the sperms from the testes – a method known as ‘Testicular Sperm Aspiration.’ In this method, the sperms are extracted from the testes, then bathed in a fluid which prepares them for fertilizing the egg, and then directly implanted into the egg which has to be extracted from the female, a process known as ‘In Vitro Fertilization,’ or IVF.
There are also surgeries available for connecting the disrupted tubes, if both ends are patent and functioning. The success rates of these surgeries in the hands of experts are over 80 per cent.
From injectable hormones to orally taken tablets, to simple lifestyle changes, there is treatment for almost every cause of male infertility, except the rare congenital causes.
Roadblocks
There are some patients, who despite having functioning testes, with functioning pathways, are unable to father children. This is often the result of two major problems – either an inability to ‘ejaculate’ sperm-containing semen at all, or an inability to ‘ejaculate’ sperm-containing semen within the vagina of the female.
An inability to ejaculate called ‘anejaculation,’ is treatable, through the ‘artificial ejaculation’ or electro-ejaculation’ which is done by applying a small electric current to the prostate, resulting in ejaculation which is then collected and deposited into the vagina of the female.
Premature ejaculation is ejaculation which occurs within one minute of the erect penis entering the vagina, or outside the vagina preventing proper insemination. Behavioural therapy and medication has been found useful to treat this condition.