Over the last few decades, sperm count has been declining steadily. Many studies have linked this alarming trend to our modern high-fat and nutrient-deficient diet.
One-third of the time the problem lies with the male, one-third of the time it lies with the female, and one-third of the time infertility is caused by problems with both the male and the female.
Infertility, which affects as many as one in six couples, is defined as the inability of a couple to conceive a child after one year of unprotected sex and is usually diagnosed through medical interviews and physical examinations of both partners.
Common causes
Infertility can be caused by a wide variety of factors. One-third of the time the problem lies with the male, one-third of the time it lies with the female, and one-third of the time infertility is caused by problems with both the male and the female. Sometimes either the sperm or the egg are unhealthy or there is some sort of mechanical obstruction keeping the sperm from fertilizing the egg. Once an egg is fertilized it must be able to become implanted in the uterus and then the embryo must be healthy and have the proper hormonal environment in which to develop properly. Metabolic imbalances, stress, increasing age, smoking, alcohol, exposure to toxic chemicals and drugs, and nutritional deficiencies or excesses can all negatively affect fertility. Infertility afflicts thousands of married couples leading to untold mystery and frustration. In India, 15-20 per cent of the married couples in their fertile age group suffer from infertility.
With the recent advancements in the management of infertility, the couple can realize their dream more reliably and that to at a fraction of what it costs to seek similar treatment abroad. A detailed history of both the partners and clinical examination is carried out. Depending upon the findings, previous investigations and treatment is done. There are various modes of treatment offered to curb infertility.
About six per cent of males between the age group of fifteen and fifty struggle with infertility. Male infertility can be caused by a variety of problems. Some of the more common disorders are listed below.
Deficient sperm production
Ninety per cent of male infertility is caused by the failure to produce enough sperm. Azzospermia occurs when no sperm is produced while olibospermia is diagnosed when few sperm are produced. Since most sperm are destroyed before even reaching the egg, the more sperm there are the better the chances that one will successfully fertilize the egg. However, a low sperm count, or a total sperm count of less than five million/ml, does not necessarily mean that a man is infertile but, if the sperm that he does have are healthy, properly formed, and mobile.
A low sperm count is determined by analysing a semen sample. Over the last few decades, sperm count has been declining steadily. Many studies have linked this alarming trend to our modern high-fat and nutrient-deficient diet. Since sperm are highly vulnerable to free radical and oxidative damage, healthy sperm formation requires an adequate and ready supply of the proper nutrients and antioxidants. Other possible reasons for low sperm count include increased scrotal temperature (elevated temperatures hinder the maturation of sperm), varicoceles, environmental factors (pollution and exposure to heavy metals), and exposure to synthetic estrogens such as those found in birth control pills and in livestock.
Varicocele
A varicose vein around one of the two spermatic cords can cause blood to pool in the testis; this, in turn, causes the temperature to increase in this area. Higher temperatures decrease sperm production and can lead to infertility. Fortunately, this problem can be fixed by surgery. Infections: Twenty-eight to seventy-one per cent of infertile men show some signs of an infection of their reproductive organs. The presence of anti sperm antibodies, which attack and destroy the sperm, are usually a good indicator that an infection is present. Of these infections, chlamydia trachomastis is the most common and the most serious. This disease is sexually transmitted and can damage the epididymis and the vas deferens in the male. Such infections are usually treated with an antibiotic.
Ductal obstruction
Blockage or damage to the spermatic tubes which is usually caused by a sexually transmitted disease and infections or a congenital abnormality.
Retrograde ejaculation
Retrograde ejaculation is caused when the nerves or muscles in the bladder do not work properly. What happens in this case sperm is transported backwards into the bladder instead of forward and out through the penis. Sometimes men will have cloudy urine after an ejaculation because of this.
Cryptorchidism
If the testes do not properly descend into the scrotom this is called cryptorchidsm. Cryptorchidism is fairly common in premature births and occurs in full term births at a much lesser rate. Usually this resolves itself within a few weeks, but sometimes corrective surgery is needed. Cryptorchism can seriously impair fertility rates.
Cystic fibrosis
Diseases like cystic fibrosis can affect male fertility. Men who have undergone chemotherapy or had sexually transmitted diseases may also be at greater risk of infertility.
Obstructions in reproductive tract
Obstructions in the male reproductive tract system is another cause of infertility. Men with obstruction problems are usually making sperm but it is not making its way outside of the penis. Common causes of obstructions are urinary tract infections, scarring from sexually transmitted disease, injury, vasectomy or anatomical defects.
Hormone deficiencies
Deficiencies in male hormone production such as testosterone can affect sperm production. Doctors usually ask questions about when puberty was started. The age at which males enter puberty can be an indicator of hormonal disorders.
Other disorders
Other disorders that can cause male infertility include abnormal development or damage of the testes (caused by endocrine disorders or inflammation), disorders of accessory glands, coital disorders, exposure to diethylstilbestrol (DES) a synthetic estrogen that causes cysts in the male reproductive tract, undescended testicles, and in rare cases genetic disorders such as a chromosomal abnormality.
(Author is senior consultant - Gynaecologist & IVF,
Apollo Hospitals, Bangalore)