By Aishat M. Abisola
Infertility affects nearly one in seven couples, meaning they have been unable to conceive after at least a year of regular unprotected sex. In up to half of infertile couples, male infertility is ei-ther the sole cause or a contributing factor.
Male infertility can result from producing too few sperm, producing sperm that do not function or move properly, or having blockages that prevent sperm from reaching the semen. Illnesses, injuries, long-term medical conditions, lifestyle choices, environmental exposure and certain treatments can also affect male fertility.
Symptoms and when to seek medical care
The main indication of male infertility is difficulty achieving a pregnancy. In many cases, there are no other obvious symptoms.
Men should consider consulting a healthcare professional if pregnancy has not occurred after one year of regular unprotected sex. Medical evaluation may be appropriate after six months when the female partner is older than 35.
How male fertility can be affected
Successful conception requires several processes to work properly. The reproductive organs must develop normally, the testicles must produce healthy sperm, and the body must produce adequate levels of testosterone and other hormones.
Sperm must also travel through the reproductive tract and mix with semen before ejaculation. A low sperm count reduces the likelihood of fertilising an egg. A sperm count below 15 million sperm per millilitre of semen or fewer than 39 million per ejaculate is considered low. In addi-tion, sperm must have sufficient movement and function to reach and fertilise an egg.
Environmental and lifestyle factors
Exposure to certain chemicals and environmental conditions can negatively affect sperm pro-duction and quality. Industrial chemicals, pesticides, herbicides, organic solvents and some paint-ing products have been associated with reduced sperm counts. Long-term exposure to lead and other heavy metals may also impair fertility.
Radiation can temporarily reduce sperm production, while high doses may cause longer-lasting damage. Excessive heat around the testicles may also affect sperm production. Frequent use of saunas and hot tubs has been associated with temporary reductions in sperm count. Prolonged sitting, including extended laptop use, and tight clothing may increase scrotal temperature, alt-hough further research is needed to determine their impact.
Lifestyle choices are also important. Anabolic steroids used for muscle building can shrink the testicles and reduce sperm production. Cocaine and marijuana may temporarily reduce sperm quantity and quality. Excessive alcohol consumption can lower testosterone, contribute to erec-tile dysfunction and reduce sperm count. Smoking may also reduce sperm production, while exposure to second-hand smoke may affect fertility.
Obesity can impair male fertility through effects on sperm quality and hormonal balance.
Medical causes
Several medical conditions can interfere with male fertility.
Varicocele, a swelling of the veins that drain the testicles, is one of the most common treata-ble causes of male infertility. It can reduce sperm production and quality.
Infections such as epididymitis, orchitis and certain sexually transmitted infections, includ-ing gonorrhoea and HIV, can interfere with sperm production, damage testicular tissue or cause scarring that obstructs sperm movement.
Ejaculation disorders, including retrograde ejaculation, can also prevent sperm from being released normally. In retrograde ejaculation, semen enters the bladder instead of leaving through the penis. Diabetes, spinal injuries, certain medicines and surgeries involving the bladder, pros-tate or urethra can contribute to this condition.
The immune system may sometimes produce antibodies that attack sperm, treating them as harmful substances. Tumours, whether cancerous or non-cancerous, may affect reproductive organs or hormone-producing glands. Treatments such as surgery, chemotherapy and radiation may also impair fertility.
Men whose testicles fail to descend into the scrotum during development may have reduced fertility. Similarly, disorders affecting the hypothalamus, pituitary, thyroid, adrenal glands or tes-ticles can disrupt hormones necessary for sperm production.
Blockages in the reproductive tract may result from infections, injuries, previous surgery or developmental abnormalities. These blockages can occur in the testicles, epididymis, vas def-erens, ejaculatory ducts or urethra.
Certain genetic conditions can also cause infertility. Examples include Klinefelter syndrome, in which a male is born with an additional X chromosome, and genetic conditions such as cystic fibrosis.
Problems with sexual function, including erectile dysfunction, premature ejaculation, painful intercourse and certain structural abnormalities, can make conception difficult. Psychological and relationship difficulties may also contribute.
Some medicines can reduce sperm production, including testosterone replacement therapy, long-term anabolic steroid use, chemotherapy and certain medicines used to treat ulcers or ar-thritis. Vasectomy and some scrotal, testicular, prostate and cancer-related surgeries may also prevent sperm from appearing in semen.
Risk factors
Risk factors include smoking, excessive alcohol consumption, illicit drug use, obesity, testicular injuries, previous vasectomy or major abdominal and pelvic surgery, excessive testicular heat, undescended testicles, previous infections and exposure to environmental toxins.
Other risks include inherited fertility disorders, a family history of infertility, tumours and chronic illnesses such as sickle cell disease and coeliac disease. Poor sleep and sleep apnoea may also affect sperm health. Certain medicines, cancer treatments, surgery and radiation can fur-ther increase the risk.
Complications
Male infertility can cause significant emotional and relationship stress. Couples may also face ex-pensive and complex fertility treatments. Some underlying conditions associated with infertility may increase the risk of other health problems, including testicular cancer.
Prevention
Not all cases of male infertility can be prevented, particularly those caused by genetic or una-voidable medical conditions. However, men can reduce some risks by avoiding tobacco and illic-it drugs, limiting alcohol consumption, maintaining a healthy weight and reducing unnecessary exposure to pesticides, heavy metals and other toxins.
Avoiding prolonged exposure to excessive heat around the testicles, managing stress and seek-ing prompt medical attention for infections, testicular problems and reproductive difficulties may also help protect fertility.
Male infertility is a medical condition with multiple possible causes, and inability to conceive should not automatically be attributed to the woman. Proper medical evaluation can identify underlying problems and, in many cases, appropriate treatment or assisted reproductive options can improve the chances of conception.
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