Male infertility refers to a male’s inability to cause pregnancy in a fertile female. It encompasses various conditions and factors that can impede the production or function of sperm, hindering the conception process.
Male Infertility
Causes of Male Infertility
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Varicocele
A varicocele is a swelling of the veins that drain the testicle, similar to varicose veins in the legs. It's the most common reversible cause of male infertility. Varicoceles can prevent the testicles from cooling effectively, which may affect sperm production and function.
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Infection
Infections can interfere with sperm health or sperm passage. Examples include epididymitis (inflammation of the epididymis) or orchitis (inflammation of the testicles). Some infections can result in permanent testicular damage, leading to infertility.
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Ejaculation issues
Conditions such as retrograde ejaculation occur when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate, or urethra.
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Antibodies that attack sperm
Immune system cells might mistakenly identify sperm as harmful invaders and attempt to eliminate them, reducing sperm functionality.
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Tumours
Cancers and non-malignant tumours can directly affect the male reproductive organs or can affect the glands that release hormones related to reproduction. Surgery, radiation, or chemotherapy to treat tumours can also affect male fertility.
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Hormonal imbalances
The hypothalamus, pituitary, and testicles produce hormones that are necessary for creating sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal gland, might impair sperm production.
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Medications and surgery
Certain medications can affect sperm production, function, and delivery. Additionally, surgery on the reproductive tract or a vasectomy can prevent sperm from reaching the egg.
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Environmental causes
Overexposure to certain environmental elements such as heat, toxins, and chemicals can reduce sperm production or sperm function. Prolonged bicycling, for instance, can increase testicle temperature, potentially impairing sperm production.
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Lifestyle factors
Activities such as drug use, tobacco smoking, and excessive alcohol can reduce sperm count. Obesity can also be linked to decreased sperm count and impotence.
Diagnosis of Male Infertility
Semen analysis
This is the most common test to assess male fertility. A sample of semen is collected and analysed for various parameters:
- Sperm count: Total number of sperm present in the sample.
- Morphology: Shape and structure of the sperm.
- Motility: Percentage of sperm that move normally.
- Volume: Amount of semen in one ejaculation.
- pH level: Acidity of the sample.
- White blood cells: Their presence might indicate an infection.
- Fructose level: Indicates if the seminal vesicles are functioning correctly.
Hormone testing
Blood tests can be done to evaluate the levels of testosterone and other hormones that are important in sperm production and sexual development.
Genetic testing
This test identifies specific genetic defects that might be causing infertility. For instance, a karyotype can detect additional, missing, or abnormal portions of chromosomal DNA.
Testicular biopsy
In cases where semen analysis shows very low or no sperm, a testicular biopsy might be recommended. It involves removing a small sample from the testicle with a needle and examining it to determine the nature of the problem.
Imaging tests
- Transrectal ultrasound: A small lubricated wand is inserted into the rectum to check the prostate and check for blockages of the tubes that carry semen.
- Scrotal ultrasound: This can help visualise abnormalities in the testicles and supporting structures.
Treatment Options for Male Infertility
Surgery
- Varicocele repair: A surgical procedure to repair enlarged veins in the scrotum can improve overall sperm quality.
- Blockage repair: Surgical procedures can correct blockages in the tubes that transport sperm.
- Vasectomy reversal: For men who have had a vasectomy and wish to conceive, a reversal surgery can restore fertility.
- Sperm retrieval: In cases where ejaculation is a problem, sperm can be extracted directly from the testicles or epididymis.
Medications
- Hormonal treatments: If infertility is caused by a hormonal imbalance, hormone replacement or medications may be prescribed.
- Medications for erectile dysfunction or premature ejaculation: Drugs can be prescribed to improve these conditions, enhancing the chances of conception.
- Antibiotics: If an infection is affecting sperm count, a course of antibiotics may be prescribed.
Hormone treatments and medications
Hormonal imbalances can impact sperm production. Treatment might involve hormone replacement or medications that alter hormone levels.
Assisted reproductive technology (ART)
These are procedures that obtain sperm and then use it to assist in fertilisation:
- Intrauterine insemination (IUI): Sperm is collected and then directly inserted into the woman’s uterus during ovulation.
- In vitro fertilisation (IVF): Mature eggs are collected from the female partner and fertilised by sperm in a lab. The fertilised egg (embryo) is then placed in the woman’s uterus.
- Intracytoplasmic sperm injection (ICSI): A single sperm is injected directly into an egg to achieve fertilisation, followed by IVF.
Prevention from Male Infertility
Avoid toxins and environmental hazards
- Chemicals: Prolonged exposure to certain industrial chemicals, such as pesticides, organic solvents, and herbicides, can reduce sperm count.
- Heavy metals: Exposure to lead or other heavy metals can also affect sperm production.
- Radiation: High doses of radiation can reduce sperm production. Limit exposure and protect oneself if working around radiation.
Avoid drug and tobacco use
Both recreational drugs and tobacco can decrease sperm quality and count. Quitting smoking and avoiding drug use can improve fertility.
Limit alcohol intake
Excessive alcohol consumption can lead to decreased testosterone levels and sperm production. It’s advisable to drink in moderation.
Maintain optimal weight
Being either overweight or underweight can affect hormone production and reduce fertility. Maintaining a balanced diet and regular exercise can help achieve and maintain a healthy weight.
Avoid excessive heat
Prolonged exposure to high temperatures, such as in saunas and hot tubs, can temporarily reduce sperm count. It’s also advisable to avoid tight-fitting underwear and prolonged sitting, which can increase scrotal temperature.
Manage stress
Chronic stress can interfere with hormones needed to produce sperm. Finding healthy ways to cope with stress, such as through relaxation techniques, exercise, or counselling, can be beneficial.
Practise safe sex
Sexually transmitted infections (STIs) such as chlamydia and gonorrhoea can affect sperm production. Using protection and having regular check-ups can prevent STIs.
Regular medical check-ups
Regular check-ups can help detect and treat potential health issues early, including those that might affect fertility.
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Conclusion
Understanding male infertility is helpful for couples trying to conceive. With advancements in medical science, various treatments are available to address the underlying causes, offering hope to many.
Dr Lee Fang Jann
Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders
He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).
- Bachelor of Medicine and Bachelor of Surgery (Singapore)
- Membership of The Royal College of Surgeons (Edin)
- Master of Medicine (Surgery) (Singapore)
- Fellowship of the Academy of Medicine (Urology)
- Clinical fellowship at Oxford Transplant Centre in the UK
Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.
Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.
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Frequently Asked Questions
How common is male infertility?
Male infertility affects about 1 in 20 men, contributing to 50% of all infertility cases.
Can male infertility be cured?
While some causes are treatable, others aren’t. Assisted reproductive technologies can offer solutions when a cure isn’t possible.
Are there any natural remedies or supplements that can improve male fertility?
Antioxidants like vitamin C and E may help. Herbal supplements like fenugreek have potential benefits, but always consult a healthcare professional first.
Can surgeries cause male infertility?
Yes, surgeries involving the testicles, prostate, or urethra can impact fertility. Vasectomy intentionally prevents sperm release.dure
Are there any myths or misconceptions about male infertility?
Common myths include believing infertility is mainly a female issue and that male fertility isn’t affected by age.
How often should one get tested if concerned about fertility?
If trying to conceive for a year without success, both partners should get tested. Known risk factors may warrant earlier testing.