Male infertility corresponds to a low reproductive capability due to insufficient sperm production or abnormalities in the quality of the spermatozoa produced. The couple's infertility is determined when it is impossible to achieve a pregnancy after more than a year of free and unprotected intercourse.
We speak of primary infertility when the man has never induced a pregnancy and secondary infertility when the man has already previously caused a pregnancy.
What is male infertility?
Male infertility affects 8% of men. It is a widespread cause among men. It is a general cause of infertility in couples. Compared to the past, today, it is believed that in 1 in 2 cases, the difficulty in having a pregnancy depends on male reproductive problems. The causes are insufficient sperm production or the qualitatively altered nature of sperm (due to reduced motility, altered morphology, or damaged DNA) that hinder conception.
Infertility is different from sterility, which is ascertained when there is a total absence (azoospermia) or drastically insufficient (crypto-azoospermia) of sperm in the seminal fluid or when there is no ejaculation (aspermia) or the spermatozoa present in the seminal fluid are dead (necrozoospermia ). Even if there are no sperm in the seminal fluid or the man doesn't ejaculate, it is still possible to find healthy sperm that can be used to get pregnant.
Some causes, such as genetic ones, are still being investigated by scientific research.
- Genetic causes: when there is reduced production of sperm, generally, the reason is due to an imperfect development of the testicles. This congenital disability may already exist in the foetus because of a genetic predisposition linked to toxic environmental factors.
- Cryptorchidism is the failure of the testicles to descend into their location within the first year of life. Surgery fixes the problem in the first few years of life, but the testicles still work less well than they should.
- Due to the bacteria present, the inflammatory and infectious states of the seminal tract can damage sperm, the prostate, and seminal vesicles.
- A febrile episode can hamper the reproductive capability for six months.
- Heat sources: too tight polyester pants can raise the temperature in the area of the genitals and affect fertility.
- It is an acute or chronic inflammation of the epididymis, an organ placed behind the testicle essential for producing seminal fluid.
- Varicocele is a dilation of the testicular veins. In most cases, it involves the left testicle. It can damage sperm DNA by reducing male fertility.
- Their presence reduces the fertilising capacity of sperm and can hinder their transit through the female genital tract.
- Erectile dysfunction: Erection-related dysfunctions are linked to 5% of infertility cases.
- Sexually transmitted diseases like Papillomavirus, Syphilis, Gonorrhea, and Chlamydia can provoke infertility.
- Medications: Anticancer drugs, those for the treatment of hypertension or high cholesterol (dyslipidemia), are a risk factor.
- Surgery: Surgical treatments of the genitourinary tract, inguinal hernias, or demolition treatments following neoplasms can modify, even irreversibly, the male reproductive capacity.
- Trauma and testicular torsions can affect their functionality.
- Lifestyles: Smoking tobacco or cannabis damages the integrity of sperm DNA and reduces sperm count and motility. Other risk factors include a sedentary lifestyle, obesity, poor diet, and alcohol and drug intake.
- Environmental risks: pesticides, solvents, plastics, paints, and electromagnetic radiation can reduce fertility.
Generally, there are no specific symptoms.
Exceptions are varicocele, which can be "silent" or give a feeling of discomfort or weight at the scrotum level. When the uroseminal canals are inflamed, people often go to the bathroom quickly and feel pain when they urinate or ejaculate.
The stereogram is the main examination for the evaluation of sperm and sperm.
It allows for evaluating the volume, pH, concentration, morphology, motility, viscosity, leukocytes, spermatogenetic cells, and the absence of areas of agglutination, i.e., the formation of agglomerates caused by the presence of autoantibodies and infections in progress. It must be carried out after 3-5 days of abstention from sexual intercourse. At least two ejaculates, obtained at intervals of not less than 2.5 months apart in qualified centres, shall be evaluated.
Sperm function analysis
The TUNEL, SCSA, and HALO tests allow you to identify cases of alteration of sperm DNA (sperm DNA fragmentation). It is useful when the number and motility of sperm detected by the programme are standard.
With the MAR-Test, you can find out if sperm have anti-sperm antibodies on their surface.
- Bacteriological examination
- Scrotal echocolordoppler
- Prostate-vesicular ultrasound
- Genetic analysis (blood test): the karyotype allows chromosomal irregularities to be identified.
- Testicular biopsy: to estimate the functionality of the testis
In about 30% of male infertility cases, it is impossible to identify the cause of infertility; therefore, it is not possible to use a specific therapy.
Medical treatments work best for symptomatic or asymptomatic infections of the reproductive system, which affect 15% of couples having trouble having children. These treatments involve taking antibiotics and anti-inflammatory drugs.
In the case of hormone alterations such as hypogonadotropic hypogonadism (a rare hereditary condition characterised by the deficiency of certain hormones), it is possible to intervene with a hormone-based medical therapy to restore the delicate balance of sperm components.
Antioxidants (vitamin C, vitamin E, carnitine, acetylcarnitine, glutathione, coenzyme Q10, astaxanthin) have improved some less severe infertility conditions. In the presence of varicocele, surgical correction allows natural conceptions within nine months in 25–35% of couples (depending on female age). The intervention may help improve the fragmentation of sperm DNA given PMA cycles.
If there is a more severe condition, medically assisted procreation procedures must be resorted to if conception is achieved.
ICSI, which stands for "Intracytoplasmic Sperm Injection," is a method for putting a single sperm into the cytoplasm of an egg.
IVF (in vitro embryo transfer fertilisation – IVF – In-vitro Fertilization) promotes fertilisation by selecting and preparing oocytes and sperm. Oocytes and sperm are put into contact, and fertilisation occurs spontaneously.
Even if there are no sperm in the seminal fluid, that does not mean they are not being made. When there aren't any sperm in the seminal fluid, sperm can be taken from the testicle or epididymis. Even though there aren't many of them, they can be taken by aspirating them surgically or by sticking a needle through the skin.