Male infertility is anything that causes an interruption at any point in the process of fertilizing the female egg during intercourse.
For a pregnancy to occur, the woman releases an egg from either ovary every month, which is called ovulation. This released egg travels towards the Fallopian tube. The end of the tube is shaped like the fringes of a dress. These fringes continually move in a wave like manner, to pull the egg into the tube, from where it begins to travel towards the uterus. At the end of the tube, just before it enters the uterus, it is met by a healthy sperm, which are contained in the ejaculate released during intercourse. The sperm travel upwards through the vagina into the cervix, and then into the uterus.
The sperm and the egg fuse together in a process called fertilization, and an embryo is formed. The embryo then continues the journey into the uterus and attaches to the uterine wall, in a process called implantation. Once implantation has occurred, the body starts to release more hormones that will aid in the growth of the baby, and the woman will discover that she is pregnant.
Anything that causes an interruption at any point in this process can cause infertility.
Causes of Male infertility
- Impaired sperm production – Sperm are produced in the testicles which are located inside the scrotum. Some conditions which can disrupt the production of normal sperm include:
- Undescended testes: The testis is not inside the scrotum, but is located higher up in the pelvis or abdomen
- Varicocoele: Abnormal enlargement of veins in the testes
- Raised scrotal temperature: Can be caused by long distance driving, tight underwear
- Impaired sperm transport – Some conditions can prevent sperm from being moved out of the testes and these include obstruction or malformation of the tube for transporting the sperm (vas deferens), blockage of the tube after a vasectomy (a method of permanent male contraception where the vas deferens is cut and tied off)
- Impaired ejaculation – Where there is a problem with the release of semen during intercourse. This includes:
- Premature ejaculation: Release of semen too early
- Retrograde ejaculation: The semen flows backwards and into the bladder instead of out through the penis
- Anejaculation: Ejaculation does not occur
- Impaired sperm function – This can be caused by a number of factors which include exposure to alcohol, smoking, marijuana, or steroids. Also medical conditions like diabetes, and exposure to chemotherapy or radiation treatments.
In up to 20% of cases, no definite cause can be found in either the man or the woman for infertility, when all tests done show normal results. Some of the tests done to make a diagnosis of male infertility include the following:
- Seminal Fluid Analysis (SFA): This is a test of the semen, to determine whether the sperm and fluid are healthy. The number of sperm (count), movement (motility), normal forms (morphology), live forms (vitality), total volume, acidity, and presence of an infection are checked.
- Hormonal tests: These are occasionally done to check the level of testosterone and other hormones in the body.
- Scrotal Ultrasound Scan: A scrotal ultrasound scan is done to detect abnormalities in the structure of the scrotum like varicocoele.
Depending on what abnormality is detected, the man might require referral to a Urologist for further management, with or without the need for Assisted Reproduction