Male Infertility – How to get a baby?

sperm, fertilization, live

Fertility is often regarded as an issue that only women should be concerned about. However, because it takes two to tango, not all fertility issues are due to the woman. In fact, for couples unable to conceive within 2 years, male infertility is the underlying reason up to 50% of the time.

So before you drop your partner off to the gynecologist and watch some Netflix, read a bit more about how you can help improve the chances of having a child.

Guidelines vary on the definition of infertility with most stating it as being unable to conceive after 12 months of consistent efforts. However, because 25% of couples who cannot conceive in 1 year still have an average reproductive potential, there are guidelines that extend the time frame to up to 2 years.

The other variable here is the age of the woman. If the woman is not yet 30 years old, Doctors are more willing to allow the couple to try to conceive for 1 year before actively intervening. If the woman is above 30 years old, Doctors may want to intervene if the couple is unsuccessful after only 6 months. Remember these are just rough guidelines and the final decision of when to start tests and treatments depend on your Doctor.

How do I test for my fertility?

Testing for fertility potential in men is extremely straightforward. The man just has to provide a semen sample. The sperm in the semen is then counted and various parameters such as motility, vitality and morphology are studied. This provides an indirect indication of fertility potential and does not measure fertility per se.

Golden tip – for the most accurate results, refrain from ejaculating 3 to 10 days prior to the test.

What is my role?

The man’s role in conceiving a child can be broken down into 2 crucial functions:

  • Sperm Production and Storage
  • Sperm Delivery

If these functions are not optimised, there can be a negative impact on sperm quality and the time taken to get your partner pregnant. This article will therefore revolve around these 2 functions and discuss – what the functions are, what can go wrong and what you can do about it.

Sperm Production and Storage

Sperm production and storage occurs in the testicles in a network of tiny tubes that are surrounded by cells that provide nutrients for the sperm cells to grow. The sperm cells need to “mature” from a single ball shaped cell into the full “flagellated” or tailed cells that we are so familiar with in order to successfully fertilise an egg.

Once the sperm are mature, they continue to remain within these tubules. Every 2 months, the old batch of sperm degrade and are absorbed back into the body to make way for a new batch of sperm.

Any interruptions in the maturation process or during storage can result in sperm that is misshapen – lacking a tail or head, moving abnormally or even dead.

What can go wrong?

There are 3 common factors that NEGATIVELY affect sperm production and storage, they are:

1. Testicular damage

    • Heat Exposure – Sperm require a temperature of less than 36°C to survive. Therefore, any prolonged heat exposure (e.g. cooking in industrial kitchens for long hours, soaking in a hot tub or Onsen, steam baths, tight underwear, tight jeans) can compromise sperm quality.
    • Trauma – the network of tubes in the testicles are fragile, hence any injury – falling onto your testicles or tight safety harnesses can damage the tubes and the sperm within them.

What to do?

Fortunately, because the testicles creates a new batch of sperm every 2 to 3 months, short term exposure or a single mild injury to the area is unlikely to have long term consequences on sperm quality. If your work puts you at risk of heat exposure and injury, try taking more frequent breaks to reduce the risk of injury to your testicles. Wear loose clothing like boxers instead of briefs. Stay away from tight jeans and pants. Avoid Onsens and steam baths.

2. Hormone Imbalance

    • Low Testosterone – Testosterone is the main male hormone. Sperm maturation requires Testosterone. There are several factors and illnesses that can compromise Testosterone production in the body. One of the most common factor is obesity. Because Testosterone is a fat soluble hormone, being obese results in the testosterone being “locked up” in the fat rather than helping in sperm maturation. Therefore, obesity results in a lowered testosterone in men and is why obese men find it more difficult to get their partners pregnant.
    • High Estrogen  – Estrogen is the main female hormone. Men also have Estrogen in their bodies but in small amounts. Various illnesses and diseases can increase the amount of Estrogen. Aside from lowering Testosterone levels, obesity can also increase Estrogen levels.
    • High Prolactin – Prolactin is the hormone responsible for lactation. Men also have it in small amounts in their bodies. Various illnesses, diseases and medication can cause the Prolactin level to become abnormally high.

What to do?

Measuring your Testosterone, Estrogen and Prolactin levels is done by a simple blood test. If the levels are abnormal more tests may need to be done to ascertain the cause. Very often, Doctors will advise weight loss and other healthy lifestyle changes like stopping smoking. If necessary, there are also prescription medicines that can be taken to help restore the hormonal balance and improve fertility.

3. Enlarged Veins

    • Like varicose veins that develop in your legs, similar loosening of veins can occur in the testicles too. These abnormally enlarged veins around the testes is called a varicocoele. This leads to more blood pooling in the testicles. Because the sperm need to be stored at a temperature less than 36°C, more blood pooling in the area can lead to a higher temperature and therefore poorer sperm quality.

What to do?

Varicoceles can be detected by clinical examination but an ultrasound scan is useful in determining the extent of the abnormality. Surgical repair is currently the only way to repair varicoceles and can improve fertility rates by up to 50%.

Oxidative Damage

In all 3 situations, sperm quality is compromised by a phenomenon known as Oxidative damage. This occurs when harmful molecules known as Reactive Oxygen Species are released when the body is injured. This situation can be improved by providing additional nutrients and antioxidants for the sperm to mature well. There is intense ongoing research to find compounds that help most but here are my top 3 based current clinical trial data

  • Vitamin E – Improves pregnancy rates by up to 15%
  • Co-enzyme Q10 – Improvement of Sperm movement by 10%
  • Carnitine – Improvement in Sperm movement

The main caveat to these compounds is that the data to support each one is still emerging with studies still being focused on specific types of patients rather than a general population.

Sperm Delivery

Now that we have created good quality sperm it is just as important that they reach their intended destination. Ejaculation is a reflex that propels the sperm from the testicles through the urethra and out of the penis. This propulsion is supposed to deliver the sperm to the cervix (top end of the vaginal canal), from there the sperm move upwards into the womb and up the Fallopian tubes to fertilise the egg.

Any obstructions along the path of the sperm will hinder their progress. And because sperm have a limited time to reach the egg before they die, if they are not deliver to the correct location at the correct time, fertilisation of the egg becomes difficult.

There are 4 common factors that NEGATIVELY affect Sperm Delivery, they are:

1. Retrograde Ejaculation

This means that instead of propelling the sperm forwards and out of the body, the sperm is going backwards into the urinary bladder. Risk factors that predispose to retrograde ejaculation include:

  • Previous STD infections
  • Previous mumps infections
  • Congenital malformations

What to do?

The volume of semen produced during the semen analysis is a useful marker to determine if there are any mechanical issues. The first sign of retrograde ejaculation is a Low Sperm Volume seen on the Semen Analysis. The normal amount of ejaculate produced should be between 1.5 ml to 5 ml, about half to 1 TEAspoon.

If a low volume of ejaculate is seen in the semen analysis the next step is to determine where the obstruction is. A follow up urine test after ejaculation is done to determine if there is any sperm in the urine, this would mean that instead of moving forward and out of the body the sperm is being propelled backwards into the bladder.

If the urine test does show sperm, further imaging like a MRI or cytoscope may be needed to determine the exact location of the blockage causing the sperm to be sent backwards. Surgery may be required depending on the extent of the blockage.

2. Tight Foreskin (Phimosis)

A tight foreskin becomes a bottleneck at the tip of the penis and can either block sperm from exiting the penis or reduce the force of ejaculation. In both situations, the sperm is not able to reach the cervix and make its journey to fertilise the egg.

What to do?

Depending on how tight the foreskin is, the general approach is to try to “stretch” the foreskin. If you are unable to easily retract the foreskin, DO NOT force it down. This can lead to a situation called paraphimosis which is a medical emergency. If it is REALLY tight, you might want to consider a circumcision.

3. Erectile Dysfunction

Having an erect penis is technically NOT necessary for getting your partner pregnant, however, having a penis that is hard enough to enter the desired location to deliver the sperm is useful.

What to do?

Many men face a problem of getting an erection “On Demand” when their partner is ovulating and therefore go on medication to help ensure that your delivery system is up and running when called upon. Click here to read more on ED medications. 

4. Premature Ejaculation

Ejaculation at the correct location gives the best chance of fertilisation, not being able to position the sperm at the cervix decreases the chances of getting your partner pregnant.

What to do?

There are also medications available for Premature Ejaculation but more than medicating the problem, it is important to review the technique of intercourse. This is especially important when you consider that the majority of your intercourse is directed at NOT getting your partner pregnant hence many men have developed a preference of ejaculating outside the vagina. Talk to your partner and find a comfortable position that works for both of you in order to ensure the most amount of sperm reaches its intended destination.

In Conclusion

To conclude, it is NOT just her, men play a vital role in conceiving a child and there are many factors a man should consider also especially when you and your partner are finding it difficult to get pregnant.

Have a question? Please put it in our comments section below.

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