▪️What male infertility is ?

▪️The causes of male infertility

▪️ How to diagnose male infertility

▪️Solutions to male infertility

*WHAT IS MALE INFERTILITY?*

Before we define this, we need to understand what *INFERTILITY* is first of all. Infertility is the inability for a *couple* to achieve pregnancy after regular (3-4 times/week) and unprotected (no family planning up to 6 months) intercourse for a period of at most one year.

*Male infertility* therefore is any health issue that lowers the chances of the female partner from getting pregnant. About a third of all infertility cases are of male origin.

*WHAT ARE THE CAUSES OF MALE INFERTILITY?*

The problems of male infertility usually arise from sperm production or sperm delivery.

The male reproductive system usually makes, stores and transports sperm cells. This is achieved by the functions of hormones, most importantly, Testosterone. The sperm cells and testosterone are produced in the testes, coordinated by the brain and other hormones in the body. After production, the sperm cells leave the testes to the epididymis, a tube just behind the testes. Before ejaculation, the cells move to the vas deference, a duct connecting the epididymis and the ejaculatory duct. The ejaculatory duct arises from the seminal vesicle. During ejaculation, the sperm cells combine with fluid from the seminal vesicles and the prostrate glad and together, they become the semen. It is the semen that is released by the Urethra.

The semen acts as a transport medium for the sperm cells, to enable them swim to the fallopian tubes for possible fertilization with an egg.

So a problem with the fertility of a man can be tied to either the production or the delivery of sperm cells

*Male infertility* therefore is any health issue that lowers the chances of the female partner from getting pregnant. About a third of all infertility cases are of male origin.

We define infertility on couple basis. A couple can have an infertility challenge and the cause can be the man, the woman or both.

For male factor infertility, the man is the cause why the woman cannot get pregnant, even if the woman is fertile. This emphasizes the fact that one person cannot get pregnant by themselves.

*MALE INFERTILITY IS NOT*:

▪️Quick ejaculation: The time a man spends to release the semen does not affect its production or delivery and so is not a type of male infertility. If a man spends 1 min during intercourse and still releases semen containing healthy viable sperm cells, those cells can achieve pregnancy. So even if quick ejaculation is a reproductive health challenge, it is not infertility.

▪️ Watery semen: this is used to describe semen that is light in consistency. It can be due to diet, environmental exposure to dangerous substances, genetics etc. However, if the semen contains viable healthy semen, it can achieve pregnancy and so is not infertility. Also, the fact that fluid pours out after intercourse is not a sign of infertility. Every semen will liquefy after some time, allowing all the sperm cells to find their way through the cervix into the womb, while the remaining part, plain seminal fluid, passes out. If a woman rises soon after intercourse, gravity will cause the liquefied fluid to pass out of the vagina. This fluid does not contain the sperm cells.

▪️Erectile dysfunction: this is a condition where the man loses erection during intercourse. Such a person might be producing healthy semen, but other factors affect erection. If the condition doesn’t allow the semen to be released at all, then it can lead to infertility, but if somehow, the semen manages to be released, then it is not a cause of infertility.

▪️Small quantity semen:  The total amount of semen released during ejaculation is not a determinant of infertility. Normal volume of semen released is between 1ml to 5mls. 1ml of semen, if it contains adequate and healthy cells, can achieve pregnancy. Less than this might have a challenge of having adequate number of cells.

The process of spermatogenesis (sperm production) described above will go well if the genes, hormones and environmental conditions are right. When there is a challenge with any of these, male infertility ensues.

*Disorders of sperm production*:

▪️ Structural problems: like varicocele, spermatocele, retrograde ejaculation; here the structures of the reproductive system are not in their right form. This leads to a disorder in production of the cells. For varicocele, the veins around the testes are swollen causing a stasis of blood around the testes and making the environment too warm for proper sperm production. In retrograde ejaculation, the sperm is released into the bladder due to a structural defect in the sphincter.

▪️ Functional problems: here, some of the factors functioning to produce the cells are not in the right conditions; there might be hormonal problems in the man like deficiency of testosterone or abnormally high female hormones; a person can have immunologic infertility whereby the person produces antibodies that destroy the sperm cells due to previous injury, surgery or infection. This condition however is not common.

These conditions lead to:

• Poor cell growth of sperm cells
• Poor motility
• Wrong shape
• Reduced number produced (low sperm count)
• Azospermia (no production of sperm cells)

▪️ Environmental problems: Some conditions in a man can also lead to poor production of sperm cells. These include;

• Lifestyle like smoking and excessive alcoholism, poor diet, exposure to chemicals and radiations, etc.
• Long term illnesses like cancer, hypertension, diabetes, etc.
• Drugs/medications for arthritis, infection, cancer and high blood pressure
• Childhood infections like mumps
• Long term/ recurrent genital infections.

These factors are acquired factors that can affect production of sperm cells.

*Disorders of sperm delivery*:

Here, there is damage to reproductive system at the level of the epididymis or vas deferens, following a birth defect, an infection or accident. This can cause blockage along the path of delivery of the cells, thereby making the cells unavailable during for possible fertilization, hence causing infertility, even if the quantity and quality of the sperm produced is normal.

*HOW TO DIAGNOSE MALE INFERTILITY*

Investigations done to rule out or confirm male infertility include:

▪️Blood tests: to check the hormonal levels and immunological status

▪️ Seminal fluid analysis: to check the number of cells, motility and viability, normal and abnormal forms.

▪️Ultrasound scan of the testes: to detect structural abnormalities

▪️ Biopsy: to check for genetic defects or rule out conditions like cancer

▪️ Physical examination

*SOLUTIONS/TREATMENT OF MALE INFERTILITY*

The treatment is usually tailored to the problem detected but can include:

▪️Surgery usually minor and non-invasive e.g. varicocelectomy, embolization, etc.

▪️Medications for treating infections, correcting hormonal imbalances or boosting cell production

▪️Detoxification and use of supplements: where environmental factors are implicated, the act of detoxifying the system and using immune/production boosting products have been known to help patients facing such conditions. This method though might be unorthodox and not generally accepted, but is fast gaining popularity especially in our time and environment.

▪️ ART: artificial reproductive technology can be used to help patients who are infertile to achieve their dreams of being fathers. Methods include;

• IVF: in vitro fertilization
• TESA: Testicular sperm aspiration
• ICSI: Intracytoplasmic sperm injection
• IUI: intra uterine insemination