The man is primarily or jointly responsible with the woman in approximately 50% of infertile couples. Infertility is the absence of pregnancy after one year of sexual activity without the use of any contraceptive system.
Fundamental causes of male infertility
Generally speaking, men can be infertile due to the following causes:
- Problems depositing semen in the female genital tract: These include erectile dysfunction (absence of erection), severe premature ejaculation (ejaculation before penetration can take place), absence of ejaculation (usually due to psychological problems), retrograde ejaculation (semen goes into the bladder instead of the urethra, which can happen for example in diabetic men), severe anomalies of the urinary meatus that abnormally flows into any part of the penis or the perineal area and other penile disorders such as severe curvatures or other congenital anomalies (from birth).
- Alterations in the number of spermatozoa in the semen: There may be no sperm at all, which is called azoospermia, either because they are not produced at the testicular level (due to congenital, genetic, hormonal, traumatic, toxic, vascular disorders such as the so-called varicocele, etc.) or because there is some malformation or obstruction at any level of the seminal duct (the path followed by the spermatozoa from the testicle to the urethra). These disorders can be present from birth, or be the consequence of trauma or infections. It can also happen that there is a reduced number of spermatozoa (below 15 million/ml, which is the lower limit of normality). This situation is called oligozoospermia and may be due to any of the causes mentioned above.
- Alterations in the quality of the spermatozoa. Either of the progressive motility, which must be at least 32% (if it is lower it is called asthenozoospermia) or of the shape (more than 4% must have a normal shape; otherwise it is called teratozoospermia). Its causes can be of various types, although with a high frequency they are unknown, as is the case in a large number of male infertilities.
Is it possible to prevent male infertility?
There are problems that can be detected in childhood, such as the failure of one or both testicles to descend into the scrotal sac at birth, which is called cryptorchidism. In these cases, medical or surgical treatments should be applied before the age of one year to try to avoid alterations in sperm production. All problems involving testicular enlargement at any age (trauma, inflammation, torsion, etc.) should be treated. A significant varicocele (dilatation of the veins that mainly come out of the left testicle) can affect the number and/or quality of the spermatozoa, so it may be advisable to perform a small surgery consisting of ligating the veins (varicocelectomy).
In those patients who are going to undergo certain treatments such as chemotherapy or radiotherapy, it is advisable to freeze spermatozoa beforehand in order to be able to use them in the future, if necessary, in assisted reproduction techniques.
How is male infertility studied?
First of all, an exhaustive clinical history and physical examination should be carried out, mainly of the genital area. Next, 1 or 2 semen analyses should be requested. Depending on the results of these tests, other studies such as hormonal, genetic or bacteriological studies, either in blood or semen, may be indicated. In certain cases, a small sample of testicular tissue must be obtained to determine the nature of an azoospermia with the possibility of freezing spermatozoa in the same act in case there are any.
Imaging studies such as ultrasound and Doppler may also be necessary to detect certain abnormalities of the testicle (e.g. inflammation), of its blood vessels (e.g. varicocele) or of the seminal duct.
Applicable treatments for male infertility
Whenever possible, the pathologies that may be responsible for infertility should be treated, either pharmacologically (e.g. antibiotics and anti-inflammatory drugs in cases of infections or inflammation of the testicles or seminal tract) or surgically (e.g. surgery for varicocele). In cases of low sperm count or poor sperm quality, in which no possible cause is detected, treatments such as antioxidant drugs can be applied with dubious and inconsistent results.
When there is an obstruction of the seminal duct, certain techniques such as microsurgery or endoscopic surgery may be indicated by the specialist in Andrology, either to reconstruct or unblock the duct.
When no other treatment is possible or when other treatments have failed, assisted reproduction techniques such as intrauterine insemination (sperm are deposited inside the uterine cavity) should be recommended, classic in vitro fertilization (IVF) (eggs and sperm are brought together while waiting for the latter to penetrate the former) and intracytoplasmic sperm injection (ICSI), where one sperm is injected into each of the woman’s eggs after hormonal stimulation to obtain a good number of eggs.
ICSI is the current technique of preference in severe cases of male infertility, in which sperm obtained from the semen, testicle or any level of the seminal tract can be used.
When sperm or eggs cannot be obtained, or are of poor quality, or when previously applied techniques have failed, consideration should be given to the use of donor germ cells for use in assisted reproductive techniques.