Monday ,18 March,2024
McCreadie Andias,
Infertility is usually defined as the inability of a couple to conceive even after one year of unprotected, frequent sexual intercourse. The male is solely responsible in about 20% of cases and is a contributing factor in another 30% to 40% of all infertility cases with about 7% of all men worldwide labeled infertile at some point .
The burden of male infertility is often unrecognized and its causes are poorly understood thus efforts to increase awareness and understanding are being undertaken to improve fertility outcomes and overall health for affected men.
There are several reasons for male fertility to occur, including both reversible and irreversible conditions.
Causes for male infertility can also be broadly classified due to their general underlying etiology. These include endocrine disorders (usually due to hypogonadism) at an estimated 2% to 5%, sperm transport disorders (such as vasectomy) at 5%, primary testicular defects (which include abnormal sperm parameters without any identifiable cause) at 65% to 80% and idiopathic (where an infertile male has normal sperm and semen parameters) at 10% to 20%. These are broad estimates only as accurate statistics are unavailable due to general underreporting, cultural factors, and regional variations.
Patients sent to a tertiary referral center are more likely to have their condition reported, while private patients may never have their data collected.
One of the leading contributors to male infertility is the prevalence of unhealthy lifestyle habits. Sedentary lifestyles, characterized by physical inactivity and poor dietary choices, have become increasingly common in modern society.
A study published in the journal Reproductive Biology and Endocrinology found that men with a high body mass index (BMI) were more likely to experience reduced sperm quality and infertility. Furthermore, excessive alcohol consumption, smoking, and illicit drug use have all been shown to negatively impact sperm production and function. For example, research published in the Journal of Andrology demonstrated that smoking can lead to DNA damage in sperm, potentially reducing fertility rates.
Environmental factors play a significant role in male infertility, with exposure to endocrine-disrupting chemicals (EDCs) being of particular concern. EDCs are chemicals found in everyday products such as plastics, pesticides, and personal care items, which can interfere with hormonal balance and disrupt reproductive function. For instance, a study published in the journal Human Reproduction Update highlighted the adverse effects of phthalates, a common EDC, on male fertility. Additionally, exposure to air pollution and industrial chemicals has been linked to decreased sperm quality and fertility rates in men.
A study conducted in China, published in the journal Environmental Pollution, found that men living in areas with high levels of air pollution had lower sperm counts and motility compared to those in less polluted areas.
Genetic factors also contribute to male infertility, with certain genetic abnormalities and hereditary conditions impacting reproductive health. For example, Klinefelter syndrome, a chromosomal disorder characterized by an extra X chromosome, is associated with reduced sperm production and infertility. Similarly, Y chromosome microdeletions, which involve missing segments of the Y chromosome, can impair sperm production and quality.
Moreover, inherited conditions such as cystic fibrosis and autoimmune disorders can affect the functioning of male reproductive organs, leading to infertility.
Various medical conditions can affect male fertility, either directly or indirectly. Chronic diseases like diabetes, hypertension, and thyroid disorders can disrupt hormonal balance and impair sperm production. Infections of the reproductive tract, including sexually transmitted infections (STIs) and epididymitis, can cause inflammation and scarring, leading to blockages or damage to the reproductive organs.
Additionally, structural abnormalities such as varicocele (enlarged veins in the scrotum) and testicular torsion (twisting of the testicle) can interfere with sperm production and viability.
While often overlooked, psychological factors can also play a role in male infertility. The stress and anxiety associated with infertility diagnosis and treatment can impact hormonal balance and sexual function, potentially affecting fertility outcomes.
Additionally, societal expectations and cultural stigmas surrounding male infertility may lead to feelings of inadequacy and depression, further exacerbating the psychological burden on individuals and couples.
The prevalence of infertility is variable, and epidemiologically, male infertility has been documented less in developing countries.
The burden of infertility is generally worse in the developing world due to constrained medical resources and the high cost of treatment, as well as cultural fears, taboos, and stigmas.
It is much more difficult to identify and manage infertility where medical resources are already strained with basic health care.Globally, infertility affects approximately 13% to 15% of all couples, while one in five is unable to achieve pregnancy in the first year.
With regard to male infertility, the exact prevalence is still doubtful, as male infertility is not a reportable disease. Furthermore, payment for male infertility treatment is usually private, and hence they are not reflected in medical insurance statistics. Further, male infertility is often treated in outpatient settings, and such data is not typically added to large clinical databases.Of greater concern is the widely reported general trending, over recent decades, of reductions in sperm counts globally.
The average sperm counts in 1940 were 113 million/mL but dropped to 66 million/mL in the 1990s. This trend has continued worldwide as the mean sperm count declined by 51.6% between 1973 and 2018.Even more concerning is that the rate of decline increased after 2000, from a decline of 1.16% a year post-1972 to 2.64% annually post-2000.
A study estimated that the overall pure male factor infertility could range between 2.5% and 12%. In North America, the estimated male infertility rate is between 4.5% – 6%, while it’s 9% in Australia and could be as high as 8% to 12% in Eastern Europe. In Africa, infertility prevalence rates are higher and range from 20-35%4-7. The “infertility belt”, geographical regions with high infertility prevalence, is well-known to Africa, stretching from West Africa, through Central to East Africa.
Several reports have shown deterioration of male sperm quality worldwide.Here in Kenya, a study at the Kenyatta National Hospital shows this is one of the fastest-growing causes of infertility. In 2013, only 7.6 per cent of men at the KNH fertility clinic had no sperm in their semen, but in 2018, the number doubled to 14.12 per cent.
But what remedies are there?..
Both medical and natural solutions offer avenues for addressing these issues .Some cases have been corrected medically through Assisted Reproductive Technologies (ART) with Techniques like Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), and Intracytoplasmic Sperm Injection (ICSI) can help overcome male infertility by directly facilitating fertilization or by bypassing natural barriers to conception.
Certain medications, such as Clomiphene citrate, can stimulate the production of hormones that trigger the release of testosterone and increase sperm production in some cases.
In other cases, Surgical procedures have been used to correct anatomical abnormalities such as varicoceles, which are enlarged veins within the scrotum that can cause low sperm production or poor sperm quality.Although effective, Medical solutions might not be the best for everybody due to their cost effectiveness and thus natural lifestyle solutions have been more convenient.
A healthy lifestyle, including regular exercise, a balanced diet rich in antioxidants, and avoiding excessive alcohol consumption and smoking, can improve sperm quality and overall reproductive health.
Some herbs, such as Tribulus terrestris and Maca root, have been traditionally used to enhance male fertility. These supplements may improve sperm count, motility, and morphology.
Stress can negatively impact fertility by disrupting hormone levels. Techniques like meditation, yoga, or counseling can help reduce stress and improve fertility outcomes.Some studies have also suggest that acupuncture may improve sperm quality and increase sperm count by enhancing blood flow to the reproductive organs and balancing the body’s energy flow.
Furthermore, Exposure to environmental toxins such as pesticides, heavy metals, and chemicals found in plastics and personal care products can harm sperm production and quality. Minimizing exposure to these toxins can help preserve male fertility.
It’s essential for individuals experiencing male infertility to consult with a healthcare provider to determine the underlying cause and appropriate treatment plan, which may involve a combination of medical interventions and lifestyle modifications for optimal results.
