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Common male fertility problems that may affect conception

The topic of fertility problems in women is usually openly discussed in our society. Yet male infertility continues to be a very embarrassing, and often ignored topic. When a couple is trying to have a baby, it’s the woman who usually willingly subjects herself to tests and examinations. The treatment focuses on the woman, even though oftentimes the man needs to be examined and treated as well.

If there’s a problem with conception, it often affects both partners. Therefore, diagnosis and possible treatment should begin at the same time for both. If you’ve been trying to have a baby for longer than 12 months (or for longer than six months if you’re over 35), and despite regular intercourse you are still not pregnant, do talk to your partner and encourage him to join you for a visit at the doctor's office. At first, it could be a gynecologist who will guide you and suggest some further examination.

The cause of infertility in men is usually much easier to diagnose than in women (many of the examinations done on women need to be carried out during a specific day of the cycle), but the majority of women's problems are much easier to treat. While male infertility can be very effectively treated, it usually requires more time. 

couple hoping to get pregnant

The diagnostics of infertility in men usually include:

  • Semen analysis (the most important diagnostic test of male infertility), including examining the presence of sperm antibodies in the semen.
  • Physical examination performed by an urologist.
  • Imaging studies (primarily ultrasound).
  • In case of the absence of sperm in the semen - testicular biopsy, which helps determine whether there are spermatogonia present in the male gonads.

The most common problems affecting male fertility are:

 Disorders related to sperm quality

Male problems with conception are often caused by defective sperm, including low sperm motility, low sperm count or changes in the sperm structure. Contrary to what people once thought, the most important parameter determining a man’s fertility is sperm motility, not sperm count.

Possible symptoms:

  • Disorders related to the quality of sperm don’t have any noticeable symptoms. A semen analysis is necessary to detect defects in semen.

Possible solutions in order to conceive:

  • Administration of medication that stimulates fertility.
  • Intrauterine insemination (IUI) of the woman, provided that the number and motility of sperm is good enough for this purpose.

 Ejaculatory duct obstruction

In some men, the infertility problem stems from obstructed ejaculatory ducts. Ejaculatory duct obstruction can be either congenital or acquired through sexually transmitted diseases and chronic inflammation.

Possible symptoms:

  • Ejaculatory duct obstruction doesn’t have any noticeable symptoms.

Possible solutions in order to conceive:

  • Surgical removal of the obstruction.
  • Sperm extraction from the ejaculatory duct or the testicle.

 Varicocele

This condition, just as the more commonly known vascular veins in legs, is caused by the enlargement of the veins in the scrotum. It affects relatively young men and is one of the most common causes of fertility problems. As much as 15% of all fertility problems is caused by varicocele. Varicose veins cause overheating and hypoxia of the testicles, which contribute to disorders in their functions and thus to impaired sperm production.

Possible symptoms:

  • At first, there are no symptoms.
  • Eventually, a sensation of gravity in the groin and scrotum may occur, escalating while standing up or lying down.
  • Tangible thickening of the veins.
  • A warm or “burning” sensation in the testicles.

Possible solutions in order to conceive:

  • Surgical removal of the varicose veins.

 Congenital and acquired genital defects

Male genital defects may also be serious obstacles to fertilization, because they can lead to failure or disorders in the production of sperm. Genital defects include: lack of one or both testicles, a testicle located outside of the stratum, abnormal function of the testicles, and testicular cancer.

Possible symptoms:

  • Apart from visible changes (e.g. lack of a testicle), congenital defects don’t have any noticeable symptoms.

Possible solutions in order to conceive:

  • Treatment is chosen based on the specific congenital defect and the fertility problem it generates.

 Autoimmune problems

Sometimes the male body produces sperm antibodies that destroy and impair sperm function. Sperm antibodies cause sperm clumping, thus reducing their motility and making it difficult for them to reach the egg cell. Reasons for the production of these antibodies are unknown, but they are more common in men suffering from ejaculatory duct dysfunction, testicular trauma, and a history of acute inflammation and infection of the reproductive system.

Possible symptoms:

  • Autoimmune problems don’t have any noticeable symptoms.

Possible solutions in order to conceive:

  • Intrauterine insemination (IUI) of the woman, provided that the number and motility of sperm is good enough for this purpose.
  • Administration of medication that blocks the production of specific antibodies.

Other factors that may lower male fertility, and thus greatly prolong the waiting time for conception, include:

  • Pollution (e.g. toxins, dyes, heavy metals, pesticides).
  • Overheating of the genital area.
  • Improper habits and lifestyle (smoking, excessive alcohol consumption, obesity, stress, poor diet).
  • The use of certain drugs (high doses of androgens, corticosteroids and quinine, morphine).
  • Other diseases (nephritis, diabetes, anemia, liver disease).
  • Infection (e.g. sexually transmitted diseases, complications from mumps).
  • History of chemotherapy and radiotherapy.

It is worth remembering that about 25-30% of male fertility problems remain unsolved (so-called idiopathic infertility). This means that either the main reason of fertility problems has not been diagnosed, or that there may be several factors affecting conception simultaneously.

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