Infertility is the inability of a couple to achieve pregnancy in one year after regular (at least three days in a week) unprotected intercourse. Infertility results from challenges with the reproductive capabilities of the male partner, or the female partner, or both of them.
Male infertility is a sole cause in about 20 percent of infertile couples. It contributes along with female infertility in 30 percent of infertile couples. Hence up to 50 percent of cases of infertility involves a man.
About 15 percent of couples will fail to achieve pregnancy after one year of trying to achieve it.
Types: Male infertility is divided into primary or secondary.
- In primary infertility, the man has no past history of impregnating a woman.
- In secondary infertility, the man has had other pregnancies or children attributed to him but now has challenges impregnating a woman again.
Generally speaking, some causes of secondary infertility may be more easily treated than primary infertility that may have underlying genetic or congenital (from birth) causes.
Causes: There are many causes of male infertility which can be divided into congenital or acquired.
- Congenital causes are the ones the patient is born with. They include genetic abnormalities such as Klinefelters syndrome, XX male, Kallman syndrome, Cystic Fibrosis, etc.
- Acquired causes are many. They include sexually transmitted infection, mumps, varicocoele, testicular torsion, testicular tumor, groin and scrotal surgery (if it causes injury to the reproductive tissues/organs), and systemic illnesses.
Management: Seminal fluid analysis is used to screen for male infertility using two samples which are taken one month apart. If the result is normal, no further evaluation is undertaken. If it is abnormal further investigations like sex hormone profile, scrotal and transrectal ultrasound, antisperm antibodies, genetic testing, and others become necessary.
Treatment is usually directed at underlying causes. The treatments
- Improve sperm production and/or
- Improve sperm delivery into the female reproductive system for fertilization of her egg.
Medical treatments may include
- Vitamin C and vitamin E which are antioxidants.
- Oral agents like clomiphene.
- Some herbal supplements are claimed to improve sperm production and or motility.
- Injectable agents for patients with pituitary deficiency.
Surgical treatments may be necessary in some men who have obstruction in their reproductive system which prevents adequate ejaculation of semen. The surgery aims to bypass the obstruction.
- In patients with azoospermia (total absence of sperm in semen), several sperm retrieval techniques are used to harvest the sperm from the man which is then injected directly into the egg for artificial fertilization.
- The option of sperm donation and adoption is available in men whose infertility is untreatable.
With advances in medicine, most cases of male infertility are treatable.
Dr Benjamin Odusanya is a Consultant Urologist. He is a Fellow of The West African College of Surgeons (FWACS) and The Medical College of Surgeons (FMCS). He works at The General Hospital, Marina, Lagos. He can be contacted on firstname.lastname@example.org.