Males DO matter when it comes to fertility. A lot
For a number of years, Assisted Reproduction Techniques have formed part of our daily lives as another way to have children and build a family.
Assisted reproduction techniques have made it possible for males with severe sperm disorders, who in many cases would have never been able to impregnate their partners, to be parents today. Testing both members of the couple is essential to properly diagnosing the cause of infertility as well as being able to indicate the appropriate treatment and, if necessary, assisted reproduction technique.
According to extensive epidemiological research, infertility affects 15% of the population in the Western world, a percentage which is growing at an alarming rate due to both medical and social reasons. One in every six couples has difficulties conceiving and, contradictory to what was believed for a long time, the male plays a very important role in this issue.
We would like to place emphasis on the fact that postponing motherhood -whether for professional or social reasons-, is one of the most common causes of infertility which has been steadily rising since women joined the workforce. Other causes are endocrine factors, the environment, industry, our diet, etc. Our lifestyle habits have changed radically over the last 40-50 years and this shift has had a negative impact on our fertility.
The majority of couples who haven’t been able to fall pregnant after a year of having unprotected intercourse are most likely dealing with some fertility issue. It is estimated that between 25% and 35% of cases can be attributed to the male gamete (spermatozoid) as the sole cause or main cause of infertility.
Among the sperm abnormalities that are responsible for a decreased likelihood of natural conception, we know of issues with sperm production, interaction and development.
Failures in sperm production:
- Lack of sperm production.
- Abnormalities in the number, motility and morphology of sperm.
Failures in effective gamete interactions:
- Issues with erection and ejaculation.
- Abnormalities in the transport of sperm through the male or female genital apparatus.
- Abnormalities in fertilisation.
The first analysis which is fundamental to the male fertility study is the sperm analysis, the methods and standards of which are periodically updated by the World Health Organization. It’s recommended that you undergo this analysis with a specialised laboratory and that the report includes at least the essential parameters in order to determine a possible male factor.
The sperm analysis studies a set of sperm characteristics including sperm count or sperm concentration present in the ejaculate, sperm motility and sperm morphology.
Abnormalities regarding these three fundamental parameters may vary in terms of severity, and they are often related to one another. It is recommended that two sperm studies be performed on all males with fertility issues, especially if the first study comes back abnormal.
The type and severity of sperm abnormalities detected through the basic tests will help the doctor to determine whether more advanced sperm analyses are needed, and once all necessary testing has been completed the results will guide the doctor in deciding which assisted reproduction treatment is most appropriate in each case.
Once there is evidence that a male factor is present, an andrological exam will be required and should be based on the careful examination of the patient’s medical records, starting with data collection on:
- History of diseases such as prostatitis or genital infection.
- History of testicular trauma or testicular torsion.
- History of either premature puberty or delayed puberty.
- Exposure to toxic substances or dangerous elements in the workplace such as iron, lead, mercury, radioactivity or prolonged X-ray exposure.
- History of substance abuse with tobacco, alcohol, coffee or drugs.
- Exposure of the genitals to elevated temperatures, whether for medical or non‑medical reasons.
- Enduring a hernia and the recovery process.
- Having undescended testicles.
- Long‑term use of certain medications such as those used to treat ulcers or psoriasis.
- Medications that may have been taken by your mother when she was pregnant.
- Infection with mumps after puberty.
The patient’s family history may shed light on family conditions that could have an impact on fertility, as well as any previous surgeries or medical history that can provide information regarding procedures or possible injuries that could affect the patient’s fertility. The doctor should also make note of any possible abnormalities relating to the onset of puberty.
We can’t forget that factors relating to sexuality such as the frequency of intercourse, libido, difficulties with erections, ejaculation disorders or any other issue pertaining to the normal deposit of sperm in the vagina should also be recorded.