Male infertility is the incapability of males to impregnant their fertile woman. Male infertility affects 7-10% of all men. Mainly, it solely contributes to 20% of the cause in infertile couples, and together with female factors, it constitutes approximately 30 to 40%.
Male infertility can be accounted to many reasons such as defective synthesis of sperms seen in conditions like varicocele, infections, sperm antibodies, tumours of testis, undescended testis, hormonal imbalance, genetic causes or medications and any previous surgeries. It can be caused due to improper or inadequate ejaculation of sperms like ejaculatory dysfunction, erectile dysfunction, premature ejaculation, painful intercourse, abnormalities in the urethral opening, psychological causes. Environmental and lifestyle causes like smoking, alcohol consumption, drug abuse, etc., can also affect the sperm quality.
The main presentation is the inability to conceive a child. They can also present with swelling due to dilated veins around the testicles, problems with sexual function like low or no ejaculate, reduced libido, erectile dysfunction, etc. In men who have genetic condition they can present with symptoms associated with inherited disorders such as inability to smell, recurrent respiratory infections, abnormal breast growth, decreased facial or body hair. In a few conditions, where the semen parameters are normal, the sperm is incapable of fertilising the egg, or the sperm has genetic conditions that prevent normal fetal development.
Evaluation is done when there is no conception after one year of unprotected intercourse, and where the female partner is above 35 years, evaluation is done after six months of unprotected intercourse. Men having concerns about their future fertility are also evaluated early.
A detailed reproductive history, medical conditions and history of previous fertility is taken and thorough general physical examination is done. It is recommended to abstain from sexual activity for 2-5 days before a semen analysis. The semen analysis shows absent sperms or abnormal semen parameters ranging from low sperm count, reduced motility, abnormal structure of sperms, and a combination of these abnormal parameters.
Based on the results obtained, additional tests and procedures may be recommended, including serial semen analysis, endocrine evaluation, post-ejaculatory urinalysis, ultrasonography, testicular biopsy, specialised tests on semen and sperm, genetic screening, etc.
The treatment options include surgery for conditions like varicocele repair, sperm retrieval techniques, treating infections with antibiotics, treatment of sexual problems with medications and counselling, hormone replacements and medications. Assisted reproductive technology where the sperm is obtained through surgical extraction is advised in men severely affected semen parameters or when there is no sperms seen in the semen sample. In men whose sperms cannot be obtained a meticulous counselling and the options of donor sperms is advised.
