Male Infertility

 
While problems regarding infertility are often blamed on women, men also play a significant role in creating 35-40% of the cases of infertility among couples. A variety of factors can affect a man's fertility, and some will be discussed below.

Environment

There are hazards in the workplace that can make men vulnerable to a decreased sperm count. Some of these include pesticides, x-rays, solvents in paint products and heavy metals such as lead, arsenic or mercury. As well, heavy use of drugs such as marijuana and cocaine can decrease the number of sperm and their production. Alcohol's toxic effects change the metabolism of steroid hormones in the liver, resulting in decreased sperm production. Similarly, cigarette smoking also reduces sperm counts. Many prescription medications can also affect sperm, eggs and sexual activity in general. In men, sulfasalazine, nitrofurantoin, tetracyclines, colchicines and chemotherapy all lower sperm count. Drugs such as cimetidine, ketoconazole, propranolol and antidepressants all cause impotence. Finally, conditions which increase male scrotal temperature chronically, such as frequent hot tub baths, wearing briefs, sitting for long periods of time and fever may impair spermatogenesis.

Anatomical Factors

There are a variety of anatomical factors within the male reproductive machinery that can be impaired and thus inhibit fertilization. Transport of sperm can be prevented through obstructions in the vas deferens that prevent sperm from leaving the testes. Vas deferens obstructions can result from infections such as gonorrhea or can be present at birth. Nearly 1% of males find that they do not ejaculate at the time of orgasm. This is known as 'retrograde ejaculation' where semen is ejaculated backwards into the bladder instead of outwards through the urethra. Testicular failure results in nonexistent sperm production and is untreatable. However, it may not always affect both testes. Within the scrotum, a hydrocele can result when there is an excess of normal lubricating fluid around the testes. Along with varicocele, these two factors contribute to increasing scrotal temperature, thus inhibiting sperm production.

Varicocele is the most common and easily treatable cause of male factor infertility. Occurring in 15-20% of infertile men, the condition is caused by a malfunction of testicular valves which allow for pooling of blood in the scrotum, thus elevating temperature. The resulting decrease in blood circulation is what affects fertility. Treatment for this condition is only used in extreme cases where large variscosities co-exist with pain. Surgical procedures are carried out to repair the abnormal collection of veins around the testes.

Frequency of Intercourse

Daily sexual intercourse can somewhat lower sperm count. Decreasing the frequency of intercourse, by abstaining for 10-14 days, may save up sperm and improve fertility. However, the sperm motility may be affected, since they are packed into such a high concentration.

Immunological Problems: Antisperm Antibodies

While both men and women can create antibodies to sperm, this is mainly a problem for men. Antibodies may develop on the surface of sperm, in semen or in the blood, particularly after the reversal of a vasectomy. Regarding fertility, it is the sperm antibodies that affect sperm motility and the ability of sperm to penetrate both cervical mucus and the ovum itself. During a semen analysis, antisperm antibodies cause sperm to clump (agglutinate) or shake. The process of washing sperm can increase pregnancy rates.

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