Infertility used to be defined as the inability of a couple to achieve pregnancy after one year of unprotected sexual intercourse. But the American Society for Reproductive Medicine and other experts at a recent World Health Organisation meeting have revised this definition.
The new guidelines, to be published next year, encourage women and men over 35 years of age to seek fertility evaluation if they fail to conceive after six months of trying.
An estimated 15 per cent of couples meet this criterion and are considered infertile. About 35 per cent of cases of infertility are due to female factors; 30 per cent due to male factors, 20 per cent is a combination of female and male factors, and 15 per cent are due to unexplained factors.
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In general, scientists and fertility doctors are noticing a drop in sperm count and motility, which makes it harder for couples to achieve pregnancies. Conditions leading to infertility in men are still generally underdiagnosed and undertreated.
A man’s fertility rate generally relies on the quantity and quality of his sperm. If the amount of sperm a man ejaculates is low or if the sperm is of poor quality, it will be difficult and sometimes impossible for him to impregnate a female.
Male infertility is usually caused by problems that affect either sperm production in the testes or sperm transport.
The initial step in the evaluation of an infertile male is to obtain a thorough medical and urologic history. Important considerations include the duration of infertility, previous fertility in the patient and the partner, and prior evaluations. The couple should be asked specifically about their sexual habits, including their level of knowledge of the optimal timing of intercourse and the use of potentially spermatocytes and lubricants.
Patients should be asked about a history of childhood illnesses such as testicular torsion, post-pubertal mumps, developmental delay, and precocious puberty, as well as urinary tract infections, sexually transmitted diseases, and bladder neck surgery. A history of neurological diseases, diabetes, and pulmonary infections should be elicited. Anosmia (lack of smell), galactorrhea, visual-field defects, and sudden loss of libido could be signs of a pituitary tumour. The status of the partner’s workup should also be known.
The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce hormones that trigger sperm production.
Once sperm is produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production.
Low sperm count (oligospermia) is a leading cause of infertility or sub-fertility issues among men. While it requires only one sperm to fertilise the ovum, the odds of conception are such that it takes millions of sperm per milliliter of semen to actually achieve the goal of fertilisation. A “normal” sperm count is about 20 million or more sperm per milliliter of semen. Over 60 per cent of the sperm in each sample should exhibit normal morphology and indicate typical motility – the forward swimming movement.
Oligospermia – or low sperm count – is indicated in simple tests that reveal the concentration of sperm in a given sample quantity. Sperm count can, of course, be impacted by diet, frequency of intercourse, habits like smoking and drinking, and general health and wellness issues.
Certain surgeries, including vasectomy, might prevent you from having sperm in your testicles. Inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others, are also suspect. In most cases, surgery can be performed to either reverse these blockages or to retrieve sperm directly from the epididymis and testicles.
Sperm production or function can be affected by overexposure to certain environmental elements, including:
Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead might contribute to low sperm counts. Exposure to lead or other heavy metals also can cause infertility.
Radiation or x-rays
Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced. It is being reported that keeping mobile phones in the pocket, close to the upper thigh, is extremely deleterious to sperm production with resulting low sperm count and morphology.
Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana might reduce the number and quality of your sperm as well. Alcohol can lower testosterone levels and cause decreased sperm production.
Certain occupations might be linked with a risk of infertility, including welding or those associated with prolonged sitting, such as truck driving. However, the data to support these associations are inconsistent.
Men who smoke might have a lower sperm count than those who don’t smoke.
Also, obesity can impair fertility in several ways, including directly impacting sperm and by causing hormone changes.
Bisphenol A, an additive to plastics found in many household products, can lower sperm count and motility. A 2008 study in the journal, Fertility and Sterility, showed that men with high concentrations of BPA in their urine also had low sperm counts. Food packaging is a major source of BPA which can seep into foods.
Scientists also noted that rural men who are mostly farmers who are exposed to pesticides tend to have low sperm count. The chemicals runoff gets into tap water and can disrupt hormonal processes.
Cancers and nonmalignant tumours can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. Surgery, radiation or chemotherapy to treat tumours can also affect male fertility. (Punchng.com)