The ‘M’’ factor in fertility!!!
For nearly three years, Rahul and Prerna had been trying to get pregnant, but in vain. The couple’s otherwise happy married life was starting to come under a cloud since Ankhi really wanted to become a mother, and this prompted Rahul to consult a fertility specialist. Little did he realise there was a rude awakening waiting at the end of a slew of tests the young couple had to go through: while Prerna was found to be in good reproductive health, Rahul was found to be suffering from low sperm count.
Numerous couples like Rahul and Prerna havestepped into my infertility clinic over the past 30 years to figure out exactly why they were unable to conceive a child, and it is with some trepidation that I observed that the cases of male infertility are rising in India, and fast.
This story starts with a flashback,so cut to the last century, wherethe eternal course of human evolution started accelerating unbelievably.Ubiquitousgrowth also led to several drastic environmental and lifestyle alterations, whichhave caused some serious implications on health and fitness. Apart from a considerable rise in lifestyle diseases, there has been substantial risein some of the so-called offbeat issues like male infertility.
Infertility, as defined by the World Health Organization (WHO), is the “inability of a sexually active, non-contracepting couple to achieve pregnancy in one year.” It is estimated that infertility affects one in seven to one in eight couples of reproductive age, with a male factor being solely responsible in 20% cases and contributory in an additional 30% of cases.
Reasons of male infertility
Health and lifestyle reasons
- Illegal drug use: Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease.
- Alcohol consumption: Drinking alcohol indiscriminately can lower testosterone levels, cause erectile dysfunction and decrease sperm production.
- Occupation: Certain occupations can increase your risk of infertility, including those associated with extended use of computers or video display monitors, working variable shifts or multiple shifts, and work-related stress.
- Tobacco smoking: Men who smoke may have a lower sperm count than those who do not smoke.
- Emotional stress: Stress can interfere with certain hormones needed to produce sperm
- Industrial chemicals: Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
- Heavy metal exposure: Exposure to lead or other heavy metals also may cause infertility.
- Radiation or X-rays: Exposure to radiation can reduce sperm production, though it will usually return to normaleventually. With high doses of radiation, sperm production can be permanently reduced.
- Overheating the testicles: Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or working on a laptop computer for long durations also may increase the temperature in the scrotum and slightly reduce sperm production.
- Weight: Obesity can cause hormone changes that reduce male fertility.
- Prolonged bicycling: Prolonged bicycling may lead to overheating of the testicles.
- Varicocele: A varicocele is a swelling of the veins that drain the testicles. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm.
- Infection: Some infections can interfere with sperm production or sperm health. These include some sexually transmitted infections; inflammation of the prostate gland (prostatitis); and inflamed testicles due to mumps (mumps orchitis).
- Ejaculation issues: Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.
- Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
- Tumours: Cancers and non-malignant tumours, surgery, radiation or chemotherapy to treat tumours can affect male fertility.
- Undescended testicles: In some males, during foetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum).
- Hormone imbalances: Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems.
- Sperm duct defects: Some men experience blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one or both of the tubes that carry sperm out of the testicles.
- Chromosome defects: Inherited disorders such as Klinefelter’s syndrome, cause abnormal development of the male reproductive organs, other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome, Young’s syndrome and Kartagener syndrome.
- Problems with sexual intercourse: Erectile dysfunction, premature ejaculation, painful intercourse, anatomical abnormalities (such as hypospadias), or psychological or relationship problems can adversely affect fertility.
- Celiac disease: Fertility may improve after adopting a gluten-free diet.
Certain medications: Testosterone replacement therapy, long-term anabolic steroid use, chemotherapy, certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production.
Corollaries linked with male infertility
Incapability to produce an offspring may sometimes not be as emotionally taxing as the social stigma attached with it. Almost everywhere in the world, fertility in men has always been perceived as a certificate of their manhood. This makes it even more difficult for affected men to accept this fact that they are responsible of their barren marriage; and living life with this revelation is a nerve-racking and disturbing experience for them.
Therefore, the problem of male infertility and the social stigma attached with it can put immense psychological pressure on couples, which not only hampers their health and efficiency but can also bring acrimony in their personal relationship.
The way out
It is important to understand that life does not end here; rather medical science has plenty of options to make it worth livingagain.
Novel medical advents like IVF (In Vitro Fertilization) are nothing short of a boon for such couples. The success rate of this treatment is as high as 30-40%.
“In IVF, an egg is surgically removed from the woman’s ovaries and fertilized with male sperm in a laboratory. The fertilized egg (now called an embryo) is then returned to the woman’s womb to nurture and develop. This technique is a blessing for males with low sperm count or morphologically defected sperms.Another revolutionary technique is IMSI (Intracytoplasmic Morphologically-Selected Sperm Injection), in which the sperm is selected after examining it under 6000× high magnification4. This method allows choosing those sperms, which are morphologically normal4. Through IMSI, the normal sperms are injected into each egg and 1 to 3 of these are placed in a thin catheter and then inserted deep inside the uterus by a gynaecologist. The outcome of this technique includes a higher chance of success and a lower miscarriage rate” says Dr. Manika Khanna, IVF Expert, Gaudium IVF, JanakPuri, New Delhi.
Definitely, the long-term solution of male infertility can be achieved only by giving special notice on deteriorating environment and changing lifestyles. Fortunately, in the meanwhile, innovative medical aid would continue to provide solutions for such problems.
- Thonneau P, Marchand S, Tallec A, Ferial ML, Ducot B, Lansac J, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989) Hum Reprod.1991;6:811–6.