Infertility in men is on the rise.

A photograph taken on African Day in Calgary, Alberta. (Dr. Noorali Bharwani)
A photograph taken on African Day in Calgary, Alberta. (Dr. Noorali Bharwani)

Not being able to conceive a child can be stressful. Male infertility refers to a male’s inability to cause pregnancy in a fertile female. Male infertility is commonly due to deficiencies in the semen.

In Canada, about 16 per cent of couples struggle with infertility – a figure that has doubled since the 1980s. Men are solely responsible for infertility in about 30 per cent of those cases, and contribute to half the cases overall, according to Health Canada.

A comprehensive study published this summer shows sperm counts of Western men dropped by more than 50 per cent in less than four decades. Sperm count is the best measure of male fertility.

Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperms. Illnesses, injuries, chronic health problems, lifestyle choices (drugs, alcohol, sexually transmitted diseases) and other factors can play a role in causing male infertility, says Mayo Clinic website.

How does fertilization occur?

During the fertile window, the female creates a sperm friendly fluid that enables sperm to swim up towards the egg.
Of the millions of sperms released upon ejaculation, only a handful make it to the fallopian tube where the egg is released. There, the sperm must survive long enough to meet and fertilize the egg. Isn’t that an amazing act of nature!

Besides the quality of sperms, sperm count matters. There needs to be enough sperms in the semen. A low sperm count is fewer than 15 million sperms per milliliter of semen or fewer than 39 million per ejaculate.

Likely causes for poor sperm count are: chronic smoking, obesity, diabetes, drugs, alcohol, emotional problems, stress, depression, hormonal problems and previous surgeries.

According to the British Medical Journal (BMJ October 4, 2018), around one in seven couples in the UK seek treatment for infertility when they are unable to conceive, despite regular unprotected intercourse. In about a third of patients, no cause can be identified.

Even though male partner may have suboptimal sperm parameters both partners need to be assessed for infertility, so the couple should ideally be seen together when investigating infertility.

Managing infertility is not always easy, as often exact cause is not identified. But help is there.

According to Mayo Clinic website treatments for male infertility include:

  1. Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. In cases where no sperms are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm-retrieval techniques.
  2. Treating infections. May or may not help.
  3. Treatments for sexual intercourse problems. Medication can treat some issues that affect male fertility, including hormone imbalances and erectile dysfunction.
  4. Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperms are then inserted into the female genital tract, or used to perform in vitro fertilization.

When treatment doesn’t work then one can consider using sperm from a donor or adopting a child. As somebody has said, “Parenthood requires love, not DNA.”

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