The things that may make him infertile

OFTENTIMES when a couple is unable to conceive, the woman is the one who’s first to ascribe blame to herself, and is usually first to initiate testing to get a clue as to what’s wrong. But while the problem sometimes lies with the woman, it also sometimes stems from an issue with the man, or with both partners.

“You should never assume whose fault it is. In fact, you should never use the word ‘fault’ because it is such an emotive topic, you really don’t want to be blaming or putting burden on one person or another,” Urologist Dr Richard Mayhew said. “The fact of the matter is if a couple is having problems having children, sometimes it is significantly a male factor, in another third of the time it is more significantly a female factor, and in another third you might find problems with both.”

It is believed that more than 90 per cent of male infertility cases are due to sperm abnormalities like low sperm count, poor sperm quality, or both.

“Even in a situation where the man has been assessed and has been found to have problems, the female still needs to be assessed,” Dr Mayhew explained. “Because a significant number of times there is also a problem on the female side, and vice versa — if the female is having a problem the man should also be assessed because often enough it has been found that there is a male problem as well.”

Dr Mayhew said the problem of infertility in men is most times due to sperm quality.

“You can have a wide variety of things. You can have variation in the number of sperm… usually the concern is a low count — it can be low or the sperm can be completely absent.”

Dr Mayhew said the problem of infertility in men could be put into two main categories: obstruction of sperm flow through the tubes and the production of the sperm; while there is a long list of things that could cause either.

Sperm abnormalities can be caused by a range of factors, including congenital birth defects, disease, chemical exposure, and lifestyle habits like heavy alcohol consumption and smoking. It is believed, however, that in many cases, the causes of sperm abnormalities are unknown.

Sperm abnormalities are categorised by sperm count, sperm movement, or sperm shape.

* Sperm count. A sperm count of less than 20 million/ml is considered low. Azoospermia refers to the complete absence of sperm cells in the ejaculate, and is said to account for 10 to 15 per cent of cases of male infertility. Obstruction anywhere in the passage through which sperm travels can reduce sperm count.

* Sperm movement. If the movement of the sperm is slow, not in a straight line, or both, the sperm will have difficulty breaking through the cervical mucous or penetrating the hard outer shell of the egg. If 60 per cent or more of the sperm are moving normally, the sperm is at least average in quality. If less than 40 per cent of sperm are able to move in a straight line, the condition is considered abnormal. Sperm that move sluggishly may have genetic or other defects that render them incapable of fertilising the egg.

“The abnormalities of sperm motility may not be so much of a problem, most of the time if it is that the sperm are swimming a little slowly — if that is the only problem, then most of the time that problem would not be in and of itself the reason for somebody being infertile,” Dr Mayhew explained. “However, when you look at the sample and all the sperm are not swimming then that suggests that the sperm are dead. So then we would have to ascertain why he is producing sperm which are dead. They may not be produced dead but they become inactive soon after being laid.”

* Shape of the sperm. Abnormally shaped sperm cannot fertilise an egg. About 60 per cent of the sperm should be normal in size and shape in order for fertility to take place. The perfect sperm structure is an oval head and long tail.

Other cause of infertility in males are retrograde ejaculation, structural abnormalities, and genetic disorders.

“Then there are other issues that can happen, one can produce normal sperm but have retrograde ejaculation, where the semen is not going forward but is going back into the bladder,” Dr Mayhew explained.

Retrograde ejaculation occurs when the muscles of the bladder wall do not function properly during orgasm and sperm are forced backward into the bladder instead of forward out of the urethra impairing the quality of the sperm. This can be caused from surgery to the lower part of the bladder or prostate, diseases such as diabetes and multiple sclerosis, spinal cord injury or surgery, some types of medication and ageing.

Structural abnormalities that cause damage to the testes, tubes, or other reproductive tissues can affect a man’s ability to reproduce, or in cases where the male child was born with a penile defect like the testicles failing to descend from the abdomen into the scrotum or where there is a birth defect of a blockage in the tubes that transport sperm.

Certain genetic inherited disorders like polycystic kidney disease, cystic fibrosis and Klinefelter Syndrome (marked by two X and one Y chromosomes) can impair fertility.

Mayhew said, however, that genetic causes of infertility often cannot be corrected despite tests done. But he said if a couple finds that they cannot produce a child, detailed assessments should be done to determine the exact cause.

“Oftentimes men will come in and think it is just a matter of you getting medication and everything is all right, but it is really not as simple as that. It does require some detailed assessment,” the doctor said.