Latest statistics reveal that 1 out of 7 couple is unable to conceive naturally. ‘Naturally’ would usually mean post a year of unprotected sexual intercourse. In our country the common tendency in such cases is to point the finger of doubt at the female partner. Yet, again, statistics reveal that in almost 50% of such cases the male partner is responsible. It is a problem that has shown an upward trend over the past years. Though it is difficult to zero in on the exact cause of this, changing lifestyle where stress and pressure of performance are two unignorable facts, is believed to be largely responsible.

Unfortunately, even in this day and age, our country has remained miles behind when it comes to either awareness or acceptance of the problem. The social stigma attached and presence of a strong male ego often prevents the men from going to the doctor and undergoing the relevant tests. This causes an inordinate delay in detection and subsequent treatment of the problem.

What causes male infertility?

Low sperm production and/or poor quality of sperm is the most common reason for male infertility. While even about three decades back sperm count in a normal Indian male was recorded at 60 million/ml, recent studies have revealed that it stands at 20 million/ml now. So, what has brought about this significant change? While factors like family history, chronic illness, and age are responsible, one cannot ignore the large role played by lifestyle factors like smoking, consumption of alcohol, and stress of modern day living. Sometimes, certain medical conditions or abnormalities (blockage) could be the cause.

Signs or symptoms to look out for

While there are no definite symptoms that would suggest infertility in males, inability to conceive is usually the first sign that indicates a fertility problem. Some other signs, however, could be indicative of male infertility. These include:

• Difficulty with ejaculation
• Poor volume of ejaculated fluid
• Low sexual drive
• Erectile dysfunction
• Pain and swelling in the testicular area
• Abnormal breast growth (a condition called gynecomastia)

If you are facing these issues, then it would be advisable to pay a visit to an infertility specialist without delay. Men with infertility issues are also known to be prone to recurrent respiratory infections, problems in the sense of smell and minimal growth of hair on the body.

What role does ‘male factor’ infertility play in conception?

The process of impregnation begins with the health of the sperm.

Are you producing healthy sperm? For this at least one of your testicles has to be functioning properly and your body has to produce the right quantity of hormones (including testosterone) to ensure a steady supply of sperm.

The journey begins: The sperm produced in the testicles are transported through thin tubes to the mix with semen before the final ejaculation.

Sperm count matters! The larger the number of sperm the more is the chance of fertilization of your partner’s egg. Fewer than 15 million sperm per millilitre of semen and less than 39 million per ejaculate is considered as low sperm count.

Sperm motility is important. Abnormal movement of sperm would mean that it is less likely to reach and impregnate the egg, hence motility of sperm plays a big role.

Sometimes certain Health conditions can lead to male infertility. These include:

Varicocele: Swelling of the veins that drain the testicle and reduce sperm quantity and quality

Infections can interfere with sperm production and health, and cause blockage in the pathway

Auto-immune disorders like diabetes: 1 in 4 men with type 2 diabetes are seen to have lower testosterone levels that is likely to lead to low sperm count, erectile dysfunction and low sexual drive.

Certain genetic disorders can lead to male infertility

Non-malignant tumours and treatment for testicular cancer can affect both the quantity and quality of sperm

Undescended testes is a condition where the testicles haven’t moved into their proper position. This increases risk of infertility and other medical conditions

Injury to the testes can be a cause of infertility as it may impact sperm production and motility

How is the condition diagnosed?

Post physical examination and understanding your family and medical history, the infertility specialist would typically advice some tests to check for the anomalies. These would include, semen and sperm analysis to check for the quantity, quality and motility of sperm. Sperm antibody and DNA tests are also recommended.

The role of Assisted Reproduction Techniques (ART)

Depending on the results of the prescribed test, the doctor may recommend hormone therapies and lifestyle modifications as an initial line of treatment, then follow up with choices of artificial reproduction techniques best suited to your condition. These could include:

Intracytoplasmic sperm injection (ICSI): Where a single sperm is injected into each egg to increase chances of fertilization

In Vitro Fertilization (IVF): Selected quality sperm from those donated by the male partner are used to increase chances of fertilization of egg in the laboratory

When Susmit Basak, (now 52), began having problems conceiving with his wife nearly 15 years ago, he had safely assumed that the problems lay with his wife, and not him. But after Susmit went for a routine sperm check, the results had shocked him.

“The fertility specialist informed me and my wife that I had no sperm,” Susmit recalled. “I sat there thinking, ‘I’m a man, and I’m supposed to procreate.’” It was a blow to his self-esteem and who he thought he was.

About one in seven married couples has trouble conceiving, according to the Centers for Disease Control and Prevention. While infertility is largely a woman’s issue, the male partner has a role to play in about one-third of cases.

When it comes to infertility issues, men tend to feel uncomfortable and find it hard to cope. Even today, many men believe that fertility is the same as virility and the fact that they are encountering trouble points to an unforeseen lack of manliness.

To help you understand some of the common factors that contribute to male infertility — and what to do if you are diagnosed, here’s a guide.

Consider how your age can affect your risk.

A study conducted in 2003 cited that, fathers who were older than 45 years were almost five times more likely to take over a year to get their partners pregnant, unlike men who were 45 or even younger, even when the age of their partners was below 25.

The older a man is, the more likely his sperms are to encounter DNA damage that does not make them as potent.

Many fertility specialists suggest today that if you are a man planning to delay fatherhood till late in life, you can consider banking sperm before your 35th birthday.

If you have been failing to conceive, get evaluated.

It is advisable for couples who cannot conceive even after a year of unprotected intercourse. If the age of one or both partners is over 35 years, they must seek help after six months of trying.

The first step involves a fertility specialist carefully evaluating the medical history of a patient. A careful physical exam is a next step. As a patient, you can expect to be asked questions like: Is there any history of infertility in the family? Did you ever have a sexually transmitted disease (STD)?

The next step is to check the sperm count or do a semen analysis, which provides information about the shape, speed, and number of sperms. If the results of a semen analysis suggest that sperm count is low, do not panic: Sperm count can fluctuate from one week to the other, and sometimes even from one day to the other. Your doctor is likely to ask you to repeat semen analysis about a month later.

Seek support for male infertility

“I did not want to tell anyone,” said Susmit.” It was the first time in his relationship with my wife, Sampa, where he felt like he could not provide what she wanted.

Although Sampa successfully conceived via IVF and gave birth to their son in 2010, at one point in the six-year infertility process, Susmit said that he had to undergo therapy as at one point, he became suicidal owing to the shame he felt for not being able to conceive.

If treatment does not work, consider alternate options.

In rare cases, a man’s infertility issues cannot be treated, even with assisted reproductive technology (ART). In such cases, infertility specialists in Kolkata consider sperm donation or even adoption.

Initially, many couples are resistant to either idea, who was finally convinced by his wife to explore sperm donation. A common worry is that the donor isn’t a clone; everyone would soon come to realize that the baby is not biologically their child.

Know that diet and lifestyle play a key role

Women, over the years, have been advised to get themselves “pregnancy ready” before they even try to conceive, such as by maintaining a healthy weight and avoiding cigarettes and alcohol consumption. Similar tips also hold for men.

One of the primary reasons why sperm count may be dropping is due to the rising rate of obesity. Obese individuals are about 1.5 times more likely to have a low semen volume than men who have normal weight; those who were overweight are 1.2 times more likely to have low semen volume.

Smoking and heavy drinking may also be factors. Recent studies have shown that smokers were significantly likely to have lower sperm counts as well as sperm defects, unlike nonsmokers.

Diet is important. A Mediterranean-style diet that is rich in whole grains, nuts, fatty fish, fresh fruits, fresh vegetables, and healthy fat like olive oil is associated with improved sperm quality, per a 2018 study published in the journal titled Fertility and Sterility.

There is evidence to show that heat — from tight undergarments — can have a role to play. A study conducted in 2018 comprising 656 men (published in the journal Human Reproduction) showed that men who tend to wear boxer shorts showed a 25% higher concentration of sperms than those who did not.