Male infertility is still a taboo subject. Discovering that you are infertile seems to be the end of the dream of being a father. A detailed clinical evaluation can provide information for an early diagnosis to be performed accurately and, consequently, a therapy to be proposed.
It is estimated that male infertility affects about 80 million people around the world.
Male infertility is the inability of a man to produce sperm in sufficient quantity or quality to fertilize the egg and result in a pregnancy.
Discover the main causes of male infertility
1) Varicocele is the main cause of male infertility. It is present in 15% of the male population and in approximately 40% of men with primary infertility who have never become pregnant. This number can increase to up to 80% of men diagnosed with secondary infertility (who have already become pregnant but are unable to conceive again). There may be a hereditary issue involved in the predisposition to the onset of this disease, which always occurs in adolescence.
2) Cryptorchidism (undescended testicle) is an important cause of male infertility and may even be associated with the development of a testicular tumor. An early evaluation by the specialist is important, because the sooner the cryptorchid testicle is corrected, the greater the chances of preserving male fertility. In cases of unilateral cryptorchidism, the chance of the boy developing infertility in adulthood is 30%. This risk more than doubles when cryptorchidism is bilateral.
Cryptorchidism correction surgery does not increase sperm production, but rather protects against a worsening of the condition.
3) Cystic Fibrosis is a genetic disease that is also known as the salt kiss disease because the body’s secretions are high in salt. About 4% of the Brazilian population carries a cystic fibrosis gene without, however, having the disease.
Most of the time, the disease is diagnosed shortly after birth by the famous foot test (especially in the most serious cases), but it can only be diagnosed in adulthood.
4) Klinefelter syndrome is when the man does not ejaculate sperm, characterizing him as a carrier of non-obstructive azoospermia. The chances of success for sperm acquisition are very low, not exceeding 30%.
5) Kallmann syndrome is characterized as testicular insufficiency generated by a reduction in pituitary hormones associated with anosmia (absence of smell perception). The replacement of some injectable hormones, such as HCG and FSH, has the function of stimulating the testicle to produce sperm and testosterone again.
6) Use of traditional cigarettes, electronic cigarettes and vaporizers affects man’s reproductive function. The habit of smoking and the consequent inhalation and absorption of toxic substances by the body can change the volume of semen, impair its quality, altering the concentration and motility of sperm.
With more free radicals in the semen, smokers can experience what we call oxidative stress, which is often related to increased sperm DNA fragmentation. High rates of fragmented DNA indicate a low capacity for natural pregnancy, an increase in the number of miscarriages and the need for a greater number of IVF treatments to achieve a pregnancy.
7) Obesity leads to a chronic increase in testicular temperature. A study by the University of Utah in the United States has shown that obese men in their 60s have lower sperm counts than leaner individuals in the same age group.
When exposed to constantly higher temperatures, the testes undergo a process of oxidative stress, with the excessive production of fearsome free radicals. These free radicals act by eliminating sperm-producing cells, in addition to impairing the quality of sperm produced for ejaculation.
Obese men also tend to convert the testosterone hormone produced by the testis into the typically female hormone estradiol. Fat tissue induces an increase in female hormone production in male patients. So the more fat, the more female hormone in the body, generating a hormonal change that disfavors the production of good sperm.
According to urologist Antonio Cesar Cruz, men can be fertile all their lives. “Age is not a factor in reducing sperm production. Men produce sperm throughout their lives. It’s very common to find men over 80 who are fathers. It’s different from women who are born with all the eggs and only mature each cycle menstrual cycle”, explains the specialist.
8) Testosterone and anabolic use is a major cause of infertility in young adult men. The use of any dose of testosterone and other anabolic steroids can stop sperm production, either temporarily or permanently, depending on the time of use, the doses used and the individual susceptibility of each man.
The use of these substances inhibits the production of FSH, the hormone responsible for the production of sperm by the testis. When chronically inhibited, the death of sperm-producing cells occurs and, as a consequence, the testis loses volume and becomes irreversibly small.
9) STIs (sexually transmitted infections) are important causes of male and female infertility. According to the Ministry of Health, among Brazilians aged between 15 and 24, only 56.6% use condoms during sexual intercourse.
Infections such as gonorrhea and chlamydia can affect the testicles, leading to an infection known as orchitis, which can affect sperm production. Many men end up getting infected and often, because they do not show symptoms, they become STIs disseminators to their partners. In women, infectious agents can lead to infection of the tubes and endometrium (endometritis), causing a significant loss of female reproductive potential.
Spermogram: test that evaluates sperm and seminal fluid. Based on the result, the doctor will have better information to conduct infertility treatment.
Sperm DNA fragmentation test: maps the percentage of sperm with DNA alterations.
Imaging exams: complements the patient’s diagnosis and can be ordered, such as testicular ultrasound with color Doppler.
Hormonal dosages: evaluates changes in hormonal rates involved in sperm production – such as LH, FSH and testosterone.
Genetic assessment: in some cases, the investigation of genetic causes for male infertility must be carried out, especially in the most severe cases. The most common tests are karyotyping, Y-chromosome microdeletion screening, and screening for changes in cystic fibrosis genes (CFTR).
Clinical treatments, when a dysfunction or low hormone is corrected.
Surgical treatments, such as varicocele, and vasectomy reversal.
Laboratory, when using artificial insemination and fertilization in vitro (fertilization of an egg by a sperm) by changes in number and quality.
Family planning x vasectomy and its reversal
In Brazil, surgical sterilization is regulated by Law No. 9,263/1,996, which deals with family planning, which establishes in its article 10 the mandatory criteria and conditions for its execution.
The law determines that the surgery should be performed in men over 25 years of age and with two living children, provided that a minimum period of 60 days is observed after the express manifestation of the desire and advice by a multidisciplinary team, in order to discourage early sterilization.
A vasectomy can always be reversed, but the chances of success depend on three major factors: time since the vasectomy, age of the wife, and the surgeon’s skill in performing this surgical procedure, preferably with the microsurgical technique.
Vasectomy is a safe procedure, which does not carry the risk of prostate and testicle cancer, does not increase the risk of developing high blood pressure, heart disease or dementia. In addition, vasectomy does not alter the production of hormone levels, sexual pleasure or libido.
Absence of sperm can cause suffering
Male-caused marital infertility can negatively affect the psychological side of men, especially when the factor is associated with the absence of sperm. In these cases, the man can have his virility strongly impacted, to the point that the man himself questions his role in the marital relationship.
Although there is no direct relationship between sperm production and testosterone production and masculinity, many men make this association in a negative way, harming their relationship with their partner because they feel unable to provide for it naturally with the formation of a family.
In these cases, whether the male factor is severe or not, the doctor must often have the sensitivity to ask for help from a more qualified professional, such as a psychologist, to deal with the frustrations and fears inherent in the diagnosis of male infertility.
Sources: Antonio Cesar Cruzurologist, professor of urology at FMO (Faculty of Medicine of Olinda) and professor of urological laparoscopy at Ircad – Latin America; Daniel Suslik Zylbersztejnmember of the Sexual and Reproductive Health Department of the SBU-SP (Brazilian Society of Urology – São Paulo Regional), medical coordinator of Fleury Fertilidade and medical director of DSZ reproductive medicine; Luiz Fernando Dale, gynecologist specializing in reproductive medicine and director general of the Dale Clinic; and Bernardo Pugliaurologist and medical director of the Puglia Institute.