INFERTILITY IN MEN

Infertility is the inability of the female partner to conceive after one year of regular intercourse. There is Primary infertility where the couples have never been able to become pregnant and secondary infertility where couples have been pregnant at least once, but have not been able to become pregnant again

Although infertility itself does not cause physical illness, it can have a major emotional impact on the couples creating problems with their marriage and individuals may experience depression and anxiety.

The male reproductive system creates sperm that is manufactured in the seminiferous tubules within each testicle. The head of the sperm contains the DNA, which when combined with the egg's DNA, will create a new individual. The tip of the sperm head is the portion called the acrosome, which enables the sperm to penetrate the egg. The mid piece contains the mitochondria which supplies the energy the tail needs to move. The tail moves with whip-like movements back and forth to propel the sperm towards the egg. The sperm have to reach the uterus and the fallopian tube in order to fertilize a woman's egg.

CAUSES

Infertility in men can be caused by a wide range of both physical and emotional factors due to:
• Low Sperm Count: Men are most likely to be fertile with a sperm count over 48 million per milliliter of semen.
• Sperm Motility: is the sperm's ability to move. If movement is slow, not in a straight line, or both, the sperm have difficulty invading the cervical mucous or penetrating the hard outer shell of the egg.
• Sperm Morphology: Abnormally shaped sperm cannot fertilize an egg. About 60% of the sperm should be normal in size and shape for adequate fertility.
• No sperm: Complete absence of sperm which may be due to obstruction or a failure to produce sperm in the testes.
• Low-quality sperm: Quality of sperm is determined by its ability to move or its shape and structure. The quality of the sperm is often more significant than the count
The above mentioned factors may be the end result of one or a combination of factors that include chronic illness, infections of the testes or epididymis, mumps, scarring due to infection including sexually transmitted diseases, genetic disorders, radiation exposure / chemotherapy or exposure to chemicals, malnutrition/older age, genetic defects, structural abnormalities and environmental factors such as exposure to high heat for prolonged periods.
Partial obstruction anywhere in the long passages through which sperm pass can reduce sperm counts. Personal lifestyle such as smoking, heavy use of alcohol, marijuana or cocaine also contribute to risk factors of infertility

DIAGNOSIS
A complete medical history and physical examination of both partners is essential. A physical examination of the scrotum and sperm analysis is essential for any male fertility work-up.

Checking the size of the testicles is helpful and can detect: large enough testicles that possibly interfere with fertility (varicocoeles), smaller-sized and softer testicles that can give clues to hormone problems which are strongly associated with problems in sperm formation. The penis is also checked for warts, discharge from the urinary tract, and incorrect location of the urethra opening (hypospadias).

Semen analysis is done in evaluating male infertility. The man will need to provide a sample which should be taken within the hospital premises or at least someplace nearby, since it's important that the analysis take place quickly. A trained expert assesses the man's sperm count, their shape, movement and other variables. Generally, a higher number of normal-shaped sperm means higher fertility

TREATMENT

Treatment depends on the cause of infertility. It may involve:
• Education and counseling
• Medical procedures such as Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF), where the harvested sperms are used to fertilise the egg and implanted into the uterus.
• Medicines to treat infections and promote ovulation

PREVENTION

The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some factors that may reduce sperm number and/or quality include:
• Alcohol
• Drugs
• Environmental toxins
• Smoking cigarettes
• Health problems
• Medicines
• Radiation treatment and chemotherapy for cancer
• Age
• Sexually transmitted diseases (STDs) often cause infertility, practicing safer sex behaviours may minimise the risk
• Maintain a healthy diet, weight and lifestyle to optimise your chances of getting pregnant and having a healthy pregnancy