HEALTH TALK: Can’t have kids? Not her, you

Yes, I’m talking to you men, I guess it’s in our culture, but every time a couple have difficulty having kids, it’s almost always blamed on the woman.

I don’t know if there are figures for Dominica, but in the U.S., 10% to 15% of couples are classified as infertile, meaning they’ve been trying to get pregnant with frequent, unprotected sex for at least one year with no success. Take note that I said one year – this is the definition. Many of you try for two months, and conclude somebody is infertile when you come up empty, then, of course, you run to the doctor.

Half of cases result from MALE INFERTILITY, the causes which are many (see later). Even if the male has the difficulty, though, the female partner may also have fertility issues, so both may need treatment for a pregnancy to occur. But don’t despair; help is out there, guys.

SYMPTOMS OF MALE INFERTILITY

The main thing is the inability for couples to get pregnant. There may be no obvious signs or symptoms. But if male infertility is caused by a hormonal problem, you may have things such as reduced hair growth on the face or body, or a low sex drive.

CAUSES

Male fertility is a complex process that involves many factors, including an axis between brain and genitals involving hormones. To get his partner pregnant, a man must be able to deliver healthy sperm into the vagina that are able to reach, penetrate and fertilize a woman’s egg. Take it easy now, guys, no need to get excited? And you women, too.

•    Sperm must have the proper shape and be able to move toward the egg for fertilization to occur. Abnormal sperm shape and structure may cause impaired mobility; sperm may not be able to reach or penetrate the egg.

•    There has to be enough sperm in the semen to make pregnancy possible. Sperm is what you can’t see, semen is what it is transported in. Normal sperm concentration is greater than or equal to 20 million sperm per milliliter of semen. 10 million or fewer sperm per milliliter of semen indicates low sperm concentration (sub-fertility). Very rarely, a man is able to produce no sperm at all.

Generally, causes of male infertility include impaired semen production or function, impaired sperm delivery, lifestyle, and environmental exposure.

IMPAIRED PRODUCTION OR FUNCTION OF SPERM

Following are among the problems that can cause problems with sperm.

•    Varicococle. This is a swollen vein in the scrotum that may prevent normal cooling of the testicle, causing reduced sperm count and motility.

•    Undescended testicle. This is when one or both of your testicles (balls) fail to descend from the abdomen into the scrotum during fetal development. Because they are exposed to the higher internal body temperature, compared with that in the scrotum, sperm production may be decreased.

•    Testosterone deficiency (male hypogonadisur). Infertility can result from disorders of the balls (testicles) themselves, or an abnormality affecting the glands in the brain that produce hormones that control the testicles (the hypothalamus or pituitary glands).

•    Chromosome defect. Inherited disorders of the testes can cause abnormal development of the testicles.

•    Infections. Infections may temporarily affect how your sperm moves. STI’s such as Chlamydia and Gonorrhea, are often associated with male infertility. These infections can cause scaring and obstruct sperm passage. If mumps occurs after puberty, testicular inflammation can impair sperm production. Prostatitis, urethritis or epididymitis also can affect sperm motility.

•    Hormonal disorders. These conditions affect the release of hormones needed for sexual development or sperm production.

IMPAIRED DELIVERY OF SPERM

Anything affecting the delivery of sperm from the penis into the vagina can cause infertility. Examples of problems that can interfere with sperm delivery follow.

•    Sexual issues. Erectile dysfunction (ED), premature ejaculation (a form of ED), painful intercourse (dyspareunia) or psychological or relationship problems can contribute to infertility.

•    Blockage of epididymis or vas deferens. Some men are born with blockage of the part of the testicle that stores sperm (epididymis) or have a blockage of the tube that carries sperm (vas deferens) from the testicle out of the penis.

•    Retrograde ejaculation. This occurs when semen enters the bladder during orgasm (cum) rather than going out through the penis. Conditions causing this include diabetes, bladder, prostate or urethral surgery, and the use of certain medications.

•    No semen (ejaculate). This can occur in men with spinal cord injuries or diseases. This fluid carries the sperm from the penis into the vagina.

•    Misplaced urinary opening (hypospadias). A birth defect can cause the urethra to be abnormally located on the underside of the penis. If not surgically corrected, hypospadias can prevent sperm from reaching the woman’s cervix.

•    Anti-sperm antibodies. Antibodies that target sperm or weaken or disable them usually occur after surgical blockage of part of the vas deferens for male sterilization (vasectomy). These antibodies may cause infertility.

•    Cystic fibrosis. These men often have a missing or blocked vas deferens.

GENERAL HEALTH AND LIFESTYLE

These include the following:

Alcohol and drugs: Alcohol and illicit drugs, anabolic steroids, cocaine, and marijuana may temporarily reduce sperm number and quality,

Tobacco smoking:
Smokers may have a lower sperm count than non-smokers. This may even apply to secondhand smokers.

Emotional stress:
This will affect your hormones. The rest needs no more discussion.

Malnutrition: Deficiencies in Vitamin C, Selenium, Zinc and Folate may contribute to infertility.

Obesity:
This can cause hormone changes that reduce male fertility. If you’re overweight and can’t have kids, guys, lose the weight!

ENVIRONMENTAL EXPOSURE

Heat, toxins and chemicals can reduce sperm production or function. Some causes include:

Pesticides and other chemicals: Herbicides and insecticides may cause female hormone-like effects in the male body and may be associated with reduced sperm production and cancer of the testicles. Lead exposure may cause infertility; beware painters.

Overheating the testicles:
Sitting for long periods (truck and bus drivers) or wearing tight clothing may increase your scrotal temperature and reduce sperm production. Frequent use of saunas or hot tubs may have the same adverse effect or sperm production and sperm count.

Cancer and its treatment:
Radiation and chemotherapy treatment for cancer can impair sperm production. The closer the radiation treatment to the testicles, the higher the infertility risk.

OTHER RISK FACTORS

Some of the risk factors have been mentioned under “causes.” Others include:

•    Age. Men older than 35 may have a gradual decline in fertility.

•    Celiac disease. This is a digestive disorder caused by a sensitivity to gluten. If untreated, it can lead to male infertility. Fertility may improve after adopting a gluten-free diet.

TESTING AND DIAGNOSIS

Without going into a great deal of detail, I’ll just say that we make the diagnosis by:

•    General physical examination and medical history.

•    Semen analysis. Everything about your sperm is analysed on a specimen produced by masturbating or interrupting sex, and getting it to the lab within half an hour.

If your semen analysis is normal, thorough testing of the female partner is recommended before further male infertility tests are recommended on you.

Depending on initial findings, more specialized tests may be recommended to determine male infertility cause.

•    Scrotal ultra sound
•    Hormone testing
•    Genetic tests
•    Testicular biopsy
•    Anti-sperm antibody tests
•    Vasography

The relevance or these tests have been alluded to already; the idea being to determine whether there’s sufficient production of sperm or blockage of their passage.

TREATMENT

Treatment for male infertility will depend on the cause, if one is found. Treatments include:

•    Surgery, such as for varicoceles, or an obstructed vas deferens.

•    Treatment for sexual problems. We’re talking about ED in all its varieties. Counseling or medication are two of the approaches.

•    Hormone issues. Treatment with hormones or medications that change hormones levels may be recommended.

•    Assisted reproductive technology (ART). For a variety of structural problems mentioned before, sperm can be taken from the testicles or recovered from the bladder and injected into an egg. The most effective ART is in vitro fertilization (IVF). You must have heard or read enough about this already.

Sometimes, problems of male infertility can’t be treated, and it’s just impossible for a man to father a child. Doctor may in this case recommend to you and your partner that you consider either using sperm form a donor or adopting a child, depending on how bad you want one.

See you next week.

Dr. Victor Emanuel has been an educator of medical professionals in training, and the public, for over 20 years in Dominica. The contents of his articles are based on facts and research conducted, and not of his opinion.

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7 Comments

  1. Anonymous
    October 11, 2010

    Thanks Doc for the information….i am definitely makin a well needed visit to your office

  2. wellyes
    October 7, 2010

    @we the willing.
    i really like ur comment cause just recently a female confided in me that she has never had a real orgasm.. and she is married!!… i am female and i have had orgasms…but i suspect there are alot of women who have never experienced a real one

  3. Watcher
    October 6, 2010

    Doc very informative article. Men as well as women read abd you will lean a lot.

  4. bwadiab
    October 6, 2010

    Thanks doc for clearing this up. Only now I understand what folks mean when they say “mister have no balls” ( Undescended testicles).But I wonder how they got to know.

  5. FAE
    October 6, 2010

    This is a fascinating article…too often when a couple cannot conceive society blames the woman and not the man for shooting blanks…or when they keep having a child of the same sex it is the woman’s fault knowing that the woman is only the carrier not the one who decides on what the sex is…

  6. WE THE WILLING
    October 6, 2010

    Doc could u please have an article on a woman reaching a climax. Some of us fake it. Is there a cure or help for this problem. There are also many women who has never had one. Thanks

  7. only
    October 6, 2010

    Most of the infertility these days is coming from toxic chemical substances that people come in contact with or ingest as well as substances that the vaccine manufacturers are putting in the vaccines. The eugenicists want 0 population growth.

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