Infertility, in 10-15% couples, is defined as the inability to conceive after 1 year of regular unprotected intercourse. According to the latest statistics from WHO, infertility is experienced by approximately 50-80 million people globally with male factor contributions in 20-30% cases.
Diagnosis of male infertility is based on seminal examination or sperm analysis including concentration, appearance, and motility of sperm. The normal sperm count ranges between 15-200 million per ml semen. If the concentration is less than 15 million, it is called oligospermia. Meanwhile, if there is no sperm at all, it is called azoospermia. Sperm motility is the main parameter in determining spermatozoa fertility. Therefore, in the analyzed semen, there must be at least 50% of motile sperm.
Common Causes of Male Infertility
The causes of male infertility are hormonal disturbances, lifestyle issues, psychological, sexual, and psychological problems, along with chromosomal abnormality and single gene defect.
Gonadotropin and sex-related hormones showed importance in growth, development, and proliferation. If the brain cannot produce GnRH, then the testosterone will be reduced and sperm production will be stopped.
Physical factors can hamper sperm production and block the ejaculation pathway. Enlargement of sperm vessels or varicocele is the most common cause of male infertility (40%). Testicle torsion in the sac can cause damage to the testicles due to pressure and testicle circulation disorder. Acute or chronic infection of the genitalia are also cause male infertility while sexually transmitted diseases such as gonorrhea and chlamydia cause infertility due to obstruction in the epididymis.
Many sexual problems are physical and psychological. Erectile dysfunction, or impotence, premature or absent ejaculation are examples of sexual intercourse problems.
Men are exposed to harmful substances at work such as toxins, insecticide, silica, mercury, lead, and radiation causing infertility. Prolonged sun exposure also causes temporary sperm decrease. Work that requires sitting for a long time (such as driving) or exposed to high temperature (like in the kitchen) can also be a contributing factor.
Obesity is the main factor contributing to the low semen volume, sperm concentration, and the total sperm count. This is due to the disorder of testosterone conversion by fat tissues affecting the hormone pathway from the brain, reducing gonadotrophin and spermatogenesis.
There is no actual agreement on the effect of alcohol consumption on sperm and fertility. However, progressive sperm decline has a correlation with alcohol and smoking. Drug abuse and pollution factor also affects sperm motility. A study showed teratozoospermia in 63-72% males consuming alcohol. In severe alcoholism, there is no normal sperm found and 64% experienced oligospermia. Therefore, slow testicle damage occurred from routine alcohol consumption.
Diet is also important because studies showed that excessive consumption of processed meat, full cream milk product, coffee, and sweet beverages tend to cause poor sperm quality.
Men with high stress level in fact have low testosterone level and high FSH-LH compared to others, causing decrease in sperm count, morphology, and motility.
Use of tight underwear and pants can also affect spermatogenesis due to high environment temperature for testicles.
Genetic factors are found in 15% of male infertility cases and can be divided into two groups, chromosomal disorder and single gene mutation. As many as 14% men with azoospermia and 2% with oligospermia have chromosomal disorder. Some disorders are hereditary and some are not. The most common genetic cause for azoospermia is aneuploid sex chromosome in 14% case of male infertility.
Although it has been studied by many experts, 70% infertility causes are still unknown. Although so, efforts are still underway to find out the causes to find the complete understanding in order to be able to manage infertility couples. Because male infertility can be a sign of comorbidities, early diagnosis and finding can be an opportunity to improve overall health.