EDITOR’S NOTE | Jamin Brahmbhatt is a urologist and robotic surgeon at Orlando Health and an assistant professor at the University of Central Florida School of Medicine in the United States.
When opposite-sex couples are trying to get pregnant and are unable to, the attention often focuses on the woman. This is not always the case.
Several times a month, men come into my office to ask, “Is this really my problem?”
Why are some men in denial? I think the possibility that a man may have fertility problems may be more than just a clinical concern. For men who associate their virility with their identity and self-esteem, this can lead to a profound personal crisis.
While it is easy for me to offer infertility testing and treatments, it is difficult to deal with the emotional and physical challenges that may arise for my patient or couple on their journey to parenthood. I’ve seen couples break up because of the struggle to get pregnant.
The recent decision by the court in the State of Alabama, in the United States, on what defines an embryo and access to assisted reproductive care has placed fertility issues in the spotlight, often being highlighted as women’s concerns. That’s not the case, which is why it’s crucial to broaden our focus and address male infertility. This also contributes to the challenges that couples face and affects the people involved.
When to seek treatment for male infertility
In the United States, about 1 in 8 couples have difficulty getting pregnant or maintaining a pregnancy. In this context, male infertility plays a significant role, contributing to around 40% of infertility cases.
Couples are generally advised to undergo fertility testing after a year of unsuccessful attempts to conceive, based on how long it can take for healthy couples when the woman is under 35. When the woman is over 35, couples should seek help after six months of trying. This last fact is due to the decrease in fertility that can occur with age, making early intervention important. Although the recommended ages depend on the woman, it is essential that both partners are tested during the fertility assessment.
Additionally, if there are specific health problems that may affect fertility, such as known genetic conditions, previous surgeries affecting the reproductive organs, previous cancers that have required chemotherapy, or chronic illnesses such as diabetes, men should consult a healthcare professional. before they start trying to get pregnant. This proactive approach helps resolve any potential complications earlier in the process and sets the stage for a more informed and targeted design effort.
Clear the air with facts
The first few minutes of my consultation with my male patients consist of clarifying the facts and myths about fertility. It’s about understanding what is ‘knowledge’ online and what is real medicine. Here are the main points I clarify with my patient.
Men’s fertility naturally declines with age, affecting sperm quality and genetic integrity. This process is influenced by lifestyle choices such as smoking, excessive alcohol consumption and obesity, which significantly reduce sperm quality and production. Health problems such as varicocele, infections and hormonal imbalances also impair fertility, just as environmental factors such as heavy metals and excessive heat can impair sperm function. Stress also disrupts the hormones necessary for sperm production.
It’s important to dispel the myths: tight underwear and recreational cycling have minimal impact on fertility, contrary to popular belief. Supplements, although beneficial for specific deficiencies, do not universally increase fertility and should be used with caution. Lastly, frequent ejaculations do not harm overall fertility. They may temporarily lower sperm count, but they can help improve the chances of successful fertilization by eliminating older sperm.
How to diagnose male infertility
Men of any age can start assessing their fertility at any time, and modern technology makes it easier than ever. Several “fertility” apps and semen analysis kits available for home use allow men to assess the quality of their sperm without a prescription. These tools provide an important starting point, but for those seeking a comprehensive understanding of their reproductive health, consulting an expert is critical.
Urologists with experience in male reproductive health are prepared to perform thorough evaluations that go far beyond what home tests can offer, addressing the complex issues of male infertility that can be influenced by genetic conditions, hormonal imbalances, lifestyle factors and environmental exposures.
Semen analysis is a fundamental diagnostic tool in this process. Assesses sperm count, motility and morphology – key indicators of sperm health. A sperm count of less than 15 million per milliliter, known as oligospermia, can reduce the likelihood of successful fertilization. Motility problems, where less than 40% of sperm move efficiently, can make it difficult for them to travel to the egg. Abnormal morphology, in which less than 4% of sperm have a normal shape, can impede the sperm’s ability to fertilize an egg effectively.
A complete fertility assessment also includes physical exams to check for varicoceles or other abnormalities, hormonal tests to uncover potential imbalances that could affect sperm production, and imaging studies to identify structural obstacles. By integrating this data, healthcare providers can determine the most appropriate treatment options tailored to each individual’s unique circumstances, from lifestyle adjustments and medical interventions to surgical solutions.
Male infertility treatment
Treatment for your male fertility problems can start right now. If you are sitting, get up, and if you are standing, start moving. Any improvements in physical health and activity can improve fertility potential. What else you can do depends on what you find in your detailed assessment.
Your doctor may recommend the following changes:
Start nutritional supplements. But be careful. Not all supplements that promote improved fertility are the same. A 2019 study found that many claims made on over-the-counter fertility supplements are not supported by sufficient evidence and should be used with caution. Based on research, in our office we start men off with a cocktail of Coenzyme Q10, fish oil and a combination supplement packed with beneficial antioxidants (vitamin D, vitamin E, zinc and selenium).
Repair your large veins. Recent research-backed guidelines have promoted surgical correction of high-grade varicoceles to improve sperm quality and even testosterone values. This procedure treats abnormal dilation of the veins in the scrotum, which can change the temperature around the testicles and impair sperm production. Improvements after surgery can lead to better chances of natural conception.
Start medications. Depending on the underlying cause of infertility, medications can play a crucial role. Hormonal imbalances, for example, can be corrected with medications that increase the natural production of testosterone and other hormones involved in sperm production. These non-testosterone-based medications include clomiphene citrate or anastrozole.
Direct testosterone replacement is often not recommended as it can stop full sperm production. However, recent studies have found that the use of intranasal testosterone is a viable option for men who wish to continue with replacement therapy without affecting sperm count.
Assisted production may be required. Intracytoplasmic sperm injection is a powerful technique often used in conjunction with in vitro fertilization. It involves the direct injection of a single sperm into an egg to facilitate fertilization. It is particularly useful for men with low sperm count or problems with sperm motility or morphology.
Don’t be silent
Solving the problem of male infertility requires care that goes beyond the limits of medical treatment. In a culture where men don’t talk about fertility and where infertility wrongly defines someone as less of a man, we need to create a culture where we can talk about male reproductive health.
As a urologist specializing in this area, I see the critical need for greater awareness and understanding. By providing emotional support and comprehensive education on the topic, we can transform the conversation around male infertility, making it a topic that is discussed openly rather than whispered in the bedroom or in the clinic.
Tags: Urologist Male Infertility
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