Male infertility is not typically classified as a disease, but it carries a significant psychological burden for those affected. The emotional stress involved can be so intense that it impairs a man’s ability to function effectively at work. Additionally, the pressure to maintain intimacy within a marriage often becomes a scheduled obligation, which can contribute to erectile dysfunction and a decreased desire to initiate sexual activity.
In contrast to the widespread advertising of pills that claim to increase penis size for sexual pleasure, many men face the far more pressing and complex issue of being unable to father children. When addressing male infertility, it is essential to consider all potential factors contributing to the problem, as it is a multifaceted condition.
Infertility often brings considerable emotional challenges, with nearly half of infertile men experiencing depression, grief, or feelings of inadequacy. Relationship difficulties are also common, emphasizing the importance of counseling and support groups. While such resources are easily accessible in many developed countries, men in other regions frequently conceal their infertility struggles due to social stigma.
A thorough review of the man’s medical history is a crucial starting point. This includes determining how long infertility has been diagnosed and what diagnostic or treatment measures have been attempted. It is important to explore childhood health issues such as undescended testicles, noting when the diagnosis was made and when treatment occurred, as these details can influence the cause of infertility.
Past infections, especially sexually transmitted infections, must be documented along with their treatment timelines. The number and type of infections are relevant, and further investigations may be necessary to detect any lingering effects. Medication history is also important, particularly the use of antibiotics and hormones like testosterone, which some men mistakenly believe enhance sexual performance but can sometimes cause irreversible damage if misused.
Exposure to toxins, especially in men working in chemical or petrochemical industries, can lead to gradual testicular damage due to prolonged contact with harmful substances. This occupational hazard is a significant consideration in evaluating infertility.
Physical examination is essential to assess body type, hair distribution, and overall physical condition. For example, a man with obesity and a protruding abdomen at age 35 is generally less likely to be fertile than a lean man of the same age and weight around 65 kilograms. Such observations help determine physical fitness, which can impact fertility.
Laboratory tests begin with semen analysis, which is fundamental in diagnosing male infertility. This test evaluates semen volume, sperm concentration, motility, and morphology, usually requiring two to three samples collected over several months. Normal semen volume ranges between two and five milliliters, and sperm counts typically range from 20 to 200 million per milliliter. Counts below 15 million are considered low (oligospermia) and can be classified as mild, moderate, or severe. A complete absence of sperm is known as azoospermia. If sperm count is low, further analysis helps identify whether the cause is reduced sperm production due to surgery, hormonal imbalance, or past infections, or increased sperm destruction possibly caused by ongoing infections.
Hormonal testing measures testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels to evaluate endocrine function. Abnormal hormone levels guide further investigation and treatment. Imaging studies, such as scrotal ultrasound, detect varicoceles or blockages in the spermatic cord or seminiferous tubules. Transrectal ultrasound is useful for identifying ejaculatory duct abnormalities. In azoospermic men, a testicular biopsy may be necessary to assess sperm production capability.
Genetic testing can confirm conditions like Klinefelter’s syndrome, allowing for appropriate counseling and preventing unnecessary, costly treatments. Treatment depends on the underlying cause and may include lifestyle changes such as weight reduction, smoking cessation, and limiting alcohol intake to improve sperm quality and hormonal balance. Stress reduction also aids in restoring reproductive hormone levels.
Medical treatments include hormone therapy for hypogonadism or pituitary disorders and antibiotics for infections affecting sperm production. Dietary improvements involving antioxidant-rich foods like berries, nuts, and leafy greens can help protect sperm from oxidative damage. Some infertility issues are treatable with surgery, although such procedures can be expensive and are available only in specialized centers.