What factors can cause male infertility?

Men’s fertility evaluation

The very first thing you should know is that, you must see a sexologist or a urologist near you who is best in his/her field. The doctor will first do a physical exam and then order for a semen analysis. You should not shy away from giving your semen for test because, the presence of right amount of sperms, their shape and motility play very important role in getting a woman pregnant. Typically, this test will be done twice to confirm that there is no significant problem.  If you have been seeing a sexologist already but got no results so far, it is better to go for a second opinion.

Following problems can be detected from semen analysis:

1. Azoospermia – Absence of sperms in semen. This can be of two types – Obstructive and Non Obstructive. Obstructive azoospermia refers to the presence of some blockage which is not allowing the sperms to come out as a part of the ejaculate. Non obstructive azoospermia refers to a condition where there is no obvious blockage in the male reproductive system and yet there is near zero presence of sperms.
2. Oligozoospermia – A condition when the concentration of sperms in semen is less than 15 million per millilitre of the ejaculate.
3. Asthenezoospermia – Where sperms are too weak to swim through the semen and reach the egg.
4. Teratozoospermia – Abnormal sperm morphology. (The structure of the sperm is not well formed).

What can cause fertility problems in men?

1. Sexually Transmitted Infections – STDs or STIs such as Gonorrhoea or Chlamydia can cause infertility in men. If treated on time, the effect can be reversed.
2. Congenital problems, Injuries or blockage to the pipes carrying semen and sperms. Some men may be born with defective reproductive system or abnormalities in testicles or other organs. Injury to testicles, prostate, urethra can result in infertility. Surgery can be an option in some cases and in some cases, there may not be any treatment possible. The couple may have to go for sperm aspiration or look for a sperm donor.
3. Retrograde Ejaculation – A condition where the semen that is supposed to get ejaculated enters the bladder. This can be because underlying conditions such as diabetes, problems with bladder, prostate or due to certain medications.
4. Genetic diseases – Rare genetic problems such as cystic fibrosis or chromosomal disorders can cause infertility in men.
5. Autoimmune problems – The immune system in men suffering from this problem targets sperm cells as the mistake them for foreign pathogens. As a result the sperm cells get damaged and become incapable of making an egg fertile.
6. Hormonal imbalance such as that of thyroid can cause infertility. This can be treated with synthetic hormones or medicines.
7. Sexual Health problems – Erectile Dysfunction and Premature Ejaculation conditions can also lead to infertility even though there is no problem with the sperms in the ejaculate. These can be caused due to physical or mental conditions including stress, anxiety, diabetes, high blood pressure, high cholesterol etc. If a man is on anti-depressants, they may also lead to these conditions as side effect. Make sure, you tell your doctor if you are on any such medication.
8. Varicocele – Enlarged veins on the scrotum that prevent blood from flowing normally. Know more about Varicocele and how it can lead to infertility by clicking on this link. 
9. Over exercise, stress, obesity, drug abuse (Marijuana, cocaine) taking steroids, excessive alcohol, smoking etc reduces sperm count. Men working in excessive heat environment can become infertile.

Treatments for men’s infertility problems

Treatment for infertility depends on the problem or the underlying condition.

1. If the sperm count is low, your sexologist may put you on medication and advise less frequent participation in sexual intercourse. You may also need to take vitamin and mineral supplements depending on the deficiencies found in your blood.
2. Retrograde ejaculation is also treated with medicines.
3. Problem with obstructions in the tubes carrying sperms and semen may be corrected with surgery.
4. Erectile dysfunction and premature ejaculation – treatment may include medicines, exercises and mental counselling by your sex therapist. The therapy may be for both the partners in some cases.
5. Total absence of sperms in semen – Sperm aspiration techniques may be employed to retrieve sperms if that is possible. IVF, ICSI techniques may be used to impregnate the female partner. If the quality of eggs in the woman is not as required, egg donation may be an option.