Kemi Ailoje

What are the most common infertility issues faced by men?

As mentioned in our last week’s edition, male infertility usually manifests as issues with the sperm or with the process of ejaculation. These can take many form but the most common problems seen by fertility specialists in infertility treatment include:

• Azoospermia: This condition is defined as the complete absence of sperm in semen or ejaculate. But the fact that you are ejaculating seminal fluid does not mean they contain sperm to fertilise eggs and form babies.

• Oligospermia: This condition means low sperm count (15 million to greater than 200 million per millimeter is considered normal).

• Congenital absence of the Vas Deferens: The tube which transports sperm to the penis in the event of ejaculation did not develop before birth.

• Ejaculatory Duct Obstruction (EDO): Is a blockage in a man’s ejaculatory ducts, which maybe caused by injury or infection.

• Poor Sperm Motility or Morphology: Poor sperm motility means the sperm do not swim properly towards the egg, while poor morphology means that most sperm appear with abnormal forms or shapes which does not allow for normal fertilisation to occur.

• Varicocele: Sometimes we find some men develop enlarge varicose vein in the scrotum, which can affect reproductive function in several ways.

• Premature Ejaculation: This occurs whena man consistently ejaculates before penetrating the vagina which can be caused by prostate health issues, mental issues etc.

• Erectile Dysfunction: This occurs when a man cannot get or keep an erection firm enough for sexual intercourse.

Treatment of male infertility
Many fertility clinics with specialists can treat male infertility depending on the source of problem either medically, or may in case of blockage or varicocele have surgical repairs recommended.

• Vasectomy Reversal: This treatment or techniques is used where the original vasectomy was performed, a surgeon can often reconnect the tubes and normal reproductive functions restored.

• Ejaculatory Duct Resection: This is a procedure performed for men with ejaculatory duct obstruction.

• Varicocele Repair: Varicocele is an enlargement of the veins within the scrotum, repairing varicocele may provide a better environment for sperm, which could help to improve sperm count, motility and morphology.

• Sperm Retrieval: If a patient cannot produce sperm naturally the doctor can use one of the following techniques:

a. Percutaneous Epididymal Sperm Aspiration (PESA)
b. Testicular Sperm Aspiration (TESA)
c. Microsurgical-Testicular Sperm Extraction (TESE)
d. Microsurgical -Epididymal Sperm Aspiration
e. Microsurgical Testicular Sperm Extraction
f. Open Fine Needle Aspiration etc.

Sperm obtained through any of this process above is usually used for IVF/ICSI (Intra Cytoplasmic Sperm Injection) procedure and mostly done by specialists in most cases urologists under ultrasound guidance.

Donor sperm may be a last resort in some cases especially in genetic causes of male factor infertility when medical and surgical interventions fail.

Some type of male infertility are preventable while some are not since they may be genetic, however there are still some we can avoid/reduce their effect by doing the following:

• Avoid smoking
• Reduce stress
• Limit or abstain from excessive alcohol intake
• Eat healthy balanced diets
• Maintain healthy weight
• Avoid a vasectomy
• Avoid things that expose the testicles to prolonged heat
• Avoid exposure to pesticides, heavy metals and other toxins.

Psychological Effect of Male Infertility
Research suggests that men and women differ in their psychological response to infertility. While men and women are equally affected by the unfulfilled desire for a child, men are sometimes less expressive than the women, they however undergo various battles when facing personal infertility.

These battles include anxiety concerning potency, masculinity, and sexual adequacy, which seems like an assault on the man’s self-esteem, leaving them with a feeling of competition and castration. These feeling of stress, depression, guilt or anxiety in infertile men can further cause psychogenic impotence, which heightens the feeling of inadequacy that already accompanies infertility. The psychological stress of infertility has been shown to affect sperm parameters in significant and demonstrable ways that may further contribute to difficulties with erectile potency. Emotional reactions to the infertility may alter or even undermine previous sense of self as sexually adequate.

Infertility weighs on the minds of many males, as this creates mental instability, which often results in impotency.

Psychological causes of impotency includes:

• Clinical depression
• Medications
• Fatigue
• Stress
• Relationship issue
• Social interaction

The above listed issues can arise as a result of the psychological effect of infertility in men.

Psychological treatment
The most prevalent psychological management is counselling, marriage therapy and supportive partner/wife. Men naturally barely seek counselling. However it has been scientifically proven that men, who seek specialist counselling, which allows them to express their sources of anxiety and loss of confidence in sexual adequacy often feel, cope better and are able to seek solution to infertility and adequate sexual life. Dealing openly with one’s partner/spouse has also been found to help the men cope better especially when they seek counselling as a couple.

For many couples struggling to conceive, seeking help can feel hopeful and overwhelming. When faced with male infertility, do not walk on a lonely path, talk to your fertility specialist about it and you would be amazed that for most type of male factor causing infertility listed, there are solutions with the possibility of having children and healthy sexual life.