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If a couple has fertility problems, it’s usually the women who initiate seeking help. This should not be the case as men’s contribution to infertility is estimated at about 30 per cent.
Fertility problems in men either have to do with sperm production, or transport. Sperms are produced in the testes, controlled by signalling from glands in the brain. The sperms must then be transported into the female genital tract. Problems with either of the mentioned mechanisms can cause male fertility problems.
Men in good health produce good quality sperms. Poor sperm quality is observed in men who have infrequent sexual intercourse, are overweight, smoke cigarettes and use other recreational drugs.
Defective sperm production
Sexually transmitted diseases like gonorrhoea or chlamydia commonly cause obstruction of the microscopic channels that transport sperms. Men with multiple sexual partners must use condoms to reduce risks of sexual infections, and seek prompt treatment once infected.
Problems with erection, called erectile dysfunction, are caused by a variety of conditions and warrant specific measures.
Disordered sperm production can be due to a variety of reasons that include, disorders of hormone production, testicular diseases, genetic conditions and in some cases, no apparent cause is found.
Male evaluation for fertility includes a medical history and clinical examination, including examining the testes. Such evaluation is usually with a fertility specialist, but may also involve an urologist. Men are then asked to give a sample of semen, which is analysed immediately. If sperms are normal, further efforts are directed towards the woman.
Men with abnormal semen results usually need to provide a second sample to confirm the abnormalities. The degree of abnormality gives further guidance on subsequent tests. Hormone tests, including testosterone levels, will give information on testicular response following signalling from glands in the brain. Other hormones with an indirect effect on sperm production may also be checked. Testicular ultrasound imaging is necessary to exclude potential diseases in the testes that may interfere with formation and transport of sperms.
A minority of men with either very low sperm numbers, or no sperms at all require genetic tests. Such tests will occasionally reveal a genetic condition that may have otherwise escaped suspicion. For majority of men, treatment is usually successful. Simple lifestyle measures like stopping smoking and optimising weight often improve sperm parameters.
Mild abnormalities in semen can easily be addressed by inseminating sperms directly into the uterus. Modern assisted conception techniques can now assist conception even in men with the severest of semen abnormalities.
Unknown treatment
Some rare conditions have no known treatment and such men would only benefit from sperm donation, adoption or living childless.
Men must avoid over-the-counter remedies, which sometimes may be detrimental to testicular function. The better evil is to accompany their partners to a fertility consultation.
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