Male Fertility issues: Beyond Sperm

Male fertility issues go beyond sperm parameters. History-taking for a male reproductive health workup includes exploring reproductive and sexual history, developmental history, medical history, lifestyle choices and behaviors, and environmental exposures. In this article, we cover a few issues that hinder fertility. The more aware you are of these, the more effectively you can look for help.

OBESITY

Although this has grown to be a controversial topic in popular culture, body mass index and waist-to-hip ratio are in fact found to be inversely associated with certain semen quality parameters. Overweight and obese men are more likely than their healthy-weight peers to produce poor-quality sperm and have other health issues that impair fertility and other health issues. Morbidly obese men have these problems amplified and often have mobility issues that make the conception process and ejaculatory phenomenon extremely difficult. Increased body mass index is associated with reduced sperm motility and concentration. And a high waist-to-hip ratio has a stronger negative association with progressive motility and total sperm count. A normal body mass index must be 18.5 to 25. A normal waist-to-hip ratio must be 0.96 to 1.0. These values are to be taken in a contextualized manner: each person requires an individualized assessment. Apart from a high body mass index and/or waist-to-hip ratio, very low values or values that oscillate frequently also hinder fertility. If you notice that you have been overeating, undereating, feeling fluctuations in appetite, nausea when trying to eat or smelling foods, having obsessive thoughts about food, or other symptoms related to your eating habits, contact a doctor or nutritionist, and possibly a psychologist, counselor, or therapist. To help you, you should have a nutritional plan fitted to your goals of starting a family, and then check-up points daily and/or weekly to make sure you are sticking to it. These might be weigh-ins, a food journal, or a group to share your personal experiences.

VITAMIN D DEFICIENCY

Vitamin D is especially important for fertility in both sexes. Up to 90% of this vitamin is sourced from sunlight-induced production in the skin. The rest of it is derived from diet and supplements – vitamin D2 (ergocalciferol) from plant sources and fortified foods, and vitamin D3 (cholecalciferol) from animal-sourced foods; produced by the skin when it’s exposed to sunlight. In men, vitamin D supplementation can improve semen quality, fertility outcomes, and testosterone concentrations. Both low (<20 ng/ml) and high (>50 ng/ml) concentrations of vitamin D have a prejudicial effect on spermatozoa number per ml of semen, their progressive motility and morphology. There are tests available to check your vitamin D levels. Most people think that taking supplements to make sure you have your vitamin D levels normal, even if you are not sure of where your levels are, is okay. That is not true for all vitamins, but vitamin D toxicity is extremely rare due to how high the dosage you would have to intake is. If you would like to check your vitamin D levels, you can buy online a quick and reliable at-home test kit: efp.clinic/product/vitamin-d-test/ 

OXIDATIVE STRESS

The body’s cells produce free radicals during normal metabolic processes. However, cells also produce antioxidants that neutralize these free radicals. In general, the body can maintain a balance between antioxidants and free radicals. Oxidative stress is caused by an imbalance between oxidative and antioxidative mechanisms an imbalance of free radicals and antioxidants in the body. Although oxidative stress occurs naturally, high levels of it have a destructive effect on sperm, like DNA fragmentation and endangered integrity of the embryo genetic material (which may mean compromised viability of the pregnancy and development of conditions in the offspring). The extent of the oxidative stress requires analysis to determine the extent of the damage and proper treatment, like oral antioxidant supplementation. Several factors contribute to oxidative stress and excess free radical production, like diet, lifestyle, certain medical conditions, pollution, and radiation. Foods that are high in antioxidants include the following: small red beans, wild blueberries, red kidney beans, pinto beans, cultivated blueberries, cranberries, artichokes, blackberries, prunes, raspberries, strawberries, apples, pecan nuts, sweet cherries, black plums, russet potatoes, black beans, plums, and dark leafy greens. Consider that each person may have specific dietary needs

GENETICS

The interplay between thousands of genes, the epigenetic control of gene expression, and environmental and lifestyle factors determines the men’s fertility potential. Currently, checking the quality of the men’s DNA is more common. This is done through a karyotype test and not a sperm analysis. These are two separate tests. Karyotype abnormalities, deletions on the long arm of the Y chromosome, and CFTR gene mutations are well-established genetic causes of infertility in men with azoospermia and severe oligozoospermia. Autosomal and sex-chromosomal genes play a role in spermatogenic failure and male infertility too. 

VARICOCELE

A varicocele is an abnormal dilatation of the pampiniform plexus of the spermatic cord, meaning the enlargement of the veins within the scrotum when blood pools in the veins rather than circulating out of the scrotum. This may cause poor development of a testicle, low sperm production, or other problems that may lead to infertility. Varicocele is one of the most common correctable causes of male infertility. This may come with some symptoms (a dull, aching pain or discomfort is more likely when standing or late in the day, if big enough a mass may be visible and palpable, and the affected testicle may be noticeably smaller than the other testicle), but no symptoms can occur as well as there are three degrees of varicoceles: (1) smallest type, not visible without a medical assessment, (2) not visible, but can be felt, and (3) is visible and palpable. After a varicocelectomy (surgery), total sperm count and the percentage of motile sperms at three months and six months increase progressively, improvement in serum testosterone and enhancement of erectile and ejaculatory functions are also seen.

THYROID FUNCTION

The thyroid gland has an important role in male reproductive functions. The thyroid gland can overproduce (hyperthyroidism) or underproduce (hypothyroidism) thyroid hormones. Hypothyroidism and hyperthyroidism, being considered diseases, can each hinder fertility. Hypothyroidism may result in decreased sex hormone-binding globulin, total serum testosterone, luteinizing hormone, and follicle-stimulating hormone levels, increased testicular, significant drop in mature germ cells within the seminiferous tubules, compromised semen volume and morphology, and decreased motility. Hyperthyroidism may result in decreased sperm count and motility, increased testosterone, luteinizing hormone, and follicle-stimulating hormone levels, and alters sex steroid levels. To assess your thyroid function, you can buy online a quick and reliable at-home test kit – basic testing: efp.clinic/product/basic-thyroid-hormones-test/ and advanced testing: efp.clinic/product/advanced-thyroid-hormones-test/

SCROTAL HEAT STRESS

Adequate thermoregulation maintains the testis’s temperature lower than that of the body core for successful spermatogenesis. The raised testicular temperature has a detrimental effect on sperm quality. Mature spermatozoa in the epididymis are not protected from heat-induced DNA damage. Thermoregulatory failure leading to heat stress can compromise sperm concentration, motility, and morphology, and possibly damaged DNA integrity. Several types of external and internal factors may contribute to testicular heat stress: having varicocele, having cryptorchidism, using thigh clothing, using saunas or warm baths, doing long hours of cycling, putting a laptop directly on the lap, anything that increases friction and temperature directly on the genital area. As you can discern, simple changes to daily habits could help lessen heat stress.

TESTICULAR TORSION

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. This can happen at any age. Torsion of the spermatic cord is an emergency that requires surgery. It can bring damage to testicular tissue; thus, prompt evaluation and management is required to salvage the testis following an episode of torsion. The reduced blood flow causes sudden and often severe pain and swelling. Testicular torsion causes decreased sperm motility and count. Gladly, only a few people experience minor alterations in levels of gonadotropins and testosterone. In case of any discomfort or suspicion of a torsion, go to the emergency room of the hospital nearest to you or contact the national health system emergency contact.

TESTICULAR CANCER

Check our article: rediaivf.com/infertility-in-men-testicular-cancer/ 

INFECTIONS

  1. Sexually transmitted infections

Chlamydia trachomatis

This is the most common sexually transmitted disease and can be asymptomatic in about 50% of men. It can cause of non-gonococcal urethritis, acute epididymitis, increased interleukin-8 levels, and increased seminal leukocyte concentrations. The connective tissue in the testis, Leydig cells, prostate, epididymis, and seminal vesicles can also contain this infection. Regarding sperm, progressive motile is decreased and alter DNA integrity.

Neisseria gonorrhoeae

Gonorrhea is the second most frequently reported sexually transmitted disease. It may lead to prostatitis, epididymal-orchitis, testicular damage, ductal obstruction, and damage to the male germ cells. This infection negatively affects fertility. Usually, the infection is symptomatic with severe dysuria and a purulent urethral discharge. 

Mycoplasmataceae

Ureaplasma urealyticum is frequently found in the urethra of sexually active men and is associated with symptomatic and asymptomatic non-gonococcal urethritis, pelvic inflammatory disease, and decreased sperm morphology, concentration, motility, and vitality. Mycoplasma is another genus of the mycoplasmataceae family that lowers sperm’s penetration rate into zona-free hamster oocytes, count, motility, morphology, seminal reactive oxygen species production, and total antioxidant capacity.

  1. Prostatitis

Prostatitis is an inflammation of the prostate gland. This is the most common urological diagnosis in young and middle-aged men. a classification of prostatitis symptoms follows as such: (1) acute and chronic bacterial prostatitis, (2) chronic pelvic pain syndrome, and (3) asymptomatic inflammatory prostatitis. Men with chronic prostatitis present an episodic, relapsing condition characterized by pelvic pain, irritative voiding symptoms, and effects on sexual function. Escherichia coli is the cause of bacterial prostatitis in most cases. Other causes include Chlamydia trachomatis, Ureaplasma urealyticum, Nesisseria gonorrhea, and Klebsiella species. Prostatitis is linked with decreased prostatic excretory function and a negative impact on sperm morphology and motility. 

  1. Epididymitis

Epididymitis is an inflammatory condition of the epididymis. This can be caused by Chlamydia trachomatis or Neisseria gonorrhoeae in younger men, whereas Escherichia coli is predominantly found in older men with a higher risk of urethral strictures, bladder neck obstruction, or benign prostatic hyperplasia. Epididymitis leads to loss of sperm function, deterioration of sperm concentration, motility, and morphology, azoospermia and/or oligozoospermia, and leukocytospermia. 

  1. Orchitis

Orchitis is an inflammatory lesion of the testis that can be caused by Chlamydia trachomatis and Neisseria gonorrhea in men up to 35 years old, by Escherichia coli in older men. It can also be caused by the mumps virus. Orchitis may cause tubular damage, degeneration of the germinal epithelium, thickening of the lamina propria, fibrosis of the tubules, testicular atrophy, intratesticular obstruction, and poor sperm quality.

  1. Urethritis

Urethritis is an inflammation of the urethra caused by Chlamydia trachomatis, Mycoplasma, and Neisseria gonorrhoea. Non-sexually transmitted uropathogens such as Enterobacteriaceae and staphylococci are also triggering urethritis Symptoms of urethritis in men typically include urethral discharge, penile itching, or tingling, and dysuria. 

  1. Escherichia coli infection

Escherichia coli causes most infections in the urogenital tract and male accessory gland. It negatively impacts sperm motility, sperm cell’s mitochondrial function, acrosome reaction, and fertility potential, and it may induce early apoptotic events. 

If you have any discomfort, pain, bad smells, or other symptoms down there, or if you have been informed you have slept with someone who has an infectious disease, see a healthcare professional. For those who have unprotected sex, regular check-ups are advised. There are antibiotics that one can take, whether orally or administered by a doctor (in a vein or large muscle), that cure the infection. Other products, like an ointment, may ease the discomfort and irritation. Check-ups post-treatment may be needed. 

SEXUAL DYSFUNCTIONS

Sexual dysfunction encompasses different issues like too low or too high sexual desire, lack of sexual satisfaction, and orgasm disorders like erectile dysfunction and premature ejaculation which have a prevalence of one in six infertile men, and orgasmic dysfunction has a prevalence of one in ten infertile men. The impact of the psychological components cannot be discarded as this is a heavy subject that affects self-esteem, intimacy, and relationships. A full assessment of the patient is necessary before jumping to any conclusions. Other medical conditions, environmental stressors, and even medications can cause these issues. Here a physician to address the possible bodily reasons for the dysfunction and mental healthcare professional to address the possible psychological reasons and consequences are necessary. If you are in the UK and you are looking for mental support, you should try bica.net/ Besides this, if you are looking for more relaxed and peer-based support, you should try himfertility.com/ and them-ancave.co.uk/

CHRONIC ALCOHOLISM

In frequent and/or heavy drinkers, semen volume, count, motility, and morphology tend to decrease, and impotence, testicular atrophy, gynecomastia, and loss of sexual interest can and often do occur. Sexual disorders have been reported in men who are long-term alcohol users. For people with alcohol 

Other drugs

Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may, directly and indirectly, induce sexual dysfunction and decrease overall sperm quality. In most cases, the effects are reversible after the discontinuation of the drug. It is important to state that it is not just illegal drugs that provoke this, prescribed drugs may do as well (e.g., chemotherapy). When a treatment cannot be stopped and/or when the impact is potentially irreversible, cryopreservation before treatment must be proposed. 

If you are struggling with an addiction, you may try to reach a drug addiction hotline available in your country. If they are experiencing an overdose, a “bad trip”, or any other emergency, do not contact a helpline, contact the number for medical emergencies. Here are some of those contacts:

UK

USA

Canada

Medical emergency number: 911

Australia

Netherlands

  • Medical emergency number: 112
  • Narcotics anonymous: Utrecht – (+31) 6 12 17 92 65, Den Haag – (+31) 6 83 93 53 94, Zuid Nederland – (+31) 6 22 51 14 56, Alkmaar – (+31) 6 11 20 04 23, Amsterdam – (+31) 6 22 34 10 50, Rotterdam – (+31) 6 22 34 96 38 (na-holland.nl/)

Greece

Spain

Italy

Portugal

  • Medical emergency number: 112

Linha Vida SOS Droga – SICAD (Serviço de intervenção nos comportamentos aditivos e das dependências): 1414 (sicad.pt/)

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