(By Dr. Shashidhar B, Andrologist, Consults on Practo)
It's been more than four and half decades since the first baby was born by In vitro fertilization (IVF). Since then, the focus has been mainly on the female factor infertility evaluation and recommending assisted reproductive methods of conception. Male infertility is a prevalent issue, contributing to approximately 50% of infertility cases globally, as reported by the World Health Organization (WHO).
Alarmingly sperm count is decreasing at a concerning rate and it has halved during recent times which is responsible for 1 in 20 men facing fertility issues due to abnormal sperm parameters. It is estimated that around 7% of men worldwide experience fertility challenges. Today, the male factor contributes to almost 60 per cent, causing infertility where 1 in 3 couples suffer from infertility due to this.
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Consequences Of Male Infertility:
It's not only women who undergo the misery of infertility. Men also suffer the painful and isolating effects of infertility as well, with males feeling: “Here I am finding out that I am unable to pass on my genetics" (The experience of infertility treatment: the male perspective. ST Arya, B Dibb Human Fertility, 2016 Taylor & Francis). Men experience shame when faced with infertility compared to female infertility. However, there is a paucity of attention towards male infertility and there is little research or clinical intervention. Not being able to become a father is viewed as a setback by males towards their masculinity and societal attitudes also influence their acceptance of infertility treatment.
Females even if they are fertile are exposed to the risks associated with IVF/ICSI when the decision is made to go ahead with treatment options ignoring male factor infertility. This translates to a disproportionate and unjust physical and psychosocial burden towards females.
Causes Of Male Infertility:
Recent research shows a decline across the entire male reproductive spectrum, including sperm count, testosterone levels, and increased erectile dysfunction. Male infertility can have various causes, such as genetic mutations, lifestyle factors (e.g., sedentary behaviour, diet, alcohol abuse), medical conditions, medications, and hormonal imbalances.
For example, conditions like adult growth hormone deficiency, brain tumours or trauma, and hypopituitarism can disrupt the delicate hormonal interplay crucial for sperm production.
Hormonal irregularities such as excess estrogen, abnormal follicle-stimulating hormone (FSH) levels, and primary hypogonadism can also lead to impaired sperm production or function.
Additionally, genetic conditions like myotonic dystrophy and Noonan syndrome, often overlooked in fertility discussions, can affect male fertility. Environmental factors can also play a role.
Studies suggest chemicals in household items like plastics and phthalates (found in makeup, shampoos, soaps, and pesticides) can negatively impact sperm quality.
Furthermore, rising global temperatures and heat waves may be detrimental to spermatogenesis (sperm production).
Finally, advanced paternal age has been linked to lower sperm quality and decreased fertility.
Discussions on male infertility are still rare even in modern times, and they are always overshadowed by open discussions on female infertility. But times are changing as men desire a more inclusive process in fertility treatment and expect to be evaluated, diagnosed, and intervened rather than subjecting the female partner to unnecessary investigations and undergoing pain and trauma of unindicated IVF/ICSI. Fertility professions play an important role as most couples feel that their husbands are less interactive or examined clinically. No attempt is being made to treat it comprehensively and they believe there is a sense of urgency to embrace IVF/ICSI.
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