Understanding the Male Subfertility in Detail

What Is The Difference Between Infertility And Subfertility?

Infertility and subfertility might be used by some as synonyms, but they do not mean the same thing. Infertility is generally defined as failure to achieve pregnancy after 12 months of regular, unprotected intercourse, while on the other hand, subfertility means reduced fertility. Here, the capacity to father a child is diminished, but not zero. A man will be considered subfertile if conception does not take place following 12 months of unprotected and regular intercourse.

Sexual dysfunction and abnormal semen quality are two common contributing factors in subfertile couples, making it important for a man to be assessed by a gynaecologist or by a clinical andrologist. Subfertility affects 1 in 20 men around the globe [source].

There are several types of subfertility, including:

• Oligozoospermia: Oligospermia refers to the diagnosis of low sperm count among men. Usually, a healthy sperm count ranges from 15 million to 200 million sperm cells per 1 millilitre of semen. In contrast, men who are suffering from oligospermia have their sperm count below 15 million in 1 ml of semen.
• Azoospermia: Azoospermia occurs when no sperm cells are detected in a man’s semen. This might happen as a result of the obstruction of the reproductive tract, problems with the reproductive tract itself, hormone disorders, ejaculation problems, or testicle problems.
• Poor sperm quality: Poor sperm quality refers to a low sperm count, reduced motility, or an abnormal appearance of sperm cells. This is one of the main reasons for male infertility. Poor sperm quality could be due to several factors, such as smoking, alcohol use, obesity, the heat from laptops, and tight clothing.
• Sperm motility: The motility of the sperm refers to the capability of the sperm to swim efficiently through the female reproductive tract. Low motility leads to many cases of male infertility.

What Causes Male Subfertility?

Male subfertility is almost always linked to issues with the sperm. The issues may have something to do with their production, movement, or structure. As per the categories, common male subfertility reasons include:

Problems with sperm production:

• Varicocele: swelling of the veins in the scrotum resulting in high local temperatures that adversely affect sperm. This is the most frequent, but treatable, case of male subfertility.
• Hormonal dysfunction: low testosterone levels or malfunctions of the pituitary and hypothalamus glands that trigger the manufacture of sperm in the testes.
• Genetic abnormalities: Klinefelter’s Syndrome (XXY) and Y chromosome microdeletions impact spermatogenesis at a genetic level.
• Undescended testicles: failure of one or both testicles to reach the scrotal sac at birth causes defects in sperm manufacture.

Obstruction in the reproductive tract:

• Other Infections: Prior infections such as chlamydia, gonorrhoea, and mumps (in the case of mumps, when it causes orchitis) may result in scar tissue and blockage.
• Vasectomy: deliberate surgical obstruction of the vas deferens; reversal is sometimes achievable, but not always successful.
• Congenital bilateral absence of the vas deferens (CBAVD): Some males have no vas deferens to deliver sperm from the testes.

Sperm quality issues without any structural cause:

• Oxidative stress: This is an imbalance between the free radicals and the body’s ability to neutralise them. Oxidative stress may cause damage to sperm DNA.
• Idiopathic subfertility: In some cases, no clear causes of subfertility may be found even after a thorough investigation.

How Is Male Subfertility Diagnosed

Treatment And Management Options

• Surgery for varicocele: Varicocelectomy surgery can greatly enhance sperm parameters in men with clinically diagnosed varicocele. This is one of the very few approaches backed by research.
• Hormonal treatment: In case infertility occurs because of a decrease in gonadotropins (hypogonadotropic hypogonadism), administration of hormones will stimulate the production of sperm.
• Anti-infection drugs: In case there is an ongoing infection in the male reproductive system, antibiotics will be prescribed.
• Surgical sperm retrieval: If a man has obstructive azoospermia (sperm is produced but cannot leave the epididymis), procedures such as PESA (Percutaneous Epididymal Sperm Aspiration) or TESE (Testicular Sperm Extraction) can help retrieve sperm.
• Assisted Reproductive Technology (ART): IUI (Intrauterine Insemination) for moderate subfertility and ICSI (Intracytoplasmic Sperm Injection), a sophisticated procedure of IVF, wherein a single sperm is injected into an egg, has revolutionised the outlook for men with drastically low sperm counts.

For many men, subfertility may be reversible by making some small yet significant changes to their lifestyle. Sperm quality could improve if they stop smoking, limit alcohol consumption, maintain a healthy body weight, manage heat exposure, manage stress, and follow a healthy, balanced diet.

Conclusion

The problem of male subfertility is much more prevalent than most people realise, and, surprisingly, it is a lot easier to manage than one would think. It is an issue that goes largely unspoken due to the stigma attached to it and the lack of awareness among men. The crucial first step to overcoming subfertility involves recognising that having a child is a joint effort and that getting one’s semen analysed is no different from any other medical test. It does not determine who you are as a person, and asking for help is a sign of courage, not shame.