Male Infertility and its causes

Flora Pjetri Castillo

1. Introduction

Today one of the most serious social problems that developed society faces is the decline of

the birth rate. Infertility is said to affect between 48 million couples and 148 million

individuals globally, defining infertility as a disease of the male or female reproductive

system. Many countries are seeing a decline in birth rate, and while infertility may be a cause,

it is not the only reason. Shifting societal standards and increased age couples during

conception are both major factors when the fertility rate is analyzed.

The Dictionary defines the word “infertile” or barren as “inability to procreate”, or

“inability to give birth”. To be considered infertile, the couple must be unable to conceive

after 12 consecutive months of unprotected sexual intercourse (Harris et al., 2011).

Infertility is caused by a number of factors, in either the female or the male

reproductive system, but sometimes it is not possible to cause the reason for infertility in

couples.

Fertility, or lack thereof, has historically been thought to be a “woman problem” with

a harsh stigma affecting women only (Taebi et al., 2021) but male infertility is estimated to

affect roughly 40%-50% of couples within the 8-12% of couples experiencing infertility in

any form worldwide (Agarwal et al., 2021).

2. Male infertility factors

The production of fertilizing sperm, and spermatogenesis, can be impacted by a

number of factors such as biological causes, physical characteristics of the person as well as

the sperm itself, and environmental causes ranging from temperature to toxic material

exposure.
 The primary hormone for male fertility is testosterone (O’Donnell, Stanton, & de

Krester, 2017). Testosterone plays an important role in spermatogenesis and tends to drop as

men age beginning around 40 years old, therefore decreasing fertility (Harris et al., 2011).

Furthermore, testicular size decreases around 70-80 years old when compared to men aged 18

to 40 years old. While not many couples are actively trying to conceive at this age, the size of

the testes directly relates to the amount of sperm created.

One of the most common causes of male infertility is a condition called varicocele.

Varicocele is characterized when an enlarged vein or veins in the scrotum pool oxygen-

deprived blood in the area surrounding the testes instead of properly circulating it. This

overheats the testes internally where they cannot regulate an optimal sperm-producing

temperature of roughly 93.2 degrees F (Leslie, Sajjad, & Siref, 2022). Outside of low sperm

production, the characteristics of the sperm produced can have an effect on fertility. These

include low mobility and therefore non-viable sperm (Miyamoto et al., 2011) and abnormal

sperm shape (Harris et al., 2011).

Lifestyle choices including smoking, alcohol, and obesity can have up to a three-fold

risk of infertility (Sharpe, 2010). Tobacco is said to damage sperm DNA, the damage done is

irreversible, but ending smoking will prevent further damage. Smoking influences the

outcome of IVF as well as places the spermatozoa at additional oxidative damage.

Men with BMIs over 25 were found to have a 25% reduction in sperm count. This

could be due to a reduction in testosterone levels commonly found in obese people, or altered

vitamin levels. It has been established that increased heat affects spermatogenesis, so

anything that raises bodily or scrotal temperature may be a risk.

Potential risk factors include medical conditions like varicocele or viruses, sitting for

extended periods of time, hot work environments, or even a hot bath that can temporarily

inhibit fertility. One study determined a sedentary position such as sitting in a chair for
extended periods of time also affects sperm production, but not enough to be considered a

true risk (Støy et al, 2004).

Environmental factors such as daily exposure to chemicals used in farming pesticides

and nematicides, heavy metals used in metalworking (specifically mercury, lead, and

cadmium), pollutants, and cosmetics using parabens and phthalates (Harris et al., 2011;

Sharpe, 2010) affect fertility. While public awareness of the harmful nature of these materials

is increasing, especially in the cosmetic world, there needs to be a more thorough

investigation and public campaign to help struggling families. However, infertile patients

have seen lower levels of zinc, an essential heavy metal, when compared to fertile men

(Sharpe, 2010).

3. Conclusion

It is difficult to identify the sole cause of infertility, but it is important to consider all

potential factors for the best treatment plan if desired, adequate medical history should be

taken and physical examination is important in infertility diagnosis. There are a variety of

injections, surgeries, procedures, or a combination of all to address specific genetic,

hormonal, or physical conditions. To illustrate, gonadotropin-releasing hormone (GnRH) can

increase spermatogenesis and patients can see an improvement in as little as 4 months and

successful conception for 60% of couples in only 9 months (Dabaja & Schlegel, 2014). For

patients with varicocele, surgery is an option. Alternatives for cost-conscious or holistic

patients include a cocktail of antioxidants, for example, antioxidants such as tocopherols

help, however current research remains inconclusive.

To date, there are various techniques that can help with male infertility such as in

vitro fertilization (IVF), as a treatment, (particularly intracytoplasmic sperm injection (ICSI)

as well as the TESE-ICSI method where the sperm is harvested from the testes) it is one of
the most publicized fertility options, despite it only contributing to roughly 1.5% of births

nationwide. IVF occurs with lab fertilization and then transfer.

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