In 2023, the World Health Organization had stated that one in six people globally are affected by infertility.
Zooming in on India, the WHO had found that the prevalence of primary infertility ranged between 3.9-16.8 percent. However, out of these cases, 40 percent of the incidents of infertility are due to male infertility.
While this is not a small figure by any measure, male infertility (almost as much as female infertility) is a taboo in India. There’s secrecy, shame, and stigma attached to the condition.
All this, even as we have been seeing an increasing rate of male infertility in the past few years. To break down the underlying factors behind male infertility and to understand if there are any preventive measures, FIT reached out to experts.
Lifestyle, Environmental Factors To Be Blamed
The very first question that comes to mind is what causes male infertility?
Dr Ashwini S, Fertility Specialist, Cloudnine Fertility Hospital, Bangalore, tells FIT,
“Over the years, there has been a definite decrease in the sperm count and parameters to test sperm health. A few years ago, the World Health Organization too revised its guidelines and reduced the normal sperm count from 20 million to 15 million per millilitre of semen.”
There are multiple factors at play here.
According to Dr Anshuman Agarwal, Senior Consultant, Urology & Robotic Surgery, Indraprastha Apollo Hospital, lifestyle factors contribute substantially to male infertility – sedentary behaviours, obesity, poor dietary habits, excessive alcohol consumption, smoking, etc.
He adds, “Chronic stress and sleep deprivation can negatively affect testosterone levels and sperm production.”
Dr Ashwini agrees with him. She adds that our increased exposure to chemicals also impacts hormonal imbalance and, in turn, male reproductive health. She explains that with more and more pesticides and microplastics present in the food or drinks we consume, the risk factor only increases.
Interestingly, in May this year, a study published by Oxford Academic had pointed to the presence of microplastics in testicles.
Dr S Shashant, Andrologist, Ferty9 Fertility Center, also says that environmental pollutants and industrial chemicals are causes of concern. However, there can be medical conditions too, he says, like “varicocele, infections, hormone abnormalities, and genetic disorders.”
Other factors at play include untreated sexually transmitted infections that can cause inflammation in the reproductive tract, and delayed parenthood which has been associated with decreased sperm quality and increased risk of genetic abnormalities in the offspring, according to Dr Agarwal.
But It Doesn’t Stop With Infertility
However, the bigger concern for doctors is also that male infertility induced by any of these causes can lead to other reproductive health issues in men too.
For instance, Dr Shashant tells FIT, “Some environmental pollutants may end up increasing the chances of a man contracting testis cancer. Psychological stress and hormonal disruptions can reduce libido.”
That’s not it. According to Dr Ashwini, hormonal disturbances and decreased levels of testosterone can also cause erectile dysfunction.
“Emerging research suggests that epigenetic changes, influenced by environmental exposures and lifestyle choices, may affect sperm quality and be passed onto future generations.”Dr Anshuman Agarwal
What this points to, experts say, is the need to decrease taboo around male infertility.
According to research published by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, one-third of the infertility cases globally are caused due to male infertility.
Not just that, a 2022 study published in Oxford Academic had stated that since the year 2000, sperm count has globally fallen by 2.6 percent each year.
“It is important to understand that male infertility is a common issue and should not bring about any shame or fear. It impacts many men and can be addressed effectively with the right approach. Open conversations with doctors, partners, and support networks can greatly help in managing and overcoming infertility.”Dr S Shashant
For Treatment, a Multifaceted Approach Is Required
But can male infertility be treated or prevented at least?
Yes. Dr Agarwal tells FIT, “To address this issue, a multifaceted approach is necessary. This includes reducing exposure to environmental toxins, promoting healthier lifestyles, and increasing awareness about male reproductive health. Early screening and intervention for potential fertility issues are crucial.”
Dr Shashant agrees. He references a 2017 clinical guide published by Springer Journal and suggests:
Eating properly
Regular physical exercises
Avoiding cigarettes, drugs, and alcohol
Stress management
Avoiding excessive heat exposure to testicles
“Practicing safe sex and avoiding recreational drug use can prevent infections and other complications that might affect fertility.”Dr S Shashant
And treatment is possible in some cases too.
Dr Ashwini explains that hormone injections and antibiotic drugs are sometimes given to patients.
“If there’s a tract blockage in the duct, or someone is diagnosed with varicosities, we can surgically operate on them. But if the underlying factor is genetic, there’s hardly anything we can do,” she adds.
There are nutrient supplements too that can help, says Dr Shashant, which might include – Selenium, Zinc, Vitamin C, Vitamin E, etc to reduce oxidative stress.
He further adds that advanced surgical procedures (that are minimally invasive) are used to retrieve sperm in some patients too – Testicular Sperm Aspiration, Percutaneous Epididymal Sperm Aspiration, Microdissection Testicular Sperm Extraction, Physiological Intracytoplasmic Sperm Injection, etc – but these are only for extreme cases where a patient wants to conceive biologically.
However, all the experts that FIT spoke to also maintained that there’s still further research needed to “fully understand the mechanisms behind declining male fertility and develop targeted interventions.”
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