I don’t think there would be anyone who would not want to be blessed with offsprings. But still, since no one is lucky enough to get all happiness in life, there are some couples who remain deprived of having their own offsprings. Today, we are going to discuss male infertility on our show. For this, we have with us, our Ayurveda expert, Dr. Parmeshwar Arora. Welcome to the show, doctor.
Q. First of all, I would like to ask you about what exactly is male infertility?
Here, first of all I would like to define infertility. We consider a couple infertile if after one year of regular sexual intercourse without contraception, the woman has not become pregnant or has not conceived. Infertility can be because of male partner as well as female partner. In a case of male infertility, the male partner is the reason for infertility. In other words, if because of a defect in male component , the female partner is not able to conceive then it is considered male infertility.
Q. Often it is seen in our society and households that the female partner is always held responsible for infertility. Why is it so?
This is completely unjustified. I would not even say that most of the times the females are responsible in infertility. Nowadays, as I have experienced, a large number of couples approach us with a case of infertility in which we find that the female partners are perfectly alright. We don’t find any structural defect in the female partner and functionally too, they are found to be perfect i.e. they have normal ovulation and normal menstruation. But as we examine the male partner, there are problems in quality, quantity, motility or shape and size of sperm cells. Thus, the truth is as I said, while sometimes males are responsible, at other time females are responsible. It is completely wrong to blame one person and I would even say that if a couple is facing a problem of infertility and the efforts are being made keeping in mind only the female component, then that’s just half-an-effort. Rather, I would suggest that in the beginning of treatment itself, firstly the male partner should get his semen analysis done so as to rule out the responsibility of male partner. And once it has been established that there is no defect in the male component then only we should proceed with the treatment of female partner. It would be an absolutely wrong approach if we are only concentrating on the female partner.
Q. That means if any couple is going through the problem of infertility then it is important that the tests are conducted on both the partners. That was about infertility. Now please tell us, what is male infertility?
If we talk about sexual components, then for fertilization, sperms from male are required. Spermatozoa or sperms are formed in the testicles. Sperms, which are also termed in common language as male germs, have to be present in specific number. The normal standard number varies between 60 million/ml to 140 million/ml. But if the sperm count is 20 million/ml instead of being within the range of 60-140 million/ml then there are chances that the particular male has less sperm count. This condition is termed as oligospermia and this type of condition is unfavourable for making a woman pregnant or to achieve fertilization. This was about the number of sperm cells or sperm count. Sometimes, we have some patients who have no sperm count, at all. Such a condition is referred to as aspermia. In still other types of patients, although they have a good sperm count in their semen but then the quality of sperm is not good or its motility is not good or the sperms are dead. This condition is called as azoospermia. So, by performing semen analysis, we check the quantity of sperm as well as quality of sperm. Generally speaking, for fertilization, it is not only the quantity which is important but the quality is important too.
Q. That was about what male infertility is. But, what about the reasons which could be responsible for this condition?
As far as the reasons are concerned, they can be divided into two categories, namely structural and functional.
When we talk about structural reasons, we actually refer to the male genital system. The first structure of male genital system is testicles. It’s very important that the testicles are structurally perfect. The semeniferous tubules are present in the testicles and sperms are produced into these tubules. The sperms formed in semeniferous tubules enter into rete testes and from rete testes they are carried to epididymis. From epididymis, they reach vas deferens which is a duct or tube and from there, they enter seminal vesicle. From seminal vesicle, they get into ejaculatory duct where they get combined with prostatic secretions and then come out through penile urethras. So this is the structure of complete passage. If there is any sort of anomaly in this passage or in the structures or in the male gonads i.e. testes, whether it is embryological (i.e. present since birth) or has been caused due to some trauma, or there is some obstructive pathology, then it can become a reason for male infertility. Sometimes, the sperms are produced but they do not come out due to some obstruction in the passage and thus the sperms are found to be absent in the semen. So these types of reasons fall under the category of structural or obstructive reasons.
When we talk about the category of functional reasons, we refer to a condition where there is no production of sperms. In this case, the functioning of male gonads or testicles is not proper. Again, the improper functioning of testicles can be because of two reasons. Firstly, the hormonal reasons and secondly, some psychological factors. Sometimes, when we do assessment of hormones in the patient, we find it to be perfect but still the spermatogenesis is not taking place. So, in such cases, diet and lifestyle are considered to be responsible. Probably the patient is taking too much stress or consuming food items which are hot or sour, or consuming excess of alcohol, or doing cigarette smoking etc. So there could be dietary, psychological or hormonal reasons for functional disorders as all of them can disturb the formation of spermatozoa in the testes.
Talking about hormones, I would like to inform you that this axis starts from hypothalamus. The first hormones are gonadotropin releasing hormone which is released from hypothalamus (a part of brain). They are responsible for stimulating pituitary or master glands for the secretion of follicle stimulating hormone and luteinizing hormone. Both these hormones (together called gonadotropins) in association with testosterone, help in spermatogenesis. Apart from this, there are testicle hormones i.e. gonadal hormones. If there is any alteration in the coordination or the production of hormones or there is a defect in the production of hormones then spermatogenesis will be found to be absent. And if the spermatogenesis is absent because of hormonal disorder then it is said that this particular aspermia is because of hormonal defect.
Moving onto dietary reasons, when we frequently consume food items which are hot by property or sour or we consume excess of alcohol, do lot of smoking or frequently consume spicy food etc. then we are somehow increasing the heat in our body. Scrotum (a part of the external male genitalia located behind and underneath the penis that contains and protects the testicles) is generally located outside the abdominal cavity because the temperature of abdominal cavity is about 5 degrees more than the temperature of scrotal cavity. Because of the fact that wherever there is increase in heat there is no spermatogenesis, somehow naturally (or as created by god), there is an arrangement to keep the scrotum cooler. But, through our diet or psychology (i.e. by taking stress, anxiety, anger etc) we actually raise its temperature. As a result, there is disturbance in the process of spermatogenesis. Thus, if we talk about functions, then diet, hormones and behavior (i.e. psychological factors) can disturb the process of spermatogenesis by manipulating functions. As a result, we don’t find quality sperms in the semen and ultimately it results into infertility and since the male is responsible so we call it male infertility.
Q. You have defined almost all the reasons which can become a cause for male infertility. But here I have one more question, how would a common man know that it’s not his wife but he himself is responsible for infertility?
It’s a very simple question. If you are an infertile couple, the male partner would just need to give his semen for testing in the lab. If his sperm count is within normal range, the motility of sperms is normal, and its form is normal i.e. the semen is free from any infection then he can issue himself a clean chit. So just a simple semen analysis can help you to find out that whether you have any fertility related problem or not.
It was indeed an interesting discussion. Here, once again I would like to suggest our viewers that if you think that only females are responsible for infertility, then that’s actually not the truth. If there is any problem of infertility, don’t simply hold the female partner responsible. As the doctor has told us, any of the partners can be responsible for infertility. So, both the partners should get a checkup done and with a proper treatment, you can possibly have children.