Lifestyle plays a vital role in men’s general health; therefore, exercising, avoiding stress and anxiety, quitting smoking, not drinking alcohol, and maintaining a healthy diet rich in vitamins and minerals help treat male infertility.
According to World Health Organization (WHO), if a couple cannot conceive after one year of unprotected sexual intercourse, they are considered infertile. On a global scale, 50% of men suffer from fertility problems. Fortunately, most causes of male infertility can be diagnosed and treated with medications and surgery.
The most common causes of infertility in men include the low quality of semen, low sperm count, low sperm motility, and abnormal shape of the sperm. In addition, men’s lifestyle, age, erection problems, ejaculation disorders, and other diseases such as diabetes and MS can affect male fertility.
What are the causes of male infertility?
The inability to conceive a child is the main sign of male infertility. In some cases, a significant problem such as an inherited disorder, a hormonal imbalance, dilation of the blood vessels around the testicles, or a condition that blocks the passage of sperm can cause signs and symptoms.
As mentioned earlier, the main causes of male infertility include:
- Low sperm count;
- Low sperm motility;
- Abnormal sperm morphology;
- Low concentration of semen;
- Obstruction of vas deferens;
- Retrograde ejaculation;
- Hormonal imbalance;
- Kidney disorders; and
- Zero sperm count.
Azoospermia, or zero sperm count, is a condition in which there is no sperm in the patient’s semen sample. Most people stop trying to conceive when they figure out that they have azoospermia; however, if the cause of azoospermia is obstructive disorders, it can be treated by testicular biopsy. In this surgery, the fertility doctor retrieves sperm directly from the testicles and then uses it in assisted reproductive techniques such as IVF and ICSI.
Male Infertility Treatments
In the following, some of the best treatments for male infertility are introduced in detail:
Change your lifestyle
Lifestyle is one of the most important factors affecting the general health of men. Therefore, exercising regularly, being more relaxed and avoiding stress, avoiding smoking and drinking alcohol, and having a healthy diet rich in vitamins, protein, fiber, and minerals can improve sperm parameters and increase male fertility. In addition, wearing boxer shorts (or any other loose-fitting underwear) can have a significant effect on the health of the testicles and the number of sperms.
Have a healthy diet
According to recent studies, adding green tea, garlic and ginseng root to your diet will increase your libido and sperm count. Chamomile tea, Descurainia Sophia, and Zardak (Irani Salsify) can also decrease erection disorders and increase the sperm’s motility and count. Other foods that should be included in your daily meals are:
- Pistachio, walnut, and peanut;
- Leafy vegetables;
- Fish and egg;
- Maca root;
- Nigella sativa.
Take fertility medications
Depending on the cause of male infertility, different medications are prescribed to improve sperm parameters. Some of the medications used to treat male infertility are:
- Letrozole: It is used to treat sperm disorders, increase testosterone levels, and increase sperm count.
- Clomiphene Citrate: It is usually prescribed along with vitamin E to treat male infertility and increase the level of estrogen in the body. Also, people with hypogonadism and testicular atrophy should take this medication to increase their testosterone.
- Imipramine: It is prescribed to treat ejaculation problems.
- Menotropin: this medication consists of FSH and LH hormones and is used to stimulate sperm production in men.
- Bromocriptine: this drug balances the production of prolactin hormone.
- Antibiotics or antifungal drugs: since infection can cause male infertility, the doctor prescribes these medications to treat infection of the male reproductive system and help treat infertility.
- Hormone therapy: if the cause of male infertility is testosterone insufficiency, the fertility doctor prescribes some medications to increase the level of this hormone. Sometimes, the patient must take certain doses of testosterone through tablets, gels, or injections.
Surgical Treatment of Male Infertility
In cases where there is a problem in the structure of the male reproductive system, the surgeon performs some surgeries to harvest sperm directly from the testicle or epididymal tube. Some surgeries to treat male infertility include:
Varicocele refers to the enlargement of testicular veins. This disease causes pain in the scrotum and pain during sex and urinating. Also, it leads to male infertility by raising the temperature of the testicles. In varicocelectomy, the enlarged veins of the scrotum are either cut or tied off, so they gradually shrink and disappear due to the lack of blood supply. Varicocelectomy is a major operation done under general anesthesia; however, it can highly improve sperm parameters and increase the rate of fertility in men.
Testicular Sperm Extraction (TESE)
In the TESE method, a tiny incision is made in the testicles, and the tubules are examined for the presence of sperm. If there are high-quality sperm in the sample, they will be retrieved and used in IVF or ICSI, but if no sperm are found in the sample, the doctor will take the sample from other parts of the testicles to find sperm.
Microdissection testicular sperm extraction (micro-TESE)
Microdissection TESE is similar to the TESE method, with only one difference. In this method, which is usually used in people with severe and prolonged infertility, the doctor examines the testicle tissue under a microscope to find the tubes with a greater possibility of sperm presence. The procedure is done the day before the female partner’s egg retrieval.
Vasovasostomy is used for men with a history of vasectomy, testicle trauma, and damage to the vas deferens. In this surgery, the doctor sews the ends of the vas deferens to remove their obstruction.
Microsurgical epididymal sperm aspiration (MESA)
Microsurgical epididymal sperm aspiration is an open surgery in which the doctor finds motile and healthy sperm by observing the epididymal tubes under a microscope. In this procedure, the doctor has more access to small and proximal tubes within the epididymis; therefore, the chance of finding motile sperms is higher in this operation.
Percutaneous Epididymal Sperm Aspiration (PESA)
In the PESA method, motile sperms are extracted from the epididymal tubes by a very thin needle without an incision in the testicle skin. This surgery is done under local anesthesia, and the patient should be on an empty stomach. If healthy sperm are obtained from the testicles, they are used in assisted reproductive methods. Still, if no sperm are found, the patient should undergo another surgery called a testicular biopsy.
Testicular Sperm Aspiration (TESA)
If no sperm is found in the semen sample, the doctor extracts sperm from the seminiferous tubule. The TESA method is used in men who have had a failed vasectomy reversal surgery, have defects in sperm production, or suffer from congenital absence of the vas deferens due to cystic fibrosis.
Treating Male Infertility by Assisted Reproductive Techniques
After harvesting sperm through one of the methods mentioned earlier, the sperm is used in one of the following assisted reproductive methods:
In vitro fertilization (IVF)
If the patient has a low sperm count, the doctor suggests the IVF method. In this method, the doctor selects the best and healthiest sperm and puts it next to an egg in the IVF dish for fertilization. After fertilization, the resulting embryo is transferred into the mother’s uterus through a simple procedure.
Intrauterine insemination (IUI)
If the patient has a very low sperm count or his sperms have low motility, the doctor uses the IUI method. In this method, the doctor directly injects the sperm into the woman’s uterus by a narrow tube called a catheter.
Intracytoplasmic sperm injection (ICSI)
This method, also known as microinjection, is used when the sperms are too weak to fertilize an egg. The procedure of ICSI is similar to IVF, with one slight difference. In microinjection, the sperm is not placed next to the egg; rather, it is directly injected into the egg’s cytoplasm, and the embryo is transferred into the mother’s womb.
In the blastocyst embryo transfer, the egg is first fertilized in the laboratory, and five days later, the blastocyst is transferred into the mother’s uterus.