Infertility is a main concern among couples who are trying to have a child. About 40 per cent of infertility issues are found in men, the common most problem being non-functional testicles. The other reasons include absence of ducts, blockages, hormone imbalances, lifestyle factors and even age. During sexual intercouse, the male organ, penis, ejaculates sperm, which are stored in the testicles, to the female reproductive tract where it combines with the egg, resulting in pregnancy.  The most important factor that contributed to male fertility is, therefore, sperm or spermatozoa. Azoospermia is a condition in about 15 percent of men where they do not produce sperm, due to hormonal imbalance or blockage. The condition where lesser sperms are produced is called oligospermia, caused due to an enlarged vein in the testicle. Other than lesser or nil sperm count, hindered sperm movement is also another cause of infertility. Oddly-shaped and partially-grown sperm also contribute to male infertility. 

What hinders sperm formation in testicles?

The most common reasons are: 

What hinders sperm movement?

Other reasons for infertility

Lifestyle choices like smoking habits, alcoholism and drug abuse can cause infertility. Taking certain medications (for arthritis, depression, digestive issues, infections, blood pressure and cancer) too can have an impact on sperm formation. 

Diagnosis of infertility in men

A full physical examination and history study of the patient with blood and semen analysis help diagnose the infertility in men. Any defect in reproductive system, hormone balance, accidents or trauma will be investigated apart from checking exposure to radiation, heavy metals or pesticides. Any problems with intercourse, erection, structure and functioning of penis, epididymis, vas deferens and testicles will be checked. Semen analysis: Study of semen sample to ascertain sperm volume, count, concentration, motility and structure.  Transrectal ultrasound: A probe placed in the rectum checks the formation of ejaculatory duct and seminal vesicles. 

Testicular biopsy: Done under local anaesthesia, through a small incision in the scrotum or using a needle, a tissue is extracted to find cause of infertility and collect sperm for assisted reproductive technology.

Hormonal profile: Hormone check rules out major health issues and proper levels of hormones that aid fertility. 

Treatment of infertility

There are three types of treatments – non-surgical, surgical and treatment for unknown causes.The treatments that do not involve surgery are medications to treat conditions like anejaculation caused by injuries, previous surgeries, genital tract infections, congenital abnormalities, mental and emotional problems. Surgical treatments include varicocele, microsurgical vasovasostomy, vasoepididymostomy and transurethral resection of ejaculatory duct.  For unknown causes of infertility, treatment includes assisted reproductive techniques like IUI, IVF, ICSI, sperm retrieval, TESE, TFNA, PESA and MESA. These high-tech methods to join sperm and egg are deployed when sexual intercourse fails to get the woman pregnant.