Infertility in Men – The Silent Shame

We may mock Indian soap operas for the portrayal of women being in the brunt end of any familial problem. But it is not entirely a sham, you know.

They merely reflect the events in the society with a tad bit of (wait, who am I kidding? a lot of) exaggeration. For instance, let’s take infertility, a sensitive issue which is accelerating globally now. We see harsh words being thrown upon tremulous women, extreme discrimination and only women seem to be struggling with treatment. Infertility is almost always thought of as a woman’s issue, and it’s true that the social burden “falls disproportionately on women.” The focus is rarely on the husband when infertility plagues a couple.

Let’s have a reality check here!

Well, infertility isn’t just a women’s issue, it’s a couple’s issue that’s more common than you think. About 1 in 8 couples struggle with infertility, and men contribute to 50 percent of infertility cases. But when it comes to the public eye, men become the forgotten sex!

The silent shame!

“Men tend to have a greater negative attitude towards counseling and this makes it harder for them to attend counseling compared to women,” says Dr Kannappan.

A lot of times, patients with male factor infertility will still wind up doing IVF, or IUI — treatments that center on the female. That’s just how the problem is most often solved.

Well I wouldn’t blame them. It’s the patriarchy again. Apparently, infertility makes men less masculine. What a pity that the social constructs of masculinity often conflates fertility with virility.

It is a silent shame which provokes denial in men and discourages them from seeking medical support.

Infertility in men

When the problem is with the swimmers and not the egg!

Most men do not approach infertility centers for getting early diagnosis and treatments.  This is considered when they have an erectile dysfunction; or only as a last resort post their partner’s failed treatments.

 “Unlike women, who have an acute knowledge of their biological clocks, a significant population of men are still not aware of their own reproductive health,” said Dr Kshitiz Murdia, CEO and co-founder, Indira IVF.

Data by the National Population and Family Development Board (LPPKN) shows that 95 per cent of men who have normal sexual intercourse are not aware that they may have infertility.

To analyze the cause, the doctor would do a general physical exam, semen analysis, scrotal ultrasound, trans-rectal ultrasound, hormonal analysis, sometimes chromosomal analysis, and testicular biopsy. The swimmers are the culprits, in most cases associated with infertility in men. It could be the sperm production, count, shape or movement.The picture usually gets clear with a semen analysis.

Sleeping sperm - infertility

Why is infertility increasing in men?

Study showed that sperm count has declined significantly since the 1970s, which suggests both environmental and lifestyle factors.

It could be the age factor, where the new gen choose to wait longer to start their families. The latest lifestyle seems to be a contributing factor as well like smoking, drinking, obesity and drugs.

Also read, ‘Why infertility is accelerating globally‘ to understand how these factors contribute to infertility in detail.

Abnormalities of sperm could also be due to any of the following medical conditions.

  • Varicocele — an abnormal collection of bulging veins above the testicle; they’re the most common cause of correctable male infertility, accounting for 38% of cases

  • Undescended testicle

  • Infections in the testicle (orchitis), the prostate (prostatitis), or elsewhere in the body that causes a fever

  • Chemotherapy for cancer

  • Medicines such as anabolic steroids or anti-seizure medicines

  • Genetic abnormalities

  • Hormone problems

  • Other factors may include erectile dysfunction or premature ejaculation. Liver or kidney disease, or treatment for seizure disorders.

Most of them are treatable, while some are not!

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Let's treat it!

Ideally, the cause of the infertility is reversible.

Surgery to correct obstructions and variocoeles and medical treatment of hormonal problems are some of the common treatments to eliminate root cause. And of course, living right helps. A stress free life with healthy habits work wonders.

Today, assisted reproductive techniques (ARTs) offer powerful new options, and have made conception possible even for men with very low or abnormal sperm. By using some combination of ARTs for several months, most couples can expect a pregnancy between 40 to 50% of the time.

 Assisted Reproductive techniques (ARTs):

First, sperm is collected either from ejaculated semen or by a needle from the testicle. They are then processed and introduced to eggs by different methods.

Artificial insemination.

This method puts many healthy sperm at the entrance of the cervix or right into the partner’s uterus. The sperm can then make their way to the fallopian tubes.

IVF, GIFT, and other techniques.

In vitro fertilization (IVF) and gamete intra-fallopian transfer (GIFT) work like artificial insemination. Your provider collects your sperm. Then he or she mixes your partner’s eggs with a lot of high-quality sperm. He or she may mix the eggs and sperm in the lab or in your partner’s fallopian tube.

Intracytoplasmic sperm injection (ICSI).

Your provider injects a single sperm into an egg. Fertilization then takes place under a microscope. Your provider puts the fertilized egg in your partner’s uterus.

Cryopreservation of sperms:

Semen cryopreservation (commonly called sperm banking or sperm freezing) is a procedure to preserve sperm cells. Men can opt this, if they decide to undergo vasectomy or treatments that may compromise their fertility, such as chemotherapy, radiation therapy or surgery in the future. Their advancing age, lifestyle and career choices; or even donation could be some other reasons to freeze sperm.

For some men, no male infertility treatments seem to help. It could be too late already! In that case, you can use donated sperms for ARF (or) there’s always an alternative way to start a family. Adoption!

A majority of men view male infertility as rare and this, coupled with their reluctance to discuss their emotions, makes it all the more difficult to provide support that could be helpful. It’s time to ditch the notion that infertility is a woman’s issue and seek a solution for infertility struggles as a couple, the way every family should. Let’s help men break away from their shackles. It all starts with awareness.

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