DoctorSpeak: Breaking silence on male infertility

For too long, infertility has been talked about as a women-only issue. However, it is a medical problem that can affect both men and women. But buried under layers of stigma, misinformation, lack of awareness and silence, male infertility is rising rapidly in India.

A neglected half

A study by the Indian Society of Assisted Reproduction says approximately 27.5 million people (both men and women) are infertile in India. Out of these, 40 to 50 per cent cases are because of male factors.

However, in most cases men are neither evaluated early nor made aware of the possibility that there can be something wrong with their reproductive health. Most couples seek medical treatment after trying to have a child for some years, and many opt for assisted reproductive technology (ART) procedures, if advised by the doctor.

When a couple initially comes for treatment, the conversations start from female infertility only. It is only during counselling that most men realise that sperm quality is also a decisive factor in pregnancy and that they could be equally responsible for this infertility issue.

Recently, a young couple came for treatment. They had been trying to have a child for five years. The husband (31) was quite fit, a regular gym-goer and quite health-conscious. Tests, however, revealed that he had zero sperm count, while all tests of his wife (30) were normal.

Medical investigation revealed that the husband was taking steroid supplements for body building, a major reason behind his zero sperm count. He was advised to stop these supplements immediately. Within three months his sperm count started improving though not sufficiently. The couple eventually opted for IVF.

One in every six Indian couples is struggling with infertility issues. Environmental factors such as pollution, especially air, pesticides, adulterated food and lifestyle factors like stress, poor diet, lack of sleep, alcohol consumption and smoking as well as growing rates of obesity and other non-communicable diseases like diabetes, blood pressure, polycystic ovarian disease (among women), etc. are responsible for the rising infertility rate.

Defects like low sperm motility, low sperm count and abnormal morphology are prevalent causes behind failed conception. In addition, increased reactive oxygen species (ROS) are found in as many as 88 per cent of infertile men, causing oxidative stress that interferes with sperm maturation and function.

Endocrine-disrupting chemicals such as those found in pesticides, plastics like BPA and industrial pollutants can also impact hormone levels in men by mimicking or blocking natural hormones, affecting testosterone production and sperm quality.

Medical issues like varicocele (enlargement of veins within the scrotum), and infections like mumps or STDs can also impair sperm production and quality, hormonal balance, or testicular function, directly affecting male fertility.

Apart from lack of awareness there are many myths about male infertility.

Men are 'fertile forever'

One of the most popular myths is that men, unlike women, can to stay fertile even in old age. However, several studies have shown that fertility rates decline as a man ages. A study in 2020 found that conception is 30 per cent less likely for men older than 40 than in men below 30. Progressing age impacts sperm quantity, quality, and DNA integrity. Early assessment and planning are critical for making well-informed reproductive choices.

Performance equals fertility

A popular fallacy is that a healthy sex life is equal to fertility. Being sexually active or absence of any erectile problem or other such issues do not necessarily mean producing viable sperm. Fertility involves cellular function, not sexual function. Men who are sexually normal may still have serious reproductive issues.

Lifestyle is not a factor

Most people believe fertility is a biological process and is not influenced by our lifestyle. However, smoking, excessive alcohol consumption, drug abuse, physical inactivity, poor nutrition and chronic stress - all can severely affect sperm quality and hormonal equilibrium.

Even excessive use of electronic devices can also impact men's reproductive health, because high temperatures and radiation from these devices also have detrimental effects on sperm production.

Reproductive health is closely linked to lifestyle, and the neglect of this relationship jeopardises the success of conception.

Male infertility is very much a treatable problem, especially if diagnosed early, and is reversible in many cases. Lifestyle modifications, targeted medications and minor surgeries can notably improve sperm health. Evidence suggests that up to 50 per cent of male infertility cases can be treated with favourable outcomes. Treatment is often possible well into a man's late 40s or early 50s, though earlier intervention typically yields better results.

Acknowledging male infertility as a real and pressing health concern is not only a clinical necessity but a cultural reckoning. There is a need to create awareness through public health campaigns to break the taboos surrounding male infertility. It's only when both partners are heard, seen and supported that reproductive health can be truly inclusive.

— The writer is senior consultant, Jindal IVF, Chandigarh

Factcheck: In India, infertility rates are increasing among both men and women due to sedentary lifestyles, smoking, alcohol, stress, pollution, diets high in processed food, etc, leading to rise in obesity. Obesity can affect hormone production in both men and women. In men, it can lower sperm count and motility, while in women, it can cause polycystic ovarian syndrome (PCOS), a major cause of infertility. Late marriages and delayed childbirth are also significant factors. Biologically fertility declines after 35 in woman and after 40 in men.