Keeping Men Fertile
Sterility is not just a female problem

Pam Harrison

Men who have suffered a blow to the groin can hardly be blamed when they curse evolution for locating their most precious assets in such a vulnerable spot. But the human testicles operate best at two to three degrees lower than the body’s core temperature. So it falls to the scrotum, the pouch-like sac that contains the testicles, to keep them cool by not allowing them to nestle too close to the body, explains urologist Dr. Gerald Brock, a professor of surgery at the University of Western Ontario in London. “The muscles in the wall of the scrotum allow testicles to move away from the body, depending on the temperature.”

Despite this precarious position, a blow sustained by the testicles does not usually compromise a man’s fertility, but many other factors do. Male infertility is, in fact, directly responsible for about one-third of failures to conceive and another third when combined with female factors. Check out these 10 potential threats.

1. Toxic recreational substances such as tobacco and marijuana lower men’s hormone levels and decrease the amount of sperm and its motility (ability to swim to the female’s egg). Excess alcohol and cocaine use can also reduce sperm production and quality.

2. Growth-promoting drugs such as anabolic steroids are synthetic testosterone mimics. They may bulk up muscles, but they also shrink the testicles and depress the production of natural male hormones, thereby reducing or shutting down sperm production. “It can be very difficult to restore normal function in these men, depending on how long they’ve been using these drugs,” notes Brock.

3. Medications to relieve heartburn and ulcers such as H2 blockers may affect a man’s fertility. Exposure to the anti-miscarriage drug diethylstilbestrol (DES) in his mother’s womb can also have adverse effects.

4. A varicocele is a clump of dilated veins in the spermatic cord from which blood is not draining properly. This is the commonest correctable anatomical cause of male infertility. “When blood courses through a dilated vein in a varicocele, it releases excess heat and produces a radiator-like effect, decreasing sperm production and motility,” Brock says. Dilated veins can be surgically tied off and the blood flow diverted to normal veins. Alternatively, varicoceles may be sidelined by a procedure known as embolization, in which tiny steel or platinum coils are injected to block blood flow to the dilated vein.

5. Obstructions in the male reproductive tract can make men infertile, adds Dr. Peter Chan, director of male reproductive medicine at McGill University Health Centre in Montreal. Sexually transmitted diseases can cause scarring and blockages, as can biopsies or surgical procedures such as hernia repairs. Microsurgery can bypass obstructions and allow sperm to flow again. Inflammation from an infectious disease such as mumps can affect fertility, but only when the testes have been significantly inflamed.

6. Testicular torsion, in which the testicle twists on its cord pinching blood vessels and shutting down blood flow, is “a true urological emergency,” says Brock. If this is not repaired within four hours, the testicle can die. Any sudden testicular pain accompanied by swelling should be considered a medical emergency.

7. Chemotherapy for cancer and some forms of radiation can completely shut down sperm production, either by attacking fast-dividing sperm cells or by destroying the immature stem cells that give rise to sperm. Some men will never recover their ability to produce sperm following cancer treatment. Currently, the only reliable way for a cancer patient to increase his chances of fathering a child is to bank his sperm before therapy. But in a novel approach, Chan has retrieved sperm microsurgically from the testes of men whose cancer therapy left them unable to get viable sperm into their ejaculate. These surgically retrieved sperm can then be injected directly into a woman’s egg in an assisted-reproduction technology known as intra-cytoplasmic sperm injection, thereby increasing a man’s chances of fathering his own biological child.

8. Hormonal imbalances brought about by endocrine disorders can impair sperm production and quality, and also reduce a man’s desire for sexual activity. These include high levels of prolactin, a hormone found in nursing moms at elevated levels, which result in low amounts of male hormones. Reversing these imbalances medically can often restore sperm production.

9. Immunological infertility, in which the man produces auto-antibodies to his own sperm, may cause sperm to stick together and reduce their ability to reach and penetrate the egg. Blows to the testicles and infections may promote this condition. Fortunately, sperm can now be washed in the laboratory to remove the antibodies, then injected into the female partner.

10. Heat-promoting lifestyle practices, such as soaking in hot baths and sweating in saunas, may decrease a man’s sperm count. Wearing tight underwear or jeans and anything that routinely raises the temperature of the cool-seeking family jewels are potential, if not common, threats. Now researchers are eyeing heat-producing cellphones and laptops as possible “suspects of interest” in reduced sperm counts.

The good news is that once a problem is identified—as it is in 60% to 70% of cases—recent advances in reproductive medicine are greatly enhancing men’s chances of having their fertility restored. “Now the vast majority of men can be offered some sort of therapy with the expectation it may well be successful,” says Brock.

For more information, contact the Infertility Awareness Association of Canada at
1 800 263 2929 or http://iaac.ca.