The prevalence of male infertility is difficult to calculate for multiple reasons, with the two main ones being the fact that most studies are based on the diagnosis of women with difficulties conceiving, and that male infertility was not considered until very recently a disease, and therefore there was no obligation to report it.
Based on calculations showing a male engagement in 50 to 60% of infertility cases, many authors have concluded that 4.5 to 6% of men of childbearing age can suffer from infertility, and calculate an approximate of 30 million infertile men in the world. There are no reliable data in our country, but in Reprotec approximately 50% of couples have a component of male problems, this being the only problem in approximately 30%, and a combination of problems of the two members of the couple in an additional 20%.
In most cases, male infertility does not have an apparent cause, in some cases it can be due to genetic problems, chronic diseases such as diabetes, testicular disorders such as no descent of the testicles or varicocele, or infections.
Some environmental factors, such as contact with toxic substances or pesticides, and smoking may be involved as a cause of male infertility; And it is discussed about the impact that local heat can have on the production or quality of spermatozoa: while extreme temperatures cause deterioration of sperm production, it is less clear if wearing tight underwear, or the frequent use of saunas can alter the sperm characteristics; Some of the most important studies show absence of impact on parameters such as the shape of the sperm, but possible alteration of mobility; In short, the available evidence is not conclusive, and although it clearly does not allow us to recommend that all men should wear loose underwear, if it is relevant in those men with sperm alteration, try to avoid their use.
The basic examination for the evaluation of male infertility is the spermogram, or semen analysis, in which the characteristics of the semen are evaluated, such as the volume, and the quantity, mobility and shape of the sperm. In case this is abnormal, the first measure that must be taken is to repeat it in a reasonable time, to confirm if it remains altered; If so, complementary tests can be carried out, to define if there are specific causes for the alteration.
One of the most relevant problems in today’s society is the postponement of paternity: for a long time it has been known that age clearly affects the possibilities of conception in the case of women; But traditionally it has been considered that it does not affect men. Recent studies show a double effect of age in men: on the one hand, a deterioration of the semen parameters has been documented, which can decrease the chances of achieving pregnancy, on the other hand, a slight and progressive increase has been documented from 40 years and significant after fifty, of diseases such as schizophrenia or achondroplasia.
A very frequent question has to do with the men who have done a vasectomy and then decide to be parents again. Surgery offers reasonable success rates in these cases, ranging from 37% to one year, 55 to 73% when it is followed up for longer periods; However, a recent study showed two of the most important difficulties of surgery in these cases: more than half of the patients who chose the surgery later had to resort to in vitro fertilization, since they did not want to continue waiting for a pregnancy; On the other hand, the time until the moment of conception was shorter in those who chose in vitro fertilization, which in a world in which the age of the woman when looking for pregnancy has increased, represents a very important advantage. Finally, pregnancy rates are increasing with in vitro fertilization, which has improved their cost-benefit ratio.
Some of the most dramatic problems are related to testicular tumors, patients who, for different reasons, have paraplegia or quadriplegia problematics. In patients who suffer from some type of testicular cancer, the best recommendation is to store prior to treatment, be it surgical, by chemotherapy or combined, semen samples for future use if necessary.
Patients with paraplegia or quadriplegia may resort to in vitro fertilization treatment, with high success rates. Since spontaneous ejaculation is impossible, in these cases it can be stimulated by electrical stimuli, although better results have recently been seen when recovering the sperm directly from the testis through a simple puncture procedure.
The most impactful cases of success refer to both medical treatment, in cases where a hormonal dysfunction prevents the formation of sperm, and treatment with gonadotropins, hormones that stimulate the testicle restore normal sperm production; as in the surgical extraction of sperm and its use for in vitro fertilization, injecting them directly into the egg to achieve a pregnancy, in the case of disabled patients.
Finally, the prevention of male infertility involves the prevention of infections through the judicious use of the condom (condom), and regular consultation with the doctor for the prevention and treatment of general and chronic diseases, or directly the urologist in case of urinary symptoms or sexual dysfunction.