By SHAHNAWAZ AHMAD ANSARI

Two friends – Naveen Ahuja and Moqeem Kareem are in conversation while puffing…
Moqeem: Hey Naveen, what is this male infertility? Nowadays, we find people discussing. Yesterday, while coming out from canteen, I overheard one of our colleagues talking to her friend about the infertility of her husband. She is very much worried as she hasn’t been blessed with a baby seven years after her marriage.
Naveen: Yes, this issue is gaining ground as last week I also read an article in the newspaper about male infertility. It covered this pressing issue widely, pertaining to an array of factors responsible for it, presenting some startling facts as well. Actually, male infertility is a taboo in our society, but its incidence has been escalated over the decade globally. The sperm count has been in a free fall. It’s worrisome.
Some findings reveal that the incidence of infertility affects an estimated 15% of couples globally, amounting to 48.5 million couples wherein males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall. Sperm counts have been in a free fall in western countries over the last 10 years.
Infertility, in general parlance, is a condition when couples are unable to conceive a child, even though they have had frequent, unprotected sexual intercourse for a year or longer. Up to 15 per cent of couples are infertile. In over a third of these couples, male infertility plays a role. In male infertility, there is erectile dysfunction, low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, hormonal imbalances, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility. The semen analysis is one of the main tests to evaluate the male partner.
Moqeem: Oh! Now, I am able to connect that infertility case of my neighbour. Actually, one case of male infertility has come to the light recently. My neighbour Asim is 32-year-old, who got married to Salma five years ago with no issue yet, consequently Salma has been consistently ridiculed by her in-laws for her inability to conceive a child. They took her to multiple Ayurveda centres but nothing helped. A visit to the gynaecologist and a couple of tests later, she got the rude shock that the real reason behind her failed attempts to conceive was actually her husband—Asim.
Naveen: In fact, gone are the days when talking about male infertility seemed to be a taboo, but now in the face of advancement in medical science, the reality is being revealed. Infertility is most often seen as a woman’s issue and it is they who bear the brunt of not bearing a child. But according to a recent report by the WHO on the status of infertility in India, of all infertility cases, approximately 50% is due to “male infertility”, owing to various reproductive anomalies in the male.
Moqeem: You have handful of information about male infertility in general, which I didn’t expect that much from you. You are very informative. Do you have an account in Indian context? Please elaborate!
Naveen: The incidence in India is no less than the global rate. Let’s see through the data and the survey report that will give the better overview.
Male Infertility in India
The fertility rate of Indians (measured as the number of children born to a woman), has plummeted by more than 50 percent, from 4.97 during the 1975-80 period to 2.3 for the current period of 2015-20. By 2025-30, the report projects, the rate will nosedive further to 2.1, touching 1.86 from 2045-50 and 1.78 from 2095-2100, reveals the World Population Prospects – 2017 Revision Report.
Latest statistics reveal that male infertility in India is very high. It generally occurs due to low production and motility of sperm, abnormal shape of sperm or complete absence of it. A group of Indian scientists have also found underlying genetic factors for infertility in Indian men. They hope this knowledge could help them develop a genetic test for male infertility in near the future.
The AIIMS doctors have reported that over 12–18 million couples in India are diagnosed with infertility every year. They have reported that while the sperm count of a normal Indian adult male used to be 60 million/ml three decades ago, it now stands at around 20 million/ml.
Moqeem: The data seems correct because lately when Asim-Salma visited their consultant gynaecologist, she said that it is observed that male infertility factor is the primary reason for the inability to conceive in your case. The incidence is specially high between the age group of 29 and 35. They either have a combination of low sperm concentration or poor sperm motility, or abnormal morphology. However, due to social stigma, male fertility problems are considered secondary and most often go undiagnosed and untreated.
Naveen: Actually, there are so many reasons behind the rising incidence of male infertility. Earlier, it was perceived that this is only found in women, but now the share has reached almost 50%. The reasons and its remedial measures listed by the physicians so far are as follows:
Reasons behind Male Infertility
- Unhealthy lifestyle
- Lack of physical activity
- High-pressure jobs
- Pollution
- Poor diet
- Alcohol consumption and smoking
- Tobacco use affects spermatogenesis causing low sperm count
- Unhealthy lifestyle
- Using certain illicit drugs
- Being overweight
- Having certain past or present infections
- Being exposed to toxins
- Overheating the testicles
- Having experienced trauma to the testicles
- Having a prior vasectomy or major abdominal or pelvic surgery
- Being born with a fertility disorder or having a blood relative with a fertility disorder
- Certain medications
The primary causes of male infertility include low sperm production, abnormal sperm function, or blockages that prevent the delivery of sperm. But while these issues are sometimes the result of underlying health problems, they can also be caused by certain lifestyle factors. One recent study even suggests that the type of job a man has can significantly impact his chances of conceiving with a partner.
In the same study, the researchers found that 13 per cent of the men with physically demanding jobs had low sperm counts. In contrast, only 6 percent of men who did not perform such strenuous work had lower semen concentrations. The researchers were able to demonstrate that the physical demands of the job were what mattered: Other work factors like late-night shifts, heat, noise, or prolonged sitting were not associated with semen quality.
The same study reveals that diet and lifestyle are much more likely to be contributory factors than environmental chemicals such as pesticides, plastics and hormones in the water, because of the evidence that they could induce such striking effects at low levels of exposure is unconvincing.
There is a chance that women might ultimately be behind the sudden drop in sperm count, because of the rates of maternal smoking and the use of painkillers during pregnancy, and the reduced sperm counts of sons in adulthood.
A baby boy’s testes are formed during the first trimester when many women don’t know they’re pregnant, and the period immediately after their formation is critical for the production of testosterone. What we are seeing now could be the expression of a generational problem: the fact that, since the 1970s, women are more likely than ever to smoke and take over-the-counter painkillers.
Remedial Measures…
Often, the exact cause of infertility is not identified. Even if an exact cause isn’t clear, the doctor might be able to recommend treatments or procedures that will result in conception. In cases of infertility, the female partner also is recommended to be checked. This can help to determine if she will require any specific treatments or if proceeding with assisted reproductive techniques is appropriate. Treatments for male infertility include:
- Surgery
- Treating infections
- Treatments for sexual intercourse problems
- Hormone treatments and medications
- Assisted reproductive technology (ART)
In case the above-mentioned methods fail, and it’s impossible for a man to father a child. One can adopt lifestyle changes and home remedies. The following steps might be effective towards the restoration of male fertility.
- Increase the frequency of sex
- Have sex when fertilization is possible
- Avoid the use of lubricants
- Practice stress-reduction techniques
- Consider going to counselling
- Express yourself
- Stay in touch with loved ones
Some Interesting Facts about Male Infertility
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