Infertility: Not Just a Woman’s Problem
by Alex Shteynshlyuger MD
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Male Infertility is present in 30-50% of Infertile Couples
Not many people are aware of this little fact but among infertile couples 50% are caused by “female factor”, another 20% are due to male problems and 30% of couples have a combination of male and female factors predisposing to infertility. Overall, in 50% of couples issues with male fertility are present.
Hormonal Issues and Sperm Quality Issues Affect Male Fertility
A number of issues can affect men’s ability to reproduce. A number of hormonal problems can affect fertility in men. These include primary or secondary hypogonadism (low testosterone) hyperthyroidism, adrenal and pituitary abnormalities can cause such issues as high prolactin levels, abnormal estrogen levels, abnormal LH, FSH.
In addition to hormonal considerations number of other factors influenced infertility in men. These include environmental will behavioral factors as well as genetic factors. Thorough history and physical exam are important in evaluating men with infertility. At least 2 semen analysis are necessary for determining the cause of infertility and for guiding further testing and evaluation. Semen analysis in infertile men can show and number of abnormalities:
Semen Analysis in Infertile Men:
- Low sperm concentration
- Low semen volume
- Abnormal morphology or shape of sperm
- Abnormal sperm motility
- Immature sperm
- High number of lymphocytes suggesting an infectious or inflammatory process.
Behavioral factors that increase the temperature of the testis can also affect fertility. These include tight underwear, working close to heat sources (cooks, factory workers, mill workers,etc), using sauna or hot bathtubs on a regular basis.
Genetic testing is necessary in some men with infertility to determine the cause of infertility and to guide treatment options and further evaluation.
Proven Natural Approaches to Improve Fertility in Men
A number of high quality scientific studies have demonstrated that natural supplements can improve sperm quality in men. In particular the following supplements have been shown to benefit men. These can be purchased at most pharmacies and health stores. These supplements improve sperm concentration and motility as well as percent of sperm with normal morphology:
These supplements do not work overnight. At least 3-6 months of use are necessary to see benefits:
- 200 mg selenium daily
- 600 mg N-acetyl-cysteine orally daily
- 300 mg coenzyme Q10 (Kaneka, Osaka, Japan) daily
Hypothyroidism & Infertility
While hypothyroidism is not as common in men as in women, it is an important cause of infertility in some men. Symptoms of hypothyroidism in men can be rather subtle and nonspecific. In addition to infertility and poor semen parameters, hypothyroidism can cause erectile dysfunction, depression and lack of energy. It is also associated with low testosterone levels.
Both male and female partners in couples that have trouble conceiving a child should have a thorough evaluation. In as many as 50% of couples, the man will have a detectable abnormality.
In men with infertility and erectile dysfunction and poor libido, testing for hypothyroidism is recommended.
Some references of interest:
Fortunately, a prompt diagnosis of hypothyroidism is easily made with a simple blood test. Correction of hypothyroidism usually leads to reversal of symptoms which may take a few months to return to baseline levels. When hypothyroidism is the cause of infertility it can usually be successfully treated.