General Information on Fertility in Men

Fertility And Male Age

when a man reaches middle-age and beyond gradual changes in his ability to function sexually will occur. Older men often notice reduced libido, a lessening in their ability to sustain an erection and a reduction in their ability to sustain a sexual encounter. Symptoms such as these are common but not necessarily universal. However, they can also impact on the fertility of a man. These symptoms can be preceded or accompanied by associated urinary problems.

Some men will not experience any reduction in urinary functions or sexual power and prowess. However, the vast majority of men will have to deal with at least some of the above issues as they get older.

Testosterone is the male hormone circulating through a man’s body that is responsible for the development and maintenance of the male organs and characteristics such as facial hair, muscle mass and body hair. It is also responsible for the growth at puberty of the prostate gland, penis and testicles. Post-puberty it is also responsible for the production of sperm by the testes. Testosterone is also important in a male for regulating moods and the libido. Hence, the level of testosterone in a man’s blood can affect his fertility. The level of testosterone in the blood is maintained by a feed-back mechanism starting in the brains hypothalamus.

An important part of this mechanism is as follows; the hypothalamus stimulates the pituitary gland (also in the brain) to produce and release the hormone LH (luteinizing hormone). LH stimulates the Leydig cells in the testicles to produce and release testosterone. Unfortunately the Leydig cells do not release the hormone testosterone uniformly throughout any one 24 hour period. Instead the release of testosterone is rather spasmodic.

Generally the levels of testosterone in a male’s blood will vary in line with other functions of his general circadian rhythm. eg Alertness, metabolism and the release of other hormones. Generally these are at their peak during the morning and decline as the day goes on. Considering the role of the hormone testosterone in the male, this may well explain why some men experience a level of sexual arousal in the morning greater than that in the evening. The circadian rhythm can also have an effect throughout the year. Contrary to popular belief, generally levels of testosterone in males are higher in the fall than in the spring when …. allegedly …. “a young man’s fancy turns to thoughts of love”.

Any time from the age of around 40 years the testosterone level in a man can start to diminish. The main causes of this are that the pituitary gland gradually secretes less of the hormone LH. This leads to a reduction in the level of stimulation to the Leydig cells and hence a drop in the production and, therefore, the release of the male hormone testosterone.

The result of this is that there is a slow but sure reduction in the male libido, arousal and the quality of his erection. By the age of 50 years 1 in 5 males (20%) can experience erections inadequate for sexual penetration. At age 60 years the figure rises to 30% (3 in 10) and by the age of 80 years it is 50% (1 in 2). This does, of course, also mean that approximately 80% of men at age 50 experience no such sexual problems.

However, as previously mentioned, the production of testosterone is essential to the production of sperm – the male gamete. Therefore, as the level of testosterone falls it will lead to a decline in the ability of a male to father children. Advancing years do not inevitably lead to male infertility, after all 1 in 2 octogenarians are still capable of fathering a child.

Male Fertility Tests

According to the World Health Organization (WHO) there are an estimated 60-80 million infertile couples in the world. Earlier, it was believed that not being able to conceive was due to ‘female problems’. It is now recognized that a couple’s infertility could be due to disorders in the female reproductive system, the male’s reproductive tract or in both.
It is estimated that infertility is:

• solely due to the female in around 40% of the cases;
• around 30% is due solely to male factors; and
• 30% is due to a combination of both partners having abnormalities in their reproductive systems.

Infertility in women can be treated more successfully than in men. If a couple having normal, unprotected sex have been unsuccessful in conceiving for over a year, then it is important for both partners to get themselves tested for infertility. Studies show that approximately 50% of infertility cases are related to male infertility factors. If you are concerned about your fertility, it is a good idea to get in touch with your health provider and get yourself investigated for possible infertility.

So, what does testing for male infertility entail?

1. Medical History: Your health provider will require your medical history which will normally include details about your age, your sexual and birth control practices, medications you are taking or have been taking, your use of caffeine, tobacco, alcohol or drugs like marijuana etc., your exercise patterns and any history of sexually transmitted diseases.
2. Comprehensive Physical Examination: A physical examination will be conducted to assess your overall health and to check for any obvious signs of infertility which will probably include a testicular examination.
3. Semen Analysis: A simple procedure, you will be required to collect your sperm in a specimen jar for testing. The semen will be analyzed to check for volume of ejaculate, appearance, sperm count, motility and morphology, all of which have a bearing on male fertility.

Depending upon the results of the above tests, you may be required to undergo further investigations that could include blood or urine tests.

• Blood samples will be taken to test levels of testosterone and Luteineizing Hormone (LH – which indicates if there is a problem in the pituitary gland).
• Urine samples would be required to check if there are any signs of sexually transmitted disease or for the presence of sperm pointing to retrograde ejaculation (where the ejaculate flows back into the bladder).

If your health provider thinks that it is necessary to conduct further investigations, they will most probably include the following:

a) Vasography: An x-ray test that determines if there is a leakage or blockage of sperm in the vans deferens.
b) Ultrasonography: A test employed to locate the presence of a blockage or damage in the male reproductive tract including seminal vesicles, prostrate or ejaculatory ducts.
c) Antibody testing: Doctors are not entirely agreed on the value of antibody testing for determining infertility. However, if recommended, this test will be conducted to check for antisperm antibodies in the blood or seminal secretions.
d) Genetic Test (chromosome analysis): This test also known as the Karotype test, examines the chromosomes in your cell for abnormalities that could interfere with fertility.
e) Testicular Biopsy: This test is rarely required to aid in determining the possible cause of male infertility. For this test, a small sample of tissue is required to be taken from one or both testicles. This procedure is not usually conducted to detect testicular cancer.

While most fertility tests for males like physical examination, semen analysis, blood and urine tests are not painful, testicular biopsy could cause a little discomfort. And since fertility tests can be expensive, it is better to discuss with your partner about how far both of you are willing to investigate your possible causes of infertility before embarking on the investigations.

Testicular Cancer And Male Fertility

The testicles, also known as the testes, are part of the male reproductive system. Their function is to produce the male gamete spermatozoa, commonly known as sperm. They are also responsible for producing male hormones, most notably testosterone. Healthy and normal functioning of the testicles is, therefore, vital to a high level of male fertility. Many factors can affect the performance of the testicles in producing sperm. This article concentrates on the impact of testicular cancer on male fertility.

Testicular cancer is a rare disease and yet it is the second most common form of cancer affecting males in the age range 18 to 40, with the peak age group for new cases of the disease occurring to men in their thirties. These age ranges also reflect the time when many men will be considering starting a family with their partner, meaning fertility issues could be particularly sensitive to a sufferer of testicular cancer. Testicular cancer is known to be more prevalent in white males than in black and Asian males.

The cause of testicular cancer is generally unknown. There are certain risk factors that are known to contribute to an increased risk of the disease. One of these causes is male infertility itself. This, in turn, could be caused by undescended testicles (Cryptorchidism) or a history of male infertility. Testicular cancer can in itself be a cause of low sperm count in a man. Following successful treatment for testicular cancer, sperm count figures can improve.

In the last 20 years the incidence of testicular cancer has risen in both the USA (4.3%) and UK (3.4%). However, due to advances in medical treatments for the disease the resulting mortality rates have fallen. The survival rate one year after diagnoses is now 97.7% and five years after diagnoses it is above 95%. Treatments include chemotherapy and low-dose radiation therapy. For some individuals testicular cancer may result in radical surgery where the removal of one, or both, of the testicles may be necessary. It is not common for both testes to be found to have cancerous cells, so treatment of both testes is rare. The removal of a single testis (orchidectomy) will not hinder a man’s fertility or sexual performance

Following chemotherapy for testicular cancer most men undergo a temporary period of infertility. In seventy to eighty percent of men, fertility is restored in three to five years following the end of the chemotherapy regime. However, some men do become infertile after chemotherapy. Prior to entering in to a programme of chemotherapy for testicular cancer, men should discuss with their medical advisers the fertility issues that may arise and consider having a sample of sperm and semen frozen for future use.

Where radiation therapy is required the ‘healthy’ testis will be shielded from the effects of the radiation. However, following successful radiation treatment for testicular cancer contraception should be used during any sexual intercourse for two years to avoid impregnation. This is important because the radiation from the therapy can damage germ cell precursors that develop in the sperm. (Germ cell precursors are genes concerned with tissue and organ development. i.e. the radiation therapy could cause genetic damage) It is, again, highly recommended that men entering into a course of radiation therapy discuss with their medical advisers fertility issues and having a sample of their sperm and semen frozen for future use.

Sometimes, the development of testicular cancer requires an operation to remove lymph nodes located at the rear of the abdomen. This is called retroperitoneal lymph node dissection. This operation can be required if, after a course of chemotherapy or radiation treatment, the lymph nodes are still enlarged. Whilst new surgical techniques are reducing the possibility it can unfortunately result in infertility due to retrograde ejaculation. This means that the ejaculation reverses its route into the bladder rather than outward through the penis.

Doctors can prescribe drugs to treat this condition. However, the drugs do carry risks to the heart and blood-pressure and so may not be suitable to all men. There is also is a procedure whereby sperm can be extracted from urine in the bladder following a retrograde ejaculation. The sperm could then be used for artificial insemination. In case retrograde ejaculation cannot be reversed the freezing of sperm and semen samples should be considered with your medical experts.

The Prostate Gland And Male Fertility

The prostate gland is one of the fluid producing organs in the male body. Its function is to produce seminal fluid (semen) that nourishes and transports the male gamete (sperm) through the female reproductive tract. Thus its proper and successful functioning is a key factor in male fertility.
A healthy prostate gland is made up of many small fluid producing sacs that are also referred to as glands. The prostate also contains a network of pipes and muscular cells that pump the seminal fluid, along with the sperm, at the moment of a males ejaculation.

The prostate is dormant up to the point of male puberty. With the release of male hormones it grows and develops into a walnut/strawberry size, spongy and fluid filled organ sited beneath the bladder. Its lifelong task is to produce semen, the complex fluid containing proteins and minerals to protect sperm as they seek the female gamete, the ovum. (NB. The prostate also works in conjunction with the seminal vesicles and Cowper’s gland which also produce fluids that assist ejaculation.)

Following puberty the size of a healthy prostate will change very little. Apart from a possible episode of inflammation or infection of the prostate most men are completely unconscious of the glands work. At some point, usually in the man’s fifth decade, the prostate will begin to grow again. It can then develop into an intrusive problem affecting the quality of life. The prostate gland is situated in a male’s body in such a position that it can also be seriously affected by problems in another organ. The prostate is inter-connected with the seminal vesicles, the Cowper’s glands, the vas deferens and the urethra. It is also in close proximity to both the bladder and the rectum.

As such it is susceptible to problems developing in other those other sexual, urinary and bowel organs, Begnign Prostatic Hyperlasia (BPH) is a common occurrence in men over the age of 50. In short BPH is the growth of new, non-cancerous, cells in the prostate whilst old cells fail to ‘die’ off. This results in the prostate enlarging and can lead to an abnormally large prostate gland. BPH often results in urinary disorders but rarely causes problems with male fertility.

One of the secretions from the prostate is the protein PSA (prostate-specific antigen). PSA plays the vital role of liquefying coagulated semen so that the sperm are able to ‘swim’ in order to find the ovum. Abnormally high levels of PSA can indicate problems with the functioning of the prostate gland, this could be due to BPH, as described above, or the onset of cancerous cells/growth within the prostate. If cancerous cells are present a variety of treatment options may be available to the medical practitioner. A highly successful treatment for prostate cancer is radiation therapy.

During the 1960’s prostate cancer sufferers undergoing radiation therapy invariably reported sexual dysfunction following it. Modern advances in radiation surgery during the treatment of prostate problems means that this is no longer the case. There has been a great reduction in the chances of sexual dysfunction or side effects arising from radiation therapy prostate cancer treatments. Also, there are now effective therapies to alleviate and even reverse problems that occur after treatment. In summary, most prostate cancer patients can look forward to resuming an active, fertile and fulfilling sexual life after successful treatment.