The problem of male infertility is very common these days. According to an international study, for 1 out of every 5 infertile couples, the problem solely lies in the male partner. 

There was a time when male partners never got themselves tested for infertility issues and woman was blamed for not being able to conceive. After the release of movie "Vicky Donor", thankfully, the mindset of people, especially the males have now changed and they are willing to get themselves tested for such kind of problems.

When is a Man Considered to be Infertile?

To get a woman pregnant, the male partner must meet the following conditions:

1. Ability to sustain erection for a long time.
2. Healthy sperm count - Ideal sperm count in men is about 40 million per ejaculate. In some men, either the production of sperms is not adequate or there are certain blockages due to which sperms are not found in the semen.
3. Healthy and mature sperms to fertilize an egg - sperms should have a high motility rate so that they can easily reach the egg. In some cases, the structure of the sperms is abnormal and hence they are not able to penetrate the egg. 

Condition# 2 and 3 can be diagnosed through a semen analysis test. If any of the above conditions is not fulfilled, the male partner is considered to be infertile.

Types of Male Infertility

Azoospermia

Azoospermia is a condition in which there is a complete absence of sperms in the ejaculate. Azoospermia can further be categorized as "Obstructive Azoospermia" and "Non-Obstructive Azoospermia". 

Obstructive Azoospermia

In this condition, sperms are produced in the testes but somehow, they are not delivered in the ejaculate due to some kind of blockage either in the sperm carrying ducts (through which the sperms travel from the testes to the urethra) or the ejaculatory ducts (through which the semen flows out of the penis and exits the body).

Non-Obstructive Azoospermia

In this condition, the testes do not produce any sperms. Some of the major causes of Non-Obstructive Azoospermia are listed below:

1. Deficiency of FSH and LH Hormones - Pituitary hormone FSH (Follicle Stimulating Hormone) is the primary hormone that helps the testicles produce sperms, but a deficiency of this hormone will affect the production of sperms. 
2. Testicular Failure - In this condition, testicles fail to generate sperms and male sex hormones (testosterone). Generally in this case, the sperm producing ability of the testes is diminished and therefore, the pituitary gland produces more FSH in order to help testicles produce sperms. So, in such cases you will find an elevated level of LH and FSH hormones in the blood. 

Causes of Testicular Failure
1. Chromosome Abnormalities
2. Intake of certain drugs such as drugs to treat fungal and yeast infections or drugs such as marijuana.
3. Diseases such as mumps, testicular cancer etc.
4. Injury to testicles or scrotum.
5. Testicular Torsion - Twisted spermatic cord that results in cut off of blood supply to the testicles.


3. Vericocele Veins in the Scrotum- There are numerous veins with one way valves that allow blood flow from the scrotum to the heart. When the valve fails, the blood pools inside the vein. Such veins are known as varicose veins and they increase the temperature of the testes, resulting in decreased sperm count, decreased sperm motility and increased deformity of the sperms.
4. Congenital Causes - The most common congenital cause is the 'Klienfelter Syndrome' wherein there is an extra X chromosome in the male DNA that results in infertility, smaller testes and abnormal breast enlargement. The other common congenital cause is the 'Y chromosome microdeletion'.

Oligospermia

Also known as oligozoospermia, oligospermia is an infertility type, in which there are less than 20 million sperms per milliliter of the ejaculate. Though the causes are similar to the ones in azoospermia but, there are many other lifestyle factors also that can contribute to the condition of oligospermia. Some of the factors include excessive intake of alcohol and drugs like marijuana; stress, sleep disorders and emotional issues - these can lead to hormonal imbalances; smoking; wearing tight underwears; consistent use of hot tubs; sexually transmitted diseases etc.

Teratozoospermia

It is an infertility condition in which the shape of sperms is abnormal due to which they are not able to penetrate and fertilize the eggs. Normally, a sperm comprises of an oval head, a neck and a tail. But, in teratozoospermia, there are abnormalities in shape that comprise of abnormal shapes of head (round, tapering, pin-shaped, etc.), missing tail, or even multiple tails.

Asthenozoospermia

Asthenozoospermia is an infertility condition in which majority of the sperms in the semen sample are diagnosed to be immotile i.e. they have decreased motility due to which they are not able to reach the egg. Though there are not any specific causes of Asthenozoospermia but one of the major reasons for low motility of sperms can be severe teratozoospermia. Apart from teratozoospermia, other conditions such as attachment of antisperm antibodies, vericose veins and unhealthy diet can be the reasons of asthenozoospermia.

Necrozoospermia

Necrozoospermia is a condition in which majority of the sperms in the semen are dead due to which fertilization of egg is not possible.

Diagnosis

If you are not able to get your partner pregnant even after having unprotected sex for more than a year and your partner has been diagnosed to be perfectly normal, then you must visit a urologist to get yourself diagnosed for any kind of infertility. Following are some of the tests that you might need to undergo:

Physical Examination and Medical History

The urologist will carry out a physical examination of your pelvic organs like testicles and scrotum. He would also discuss with you about your past medical history, any prior surgeries or medications. After that, you would have to undergo certain lab tests listed below.

Semen Analysis

Semen Analysis is the first test that is generally done to find out the count of sperms in your ejaculate. Apart from the count, sperms's morphology (abnormalities in shape) and motility (mobility) is also determined with this test. Generally two tests are conducted over a period of time to ensure the correctness of results. If your semen analysis results are not normal, your doctor can recommend you for further tests:

1. Hormonal Tests - Blood tests to determine the levels of FSH, LH and Testosterone hormones in your blood.
2. Vital Staining Test - To see if the enough number of sperms in the semen sample is alive.
3. Antisperm Antibodies Test - To see if antibodies have attached to the sperms that can contribute to infertility.
4. Testicular Biopsy - Testicular biopsy can be carried out to see if the sperm production is normal or not. If it is normal then there is a possibility of a blockage somewhere in the male reproductive system. Testicular biopsy is mostly done in case no sperms or reduced sperms are found in male's semen and also, the results of hormone tests are normal. The Major objective of this biopsy to determine if there are any chances for the man to biologically father a child. A small sample of tissue from the testicles is taken and is studied under the microscope to see if there are any sperms in the tissue sample. In case, sperms are found in the sample, it indicates that there might be a blockage in the tubes that transfer sperms to the urethra from the testes. This blockage then can further be repaired through surgery. The sperms found in the tissue sample can also be used for fertility techniques like IVF (explained in the sections below.).
5. Scrotal Ultrasound - Test to diagnose any blockages/obstructions/varicose veins inside the scrotum and testicles. 
6. Post-ejaculation Urine Analysis - To test you for retrograde ejaculation (a condition in which sperms travel backward into the bladder instead of coming out of the penis during ejaculation)
7. Genetic/Chromosomal Tests - To diagnose the Klinefelter syndrome or Y chromosome microdeletions.

Treatment

Lots of male infertility treatments are available these days. In case a treatment cannot help the couple build their family, they can either go for a sperm donor or adoption.

IUI (Intra Uterine Insemination) - It is an assistive reproductive technique in which the semen is artificially inserted into the female's uterus to achieve pregnancy. This technique is mostly used when the sperm count is low, there is a decreased sperm motility or when male faces the problem of premature ejaculation. The process of IUI is the simplest of all the assisted reproductive techniques. In case when the male partner is found azoospermic, the couple can go for IUI with the donor sperm.

IVF (In Vitro Fertilization) - When IUI fails to help the female partner conceive, the couple can go for the more complex technique of artificial insemination i.e. IVF in which eggs and sperms are combined outside the body to form an embryo which is then planted inside female' uterus. The success rate of achieving pregnancy using IVF is three times more than IUI.

ICSI (Intra Cytoplasmic Sperm Injection) - ICSI is similar to IVF and is mostly performed when the male suffers from teratozoospermia, asthenozoospermia or necrozoospermia. In this technique, a single sperm is directly injected into a single egg and then the embryo is transferred into the female's uterus.

TESA (Testicular Sperm Aspiration) - This is surgical sperm retrieval technique which is used along with ICSI in case of obstructive azoospermia in men. With this technique, urologist recovers sperm directly from epidydymis or testicles. When the sperm is retrieved, then using ICSI, pregnancy can be achieved.