The signs of infertility are not always evident. Some of the signs of infertility include reduced volume of semen or inability to ejaculate. The semen may contain tinges of red or pink, which indicate blood. Sometimes, there may be swelling, a lump or pain in the genital region, or the testicular area.

• Past prostatitis and or genital infection
• Precocious puberty or delayed puberty.
• Testicular trauma and/or torsion.
• Exposure to toxic substances like radiation, x-rays and chemicals.
• High temperature exposure to the genitals
• Alcohol consumption
• Use of cigarettes and marijuana
• Hernia repair
• Use of prescription drugs to treat psoriasis and ulcers
• Undescended testicles
• Mumps infection after puberty

A variety of causes can cause male infertility. Some of the main causes of male infertility are-

• Varicoceles
• Sperm flow blockages
• Genetic abnormalities
• Hormonal problems
• Medications and the side effects of treatments.
• Infections of epididymis, prostate and other parts of the reproductive system.
• Excess of reactive oxygen and oxidants in the semen can also damage the DNA and the sperm’s cell membrane.

The diagnosis of male infertility starts with your fertility expert taking a thorough and complete medical history. Then a physical examination is done to make a note of any apparent abnormality. Next, semen analysis is done as a tool to measure the quality and quantity of the semen. If required, the fertility expert may ask you to undergo diagnostic and genetic testing depending on the findings of the preliminary tests. If a varicocele or other abnormalities are suspected, an ultrasound may be done to confirm it.

A fertility specialist evaluates the health of sperm and semen by performing a semen analysis on the sample provided by you. The main factors that are evaluated are the sperm count, its motility and morphology. The motility is the movement of sperms. At least 40% of the sperms must be progressively moving rapidly. Morphology is the shape and the size of the sperms. To be fertile, at least 14% of the sperm must have a normal size and shape. Sperm count is the number of sperms present in the semen. A millilitre of semen should contain at least 15 million sperms.

The normal sperm count can range from 16 to 100 million sperms per millilitre of semen. If the sperm count falls below 10 million, the sperm count is considered poor.

Fertility can be improved in some cases. Maintaining an ideal BMI, exercising regularly, consuming a healthy balanced diet, avoiding habits like smoking, drinking, and consuming drugs can help boost fertility. Some supplements and vitamins are also known to improve both libido and fertility. Talk to your doctor about supplements that suit you to help boost fertility.

The treatment will depend on many things like age, health, past illnesses, cause of infertility and personal preference. The treatment options available are-

• Artificial insemination, IVF, GIFT and other ART techniques
• Medicines and hormonal therapy
• Surgery to correct anatomical obstructions, remove scars and varicose veins.

Cycling and wearing tight clothing like lycra shorts can overheat the testicle. This can temporarily damage the sperms or lower sperm count. Saunas, hot tubs and electric blankets should be avoided if planning to have a baby.

When you have cystic fibrosis, you may have a blockage or a complete absence of vas deferens. Vas deferens is a tube-like structure that allows the passage of sperms from the testes to the penis. If there is an absence or a blockage of the vas deference, the sperms will not exit the body, causing infertility. This may be corrected by surgery. If you have cystic fibrosis, it is important to have genetic counselling along with your partner to ensure that your baby does not have the chances of inheriting the condition.

The swelling on the testicles is called varicocele. It is swollen veins. This can affect fertility as the veins are no longer able to regulate the temperature effectively. However, a small surgery can fix the problem and may also restore fertility.

In some cases, semen becomes devoid of sperms. This can be due to obstruction, small testes, hormonal irregularity or chemotherapy. If the sperms in the testes are healthy, the sperm can be retrieved surgically through a procedure called PESA or percutaneous sperm aspiration. This sperm can then be used to fertilize your partner’s eggs through various ART techniques to have a successful pregnancy.

Vasectomy reversal surgery can be done to restore normal fertility. However, sometimes the reversal is not successful. In such cases, the sperm can be retrieved and be used to fertilize your partner’s eggs and have a pregnancy through ART technology. The sperms can also be frozen for future use.

Cancer of reproductive organs, like the cancer of testicles, can affect fertility adversely. Other cancers are less likely to affect fertility directly. In such cases, it is the treatment of cancer like chemotherapy and radiation that causes infertility. Surgical treatment for cancers of the reproductive system can cause infertility as well.

Before starting the fertility treatment, sperms can be retrieved from the testicles and preserved through cryopreservation in sperm banks. Even boys who have been diagnosed with cancer can have their sperms preserved with parental consent. The process of sperm banking is quick and non-invasive. Talk to your fertility expert for more information.

It is essential to talk to both a fertility expert and your oncologist about the preservation of your fertility before the cancer treatment commences. Some of the questions you must ask are-

• How will the cancer treatment affect my fertility?
• Is there any alternative treatment for cancer that can help preserve fertility?
• What are the options of fertility preservation that I have?
• How soon should I preserve my sperms before the cancer treatment?
• Will my kids have any ill effects of my cancer treatment?

If you have been subject to chemotherapy and radiotherapy, it may not be possible to preserve your fertility after the treatment has begun. It is best to do it before the treatment starts. If you have had surgery to treat cancer and your reproductive system is unharmed, it may be possible to preserve your sperm after the treatment.

The time period recommended to wait before trying for a baby after a cancer treatment is 2 years. This is because cancer can come back in 2 years. Any damage to the sperm production is also believed to repair itself in a time period of 2 years. It is best to talk to your fertility expert to determine your unique medical circumstances before trying for a baby.