World Population Day (July 11) has passed. As we grapple with the multifaceted challenges of global population dynamics, it is crucial to turn the spotlight on a subject often overshadowed in discussions on reproductive health: male infertility. Male infertility remains a stigmatised issue, shrouded in silence and with misconceptions. This neglect exacerbates the emotional and psychological toll on those who are affected and impedes progress towards effective solutions.
In 2004, the World Health Organization (WHO) estimated that globally, between 60 million to 80 million couples struggle with infertility. However, the exact prevalence of infertility in India remains unspecified according to the Indian Council of Medical Research (ICMR) National Guidelines for Accreditation, Supervision and Regulation of Assisted Reproductive Technologies (ART) Clinics (2005). Extrapolating from WHO’s data, it is suggested that approximately 13 million to 19 million Indian couples may face infertility issues. This incidence is only set to increase, shaped by factors such as environmental pollution and adverse lifestyle shifts. Male infertility accounts for 50% of all infertility cases in the country. Thus, it is important to shed light on male infertility, understand its causes, and identify solutions to aid the millions of affected couples.
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Understanding the subject
Male infertility is not a standard experience. Its causes, and therefore its forms, vary. Infertility in men can manifest as an absence of sperm, low sperm count, low sperm motility, or both. The form of infertility can depend on various factors that include stress, hormonal imbalance, genetic, anatomical and epigenetic factors, or even exposure to certain infections. External factors such as environmental pollution and an indiscriminate use of pesticides on crops, plastics, and plasticisers can also affect fertility and influence the epigenetic makeup. Lifestyle factors such as diets, sleep patterns, work schedules, and consumption of alcohol and tobacco also play a major role. Adding to these factors is a growing preference for late marriages among youth, creating challenges due to declining sperm quality with age.
While the challenges listed above may appear daunting, male reproductive health can be safeguarded through various lifestyle interventions. First and foremost, it is imperative to be aware of reproductive and sexual health and the factors that influence it, particularly during the formative period from secondary school to junior college. Here, parents, particularly fathers, play a critical role and must educate their sons on the issue. At an individual level, young men should proactively adopt good lifestyle practices, ensuring healthy eating, regular sleep patterns, and eliminating the consumption of alcohol, tobacco, and other intoxicants. While mobile phones and laptops have become occupational hazards in most fields, their excessive usage, in proximity to the body, should be avoided. Stress is a major deterrent to reproductive health, and regular exercise, yoga, and meditation can go a long way in reducing its adverse effects on well-being. Couples together must also adopt such healthy lifestyle practices to safeguard their reproductive health and enhance their well-being.
Treatment options
While lifestyle interventions play a critical preventative role, it is also important to discuss treatments available for those grappling with infertility. Treatment options are varied, and their efficacy depends on the cause and the form of infertility. It is important to seek help from a medical professional to identify and treat the issue. The medical professional will guide the person to undergo a routine semen analysis, conducted after a two to seven day period of sexual abstinence (WHO recommended). If the issue is physical or anatomical such as blocked sperm flow, undescended testicles, or an abnormal urethral opening, these can be fixed with surgery. If the issue is an absence of sperm, then treatments such as intra cytoplasmic sperm injection (ICSI) should be undertaken. Alternatively, couples facing this issue can also opt for donor sperm insemination or adoption. In cases where the sperm count is very low, there is a chance for the couple to conceive naturally if sperm motility is very good. However, if both sperm count and motility are low, intrauterine insemination (IUI), in vitro fertilisation (IVF), or ICSI are advocated. In cases of male infertility due to gene mutation/s, genetic counselling is of utmost importance before seeking the support of assisted reproductive technologies such as IVF and ICSI.
With millions of couples in India facing infertility issues, there is an urgent need for open and informed discussions on reproductive health. It is time to recognise and address the significant issue of male reproductive health. Awareness building, sex education, and timely medical interventions are key to supporting couples on their journey to parenthood. By breaking the taboo surrounding male infertility and fostering a more informed and supportive environment, we can help many couples realise their dream of having children.
Dr. Priyanka Parte is Scientist F, Indian Council of Medical Research, National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH)
