Let's learn all about male infertility signs and symptoms
"Of all diseases male infertility is the most silent in its signs & symptoms"
Male infertility is rampantly rising. Estimated prevalence data suggests that on average 1 in 6 men would face some form of male reproductive health problems. On an average 50 to 60 percent of all patients who present to an infertility clinic will have a serious, yet sometimes undetected male factor fertility issue.
Male factor infertility can be caused by a variety of complex health conditions. But male infertility signs and symptoms can be HORRIBLY SILENT and yet very notorious.
Most patients would never even have the slightest clue that they are suffering from a pathological underlying male infertility issue.
In a classical clinical example, consider a patient with a condition called ‘Hypergonadotrophic hypogonadism’. In this group of patients, there is something wrong at the level of the testis (the testis are two spherical organs located outside the male body and are the factories where the sperm & testosterone are produced)
The brain in these patients produces all the right hormones (FSH, LH) needed for sperm production and sexual interest. However, the testis, much to our frustration and limited scientific understanding does not respond to FSH or LH. As a result, sperm production does not happen in the testis (since FSH, LH both drive sperm production). This leads to infertility and the semen analysis picture usually shows Azoospermia (no sperm in semen)
Problems with sperm transport also affect at least 20 to 30% of men too, obstructions in the tubes that transport the sperm from the testis to the penis can lead to male infertility.
All the known causes of male infertility is summarized in the table below
What is interesting here though is that, the man with Hypergonadotrophic hypogonadism will still be able to engage in regular sexual intercourse and will usually have adequate sexual drive (despite the fact the testosterone may be low). In my clinical practice, most patients go about their normal routine lives without even knowing they have such a underlying clinical condition. Male infertility symptoms are thus very silent in nature with almost no bodily symptoms/signs (except a few rare exceptional conditions). Some common male infertility signs seen are
- Erectile Dysfunction
- Pain during ejaculation (usually suggests and obstruction in the male reproductive tract)
- Testicular mass or lump
- Recurrent respiratory tract infection
- Lack of smell (Typically seen in a condition called the Kallman Syndrome)
- Decreased facial hair and body hair
- Male breast development (gynecomastia)
Its only when these group of patients start trying for a child, that they realize something is amiss at the advice of their doctor. Sadly, even today women are frequently evaluated thoroughly and men are seldom given the clinical attention they need. Most reproductive medicine consultants have not had adequate grounding in the field of Andrology and sexual health, so they sometimes miss the elevated hormones seen in men with hypergonadotrophic hypogonadism.
More interestingly, and also rarely, patients with Hypergonadotrophic hypogonadism are classified as patients with Klinefelter’s syndrome. Here is the patient is usually tall, obese, would have a very small testis and semen analysis would show Azoospermia along with his sex hormones being highly elevated. This is a genetic condition where the individual has an additional X chromosome resulting in XXY being in every cell of the human body vs. the normal XY.
The abnormal additional X chromosome affects normal sexual development and what ultimately happens is that the during puberty or the growth spurt that occurs in boys, the testis instead of becoming bigger, it shrinks and atrophies.
Male infertility symptoms are classically seen in patients with ‘Hypogondotrophic hypogonadism’. Here the opposite happens! In these patients, FSH and LH itself is not produced by the brain, hence as result, the normal male development does not occur. Most patients would present with sparse hair in the pubic region or under the arms (due to low Testosterone), they will have very low sex interest and also erectile dysfunction. Once again just as in Hypergonadotrophic hypogonadism, semen analysis will show no sperm in the semen and blood assessment of the male sex hormones FSH/LH will show very low values.
A host of clinical conditions can produce the various male infertility symptoms and signs. Some of these conditions include,
- Testis torsion
- Testis injuries
- Vanishing testis
- Undescended Testis
- Orchitis and other testicular Infections
- Klinefelter’s Syndrome & Klinefelter’s Mosaics
- Kallman’s Syndrome
- ?Environmental toxins
- Testis Cancers
- Y-Chromosome Microdeletion and genetic conditions like 47XYY/45XO/XX Syndrome
- Use of Certain Medications like anabolic steroid use
- Past surgeries done in the testis
- Environmental toxins/chemical exposure
- Lifestyle factors like smoking/alcohol and drug abuse
- Chronic long term medical illness
A well trained Andrologist will elucidate and look out for all the possible clinical conditions that predispose to male infertility. All of the above conditions affect sperm output both inters of sperm concentration and sperm motility and of course sperm quality.
The discussion does not end here though. In some patients male infertility signs and symptoms can run much deeper.
In a large proportion of men, male infertility can arise due to problems to certain specific male infertility symptoms that are sex related like erectile dysfunction, premature ejaculation (especially if ejaculation occurs before penetration), and low sex interest. Thorough medical evaluation and treatment combined with psychosexual therapy must be instituted without delay.
In some individual’s ejaculation may not happen at all during intercourse or the ejaculate may be visibly of very low semen volume. In these individuals, the treating clinician must suspect an obstruction somewhere in the male reproductive tract.
All said and done, the causes of male infertility are vast. Moreover, male infertility symptoms may not be very specific as well. Proper history taking, physical examination combined with rational yet appropriate testing will help in the right management of male infertility.
- Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, Krausz C, EAU Working Group on Male Infertility. European Association of Urology guidelines on Male Infertility: the 2012 update. European urology. 2012 Aug 1;62(2):324-32.
- Ferlin A, Arredi B, Foresta C. Genetic causes of male infertility. Reproductive toxicology. 2006 Aug 1;22(2):133-41.
Meet Dr. Shah at the Male Infertility & Sexual health Clinic
Dr. Shah is Consultant Andrologist and Sexologist in Chennai. His passion for helping men facing infertility issues stems from the fact that “Men never ever get the care they deserve as far as fertility treatments is concerned”