If it seems like the world around you has gotten a little more mustache-y this month, it's because it's Movember! (Yes, this article was spell-checked.) The Movember Foundation aims to address the crisis around men's health––specifically, that men are dying too young from diseases such as testicular and prostate cancer, and also mental health conditions that can lead to suicide. In order to mobilize around men's health, Movember asks people who can grow mustaches to do it up big. Those mustaches raise awareness and money for Movember's projects that bring attention to men's health issues and organizations that promote it.
And just in case you're wondering if you somehow stumbled into the wrong corner of the Internet, worry not, you're still in the right place. We focus on women's health, but for a moment, we're digging into men's health and of course, what it has to do with fertility.
What health issues are men facing?
Testicular cancer (the most common cancer in men ages 15-35), prostate cancer and enlargement, and erectile dysfunction are conditions that are specific to men. In addition, men are more likely to engage in high risk behavior, such as using alcohol and tobacco use. According to the American Heart Association, 1 in 3 men has some form of cardiovascular disease. Men don't see the doctor regularly, which can decrease the likelihood of early detection of a disease. It's not just about physical health; men are also 3.63 times more likely to commit suicide, and 75% of the suicides in the US are committed by men. Depression in men often looks different than it does in women - anger and aggression as opposed to sadness, and therefore, it can be dismissed by health professionals and loved ones.
What's the deal with men and infertility?
So there's already a lot on your plate if you're a dude in terms of staying on top of your health, but at least you don't have to worry about infertility...right? Nope. While infertility (defined for both sexes as not getting pregnant after one year of intercourse without birth control) is most often framed as being a woman's issue, male infertility is very real and we need to talk about it. According to the American Society for Reproductive Medicine, about 40% of infertility cases are due to male factors, which means that about 40% are due to the female factor and the remaining 20% are a combination of both partners' factors. In 50% of male infertility cases, the cause isn't actually known. The other 50% consist of issues with plumbing, i.e. how the testicles work, urinary tract blockages, sperm quality, and problems brought on by hormone imbalances,infections, injuries, environmental factors, like overheating of the testicles, exposure to heavy metals, radiation, and chemicals, and lifestyle factors, such as steroid use, weight, and stress.
Let's get more specific about some common causes of male infertility (and their treatments).
Testicular problems: Because testicles are where sperm is made and housed, issues with them can absolutely impact a man's ability to successfully impregnate someone. If one testicle hasn't descended from the abdomen into the scrotum, it can result in decreased fertility, since that testicle has a higher body temperature and that means lower quality and count of sperm. If the undescended testicle isn't...descended, it can lead to a condition called azoospermia, which means there's no sperm inside the semen, so ejaculation proves unfruitful. A vasectomy works by obstructing the vas deferens and leading to azoospermia as well, but it can often be reversed. If azoospermia isn't the result of an obstruction, it can't be treated with surgery, and IVF can be used to collect sperm and fertilize an egg.
Varicocele, the enlargement of one of the veins in the scrotum, is one of the most common causes of male fertility problems. The increased pressure created by the vein can impact the quality and the count of sperm, and can also cause the testicles to shrink. Surgery can often address varicocele.
Hormone levels: Low testosterone levels, a condition known as hypogonadism, can affect men's fertility. Testosterone aids in the production of sperm, as well as the enlargement of the penis, testicles, prostate, and more. Hypogonadism is brought on by stress, as well as aging (so much for that old adage that male fertility has no expiration date) and medical conditions like pituitary problems and treatments like chemotherapy. Men who have it might experience erectile dysfunction and low sex drive, as well as fatigue and sleep problems. While hypogonadism can be treated with testosterone replacement therapy, that isn't a solution for infertility; rather, it can decrease one's sperm count. Treatment alternatives exist, like clomiphene citrate, but many aren't FDA approved.
Ejaculation issues: The most common cause of sexual dysfunction in men are ejaculatory disorders, like premature ejaculation. In a 1999 study, 31% of a male cohort ages 18-59 had some form of one. It might seem obvious that problems with ejaculation would be a cause of male infertility, but it's more complicated than it sounds. Erectile dysfunction (ED) occurs when a man isn't able to achieve and maintain an erection, and the reasons for it are numerous. It could be due to stress, depression, neurological damage, obesity, heart disease (ED can be an indication of heart disease, blocked arteries, and high blood pressure), a side effect of medication, smoking, and age. There are a plethora of treatments for ED, including pills, testosterone therapy, injections, and surgery.
Retrograde ejaculation is a condition in which semen is ejaculated into the bladder instead of the penis. It's happens when the neck of the bladder - the same muscle that holds urine - doesn't tighten, and the sperm is able to enter the bladder during ejaculation. Retrograde ejaculation can be caused by the side effects of medication for depression and high blood pressure, as well as surgery for testicular cancer, and nerve damage from diabetes and Parkinson's. It doesn't usually reveal itself unless a couple is trying to get pregnant, and it can be addressed with medication and through the use of intrauterine insemination.
Now that you know....now what?
Needless to say, fertility is complicated, but that's not necessarily a bad thing. It's vital to include men's health and fertility in conversations about conception. According to the National Infertility Association, less than half (41%) of OB/GYNs consider a urological work up of the male partner, which includes a semen analysis, a means of assessing the amount and quality of both semen and sperm (it's also referred to as a sperm count test). Advocating for yourself is key in any medical situation, but now that you know fertility isn't just a woman's issue, you have the information you need to see to it that your doctor is being thorough. Men, if you're reading this, remember to keep on top of your reproductive health!