Hope for Male Infertility with MyCatholicDoctor
The traditional devotion in the Catholic Church for the month of March is St. Joseph. St. Joseph is known as the spouse of the Virgin Mary and foster-father to Jesus Christ. St. Joseph’s feast day is even in March, on March 19. St. Joseph is the patron saint of fathers. He is often invoked in prayers and devotions by men and couples struggling with infertility. My Catholic Doctor offers many resources and medical providers to help couples struggling with infertility, including male infertility.
There are several categories of causes that contribute to male infertility. These include systemic illnesses, surgeries, developmental abnormalities, lifestyle choices, structural abnormalities, infections, hormonal causes, and semen abnormalities. A workup for male infertility includes gathering clinical history and lifestyle preferences. Investigating structural abnormalities, infections, and hormonal causes. And lastly, it involves collecting sperm for analysis in a morally licit way.
Clinical History and Lifestyle
The beginning of a male infertility workup includes investigating clinical history. Systemic illnesses like diabetes, cystic fibrosis, cancer, and parotitis, or swelling of the parotid gland in the jaw can contribute to male infertility. Prior surgeries like surgery for an undescended testicle, hernia repair surgery, bladder procedures, and prostate surgery can affect male reproductive structures in the body (Vigil, 2021). Family history and developmental history can be important too. Undescended testicles, midline defects (like heart defects, cleft palate, and neural tube defects), and hypogonadism can be common in family lines that struggle with male infertility. Common developmental conditions, include hypospadias (where the urethral opening is on the underside of the penis and not the tip), congenital anomalies, and prenatal DES (diethylstilbestrol) exposure. Lastly, toxin exposure and occupational exposure are important to investigate. Toxins that affect male infertility, include alcohol, tobacco, recreational drugs, anabolic steroids, wet heat exposure, and chemotherapy. Some occupational exposures include ionizing radiation, chronic heat, benzene-based solvents, dyes, pesticides, herbicides, and heavy minerals (Vigil, 2021).
Structural Abnormalities
After clinical history and lifestyle choices have been vetted, structural abnormalities are explored using ultrasound. Testicular ultrasounds check for varicoceles, hydroceles, testicular calcifications, and epididymal cysts (Vigil, 2021). Varicoceles, or an enlargement of the veins of the skin holding the testes, can cause low sperm production and low sperm quality. Hydroceles, a collection of fluid in the skin surrounding the teste, can cause infertility if associated with infection or a tumor. Testicular calcifications can block seminiferous tubules, which help develop sperm. Lastly, epididymal cysts, or a fluid-filled cyst in the epididymis, can block sperm from exiting the epididymis.
Infections
Sometimes male infertility is caused by infections. Symptoms of infections, include urethral discharge, urethral itching, inflammation of the urethra, skin lesions like blisters and ulcers, and epididymitis, or a swollen red scrotum. When these symptoms are present, an infection panel is drawn. This looks at a urethral culture, Chlamydia trachomatis test, Mycoplasma vaginalis culture, Ureaplasma urealyticum culture, Gardnerella vaginalis culture, Neisseria gonorrhoeae culture, fungus culture, and HPV test (Vigil, 2021). A Syphilis rapid plasma reagin titer and Herpes simplex 1 and 2 are drawn for skin lesions. Specific treatment ranges from treatment with antibiotics, anti-fungal, and antiviral medications. Often, spouses will require treatment, as well.
Hormonal Causes
Hormones are responsible for telling the male body to produce and develop sperm. Hormone imbalance can lead to male infertility. Follicle-stimulating hormone (FSH), cortisol, oral glucose tolerance test, prolactin, vitamin D, sex hormone binding globulin (SHBG), and testosterone are part of the hormone panel drawn for male infertility (Vigil, 2021). FSH is responsible for stimulating the production of sperm. Low FSH can lead to low sperm production. If there is increased cortisol, there will be less luteinizing hormone (LH) in the male body. This leads to less testosterone in the body. Testosterone is important for sperm production and helps additional secretions that protect sperm during ejaculation. The oral glucose tolerance test checks for any insulin resistance in the body. Insulin resistance causes high glucose and high insulin levels in the blood. Glucose homeostasis is important for maintaining testosterone levels and developing healthy sperm (Faucheux, 2019). High levels of prolactin can cause low FSH and LH levels, which can lead to low testosterone levels. This can impair sperm production. Low vitamin D can contribute to low sperm production and low motility of those sperm. Finally, SHBG is responsible for transporting sex hormones, like testosterone, around the body. High SHBG levels are associated with infertility, low sex drive, impotence, and decreased sperm count and motility (Tello, 2021). High SHBG can be caused by liver inflammation, alcohol consumption, smoking, and stress. Achieving proper hormone balance can often help men achieve a healthier body and better fertility.
Semen Abnormalities
Finally, it is important to examine semen for abnormalities using a morally licit home-collection kit. There are several on the market, and most can be used with a fenestrated condom for a private collection that respects the nature of marriage. Healthy sperm are important for better chance of successful fertilization. Semen analysis examines volume, concentration, progressive motility, total motility, total sperm, morphology, and pH (Turczynski, 2021). Azoospermia is the absence of sperm in the sample. This could be because of retrograde ejaculation, congenital absence of the vas deferens or seminal vesicles, or genetic causes (Turczynski, 2021). Low sperm count, or oligozoospermia, reduced sperm motility, or asthenozoospermia, and high levels of abnormal sperm, or teratozoospermia, have many different causes. Sometimes the main cause is a genetic abnormality, like cystic fibrosis gene mutation, Klinefelter’s syndrome, 46 XX male syndrome, 47 XXY male syndrome, and Y chromosome microdeletions (Turczynski, 2021).
Treatment Options
Male infertility is an often-overlooked aspect of infertility, but there is hope for couples who struggle with male infertility. Many treatments are available that do not involve using artificial reproductive technology or in vitro fertilization methods. Some general recommendations, include working to decrease an unhealthy weight through aerobic exercise and weight-lifting 30 minutes per day five times per week and a healthy diet that is low in polyunsaturated fats and high in fiber. Men can take over the counter vitamins like vitamin B, vitamin D at 1,000 IU per day, vitamin E 400 IU per day, and vitamin C 1 gram per day (Vigil, 2021). Additionally, limiting alcohol, smoking, and recreational drug use can improve male fertility. Limiting occupational exposures can help too. Some structural abnormalities can be resolved through procedures. Infections call for treatment with medications, as stated above. Some hormonal imbalances may call for treatment with medications and lifestyle changes too. Lastly, sperm health can be boosted by improving motility and morphology. Both vitamin D and vitamin C help improve sperm motility. Limiting alcohol and smoking and working to increase physical exercise can improve sperm morphology.
Lastly, let’s not forget about the spiritual impact of male infertility. St. Joseph is a powerful patron to ask for intercessory prayer for strength to bear the cross of infertility. March is dedicated to St. Joseph, so this is a great month to pray for all those struggling with male infertility. As always, if you have any questions or concerns, please seek advice from one of the My Catholic Doctor healthcare providers. And, if you live in North Carolina and would like an evaluation for male infertility, schedule an appointment with me, as I am eager to help you achieve your conception goals.
Sources:
Faucheux, J. (2019, June 12). Metabolic Syndrome and Male Infertility. https://www.factsaboutfertility.org/metabolic-syndrome-and-male-fertility/#:~:text=In%20fact%2C%20it%20has%20been,additive%20effects%20on%20male%20fertility.
Tello, C. (2021, March 2). SHBG Blood Test, Symptoms of High Levels & How to Lower. https://labs.selfdecode.com/blog/sex-hormone-binding-globulin-shbg/
Turczynski, C. (2021, November 18). The Use and Significance of Semen Analysis for Restorative Reproductive Medicine. [Webinar]. Zoom.
Vigil, P. (2021) Reproductive Health Research Institute Guidelines. 144-147, 169-171
Author: Megan Blum, Physician Assistant and Fertility Provider with MyCatholicDoctor
About Megan: PA Megan Blum is a physician assistant with a special interest in providing restorative reproductive care to women of all ages. She has special training in FEMM and Marquette Method and is a medical consultant for both models of women’s healthcare. She became a medical provider to help provide access to fertility-awareness-based medicine to all who seek it. She believes in finding the root cause of women’s health and endocrine issues to restore women’s bodies to optimum health.
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