Although male infertility affects men worldwide, it is still not discussed widely. There is a common misconception that all men should be able to impregnate their partner. The idea that all men can fertilise an egg is a myth. Men diagnosed with male infertility may find it challenging to discuss their diagnosis out of fear of being judged, criticised, or negatively spoken of by others.

Yello spoke with Urologic Surgeon Dr Angie Murray, based in Belize about male infertility. We asked her to share some insight on male infertility, its causes, risks, and possible treatment options.

Dr Murray, why did you choose to pursue a career in urology?

I decided to become a urologist because I liked that in this surgical specialty, we can treat diseases and conditions in more than one body organ and two major systems, the urinary and male reproductive system.

What is male infertility?

Male infertility is the failure to conceive despite one year of regular unprotected intercourse. It also describes any health issue in a man that lowers the chances of his female partner getting pregnant. Approximately 15% of couples will experience infertility, and 20% will have a male factor that is solely responsible. Abnormalities in a semen analysis typically help with identifying male infertility. Other issues may contribute to infertility despite normal semen.

Tell us more about the exceptions – cases with no male-associated factors.

Idiopathic male infertility describes cases with no male-associated factors to explain impairment of sperm parameters, which is typical in approximately 30-40% of cases. These men do not have any previous history of diseases affecting fertility. They have normal findings on physical examination and endocrine, genetic, and biochemical laboratory testing, although semen analysis may reveal pathological findings.

Share some of the causes of male infertility.

Several factors might impair male fertility. Some of these factors may include:

• Malignancies (Testicular germ cell tumour – TGCT).
• Obstructions (intratesticular, epididymal, vas deferens, or ejaculatory duct obstruction).
• Urogenital tract infections (urethritis, prostatitis, orchitis and epididymitis, STDs, or VPH/HPV).
• Increased scrotal temperature because of varicocele.
• Endocrine disturbances (dysfunction of the hypothalamus-pituitary-gonadal axis, Hypogonadism).
• Gonadotoxic exposure (e.g., radiotherapy or chemotherapy use of (anabolic drugs).
• Genetic abnormalities and immunological factors.

What are some risk factors that may contribute to male infertility?

Advanced paternal age (over 40-45 years old) is one of the main risk factors associated with the progressive increase in the prevalence of male factor infertility. Environmental and lifestyle factors like smoking, excessive alcohol intake, and obesity can also affect fertility.

How is it diagnosed?

The urologist or other specialist in male reproduction will request a comprehensive medical and reproduction history, physical examination, and at least two semen analyses to diagnose male infertility. The complete evaluation results will allow the physician to recommend other procedures and tests to identify the cause of a patient’s infertility.

How is treatment decided?

The treatment of male infertility should be specific to the condition responsible. Treatment options include non-invasive management, hormonal therapy management, and surgical management. However, weight loss, increased physical activity, antioxidant treatment, and reduced smoking and alcohol intake are general recommendations and lifestyle changes that may improve male infertility.

Dr Angie Murray works at the Belize Specialists Hospital Gastroenterology and Endoscopy Center. If you are in Belize and wish to make an appointment to see her, call 501-601-4737.

You can also use our Find Yello search bar to find urologists, hospitals, specialist doctors and related services across the Caribbean.