Beyond Fertility – Part 2
Lifestyle Factors and Relationships Between Infertility and General Health In Men
Last month’s article discussed how beyond fertility a semen analysis (SA) may uncover details about a man’s health, including the possible diagnosis of testicular cancer, cancer in general, as well as many other medical conditions which may affect sperm motility in the early stages. The article also discussed how testosterone, dietary deficiencies, and being over- or underweight might affect sperm motility and fertility. This article will continue that discussion.
Obesity can affect semen analysis results. Increased BMI is associated with reduced testicular volume, a low sperm count, impaired sperm motility, increased sperm DNA fragmentation, increased infertility, a low serum testosterone level, reduced libido, and erectile dysfunction. Obesity is associated with elevated estrogen and reduced testosterone levels. Obesity gives rise to sleep apnea, insulin resistance, and cardiovascular disorders which give rise to erectile dysfunction and collectively result in hypoandrogenism (androgen deficiency syndrome) and impaired spermatogenesis. Spermatogenesis is the transformation from spermatogonia (the sperm germ cells) to primary spermatocytes, to secondary spermatocytes and spermatids to spermatozoa (mature sperm cells).
Metabolic syndrome plays a central role in obesity and leads to insulin resistance, which may ultimately lead to a low sperm count, impaired motility, and abnormality of sperm morphology.
Diabetes has a deleterious effect on semen parameters. Poor diabetic control is significantly associated with impaired sperm motility and sperm defects. Similarly, poor diabetic control is associated with an abnormal lipid profile: high cholesterol, triglycerides, LDL, and VLDL and lower HDL. Leukocytospermia, a condition in which an unusually high number of white blood cells are in the semen, is also more common in diabetic men with poor diabetic control. White blood cells can weaken the sperm.
Smoking has also been associated with an adverse effect on semen parameters.
Structural factors may also have an impact on semen parameter. There is increasing evidence that male reproductive disorders have become more prevalent during the last 50 years, with an increase in the incidence of testicular cancer and a decline in sperm counts. Testicular cancer is associated with maldescent of the testis, reduced semen quality, and decreased fertility before cancer is diagnosed.
Advanced paternal age has been associated with abnormal spermatogenesis. As men age sperm parameters decline with a continuous reduction in sperm motility and semen volume.
There are also genetic causes of male infertility.
Systematic evaluation of the male partner in an infertile couple is essential. Thorough evaluation of a man for correctable conditions that may affect his fertility is required.
Use of assisted reproductive technology (ART) is an effective intervention for fertility and a critical component for treatment of some couples. Evaluation should proceed in parallel for both male and female members of a couple to optimize treatment success.