Men’s business: Busting myths around male infertility

First things first. Around the world, infertility affects an estimated 15% of couples, amounting to 48.5 million of them. Men are found to be solely responsible for 20%-30% of infertility cases and contribute to 50% of cases overall, as per a report titled ‘A unique view on male infertility around the globe’ published in the Reproductive Biology and Endocrinology journal in 2015.

Sadly, while women’s reproductive health is often discussed, it’s not really so when it comes to men, especially in India. “Men are considered to be macho. But is it so? They get hurt too. They are exposed to labour-intensive jobs at high or extremely low temperatures. It is because of this societal pressure of men’s image that they tend to access health less than women,” says Dr Gagan Talwar, consultant, urology, Paras Hospitals, Gurugram.

From another angle, there’s no obvious reason for men to visit family-planning clinics, says Dr Niti Kautish, director, obstetrics and gynaecology, Fortis Escorts Hospital, Faridabad. “Women are drawn into the healthcare system out of a need to get a prescription for contraception. Male-based contraceptive methods are condoms and vasectomy. Condoms are available over the counter in many stores; only a small number of men have vasectomies, and then only once,” she adds.

According to Dr Kautish, sexual-health clinics, obstetrician offices, hospitals and family-planning services have traditionally been focused on women. Major barriers to including men in reproductive-health services, according to her, are a) limited funding for male services; b) predominantly female staff; c) negative staff attitudes; and d) lack of staff training for serving men’s needs.

As such, men’s reproductive health has become a big issue. Just to put things into perspective, 40% of men in their 40s and 70% of men in their 70s suffer from erectile dysfunction. “Such a large number, but not even a tenth of them approach healthcare because of fear and image. This has vast and long-lasting psychological implications which affect both personal and professional lives,” adds Dr Talwar of Paras Hospitals.

Dr Ajit Saxena, senior consultant, urologist and andrologist, Indraprastha Apollo Hospitals, feels this is the situation not only in India but elsewhere too. Some of the reasons, according to him, are a) the general feeling that men are the stronger sex; b) societal norms and values; and c) most men live in denial and do not seek help. “I have seen grown-up adults crying in my clinic because they cannot father a child. It is as if their manhood is under question. It is a big ego issue with infertile men. One of the main complications is erectile dysfunction leading to a strained relationship,” Dr Saxena explains.

Incidentally, when it comes to infertility, the onus mostly falls on women or the problem is assumed to be with them. “India has a dominant patriarchal culture; hence, unfortunately, women are often the ones with the onus of infertility. Both parties (husband and wife) contribute to the success of having a child. About one-third of fertility issues are dominated by men, one-third by women and one-third are unknown causes (unexplained). Due to our patriarchal society, there are many stereotypes for women, especially in cases of infertility or anything related to their reproductive health,” explains Dr Kautish of Fortis Escorts Hospital.

However, one should not see it as a major challenge as there are technologies and medications to overcome the problem. According to Dr Bhavna Banga, associate director – IVF, Max Hospitals, Delhi, men’s reproductive cycle (sperm formation or spermatogenesis) occurs every three months, until a man is alive. Hence, there are no significant age-related alarming concerns in men’s reproductive health as compared to women.

“A woman’s eggs get exhausted with time when she reaches menopause between 45 and 50 years. However, age impacts (above 50 years) in count, motility due to declining testosterone hormone levels as one ages. Also advanced age contribution to increase in the incidence of aneuploidy (numerical chromosomal abnormalities),” explains Banga, adding: “There are various advanced reproductive technology to take care of severe male factors (count, motility, and morphology) like ICSI, IMSI, microfluidics and P-ICSI.”

Covid shadow
Meanwhile, a recent study led by researchers at the Indian Institute of Technology (IIT) Bombay revealed that even mild or moderate Covid-19 illness could change the level of proteins related to male reproductive function that may impair fertility.

“A study conducted in India found that men recovered from Covid had significantly reduced sperm count and motility, and fewer normally shaped sperm. This was attributed to Angiotensin-converting enzyme II (ACE2), a receptor for SARS-CoV-2 to enter host cells, which is also present in testes and prostate tissues and could possibly hamper sperm production. But further research is required to establish this hypothesis,” explains Dr Kautish of Fortis Escorts Hospital.

“Covid-19 exerts adverse effects on male genitourinary system in myriad ways. It can reduce serum testosterone, reduce fertility and sexual function. Fortunately, vaccination is safe and effective in preventing many of these sequelae,” adds Dr Talwar of Paras Hospitals. There has been a higher incidence of erectile dysfunction, says Dr Saxena of Indraprastha Apollo Hospitals. “In many cases, the virus has been isolated from the semen following Covid infection. Whether it is transmitted is not known. Many cases have reported a lack of desire following the Covid infection,” he adds.

Contraception conundrum
The latest National Family Health Survey (NFHS) report has thrown light on contraception and the notions that Indian men have about the issue. According to the NFHS-5 survey that was conducted in around 6.37 lakh sample households from across the country, about 35.1% of men believe that contraception is “women’s business” while 19.6% men think that women who use contraceptives may become promiscuous.

Also, 55.2% men say that if a male condom is used correctly, it protects against pregnancy most of the time, the report said.
Poonam Muttreja, executive director of Population Foundation of India, says this data adds to the mountain of evidence that proves that development is the best contraceptive. “It’s a matter of concern that female sterilisation remains the most popular method of contraception, showing that the onus of family planning continues to be on women,” she adds.

Tips for reproductive healthcare

• Consume food rich in antioxidants like green leafy vegetables, citrus fruits, almonds, bananas, eggs and walnuts
• Avoid processed meat; it lowers sperm count
• Avoid food rich in high fat dairy; it affects motility
• Avoid excessive soy intake; it decreases sperm concentration
• Avoid fried food; it decreases sperm motility
• Exercise regularly for 30 minutes
• Avoid testosterone supplements directly
• Limit alcohol intake/smoking
• Avoid prolonged sedentary working hours (need at least 15 minutes of walking after six hours of sedentary work)
• Avoid excessive use of laptops on lap, as the heat generated from the laptop impairs the spermatogenesis (sperm production) and hence contributes to infertility
• Use adequate barrier contraception and avoid unprotected intercourse to prevent sexually transmitted diseases which could lead to obstructive azoospermia (blockage to the outflow tract)
• Practise yoga and meditation for about 30 minutes daily

— Dr Bhavna Banga, associate director – IVF, Max Hospitals, Delhi