Men’s business: Busting the myths around male infertility
First of all. Worldwide, infertility affects approximately 15% of couples, or 48.5 million of them. Men are solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall, according to a report titled “A Single View of Male Infertility Around the World” published in the journal Reproductive Biology and Endocrinology in 2015.
Unfortunately, while women’s reproductive health is often discussed, this is not really the case when it comes to men, especially in India. “Men are considered macho. But is it so? They get hurt too. They are exposed to labor-intensive work at high or extremely low temperatures. It is because of this societal pressure from the image of men that they tend to have less access to healthcare than women,” says Dr. Gagan Talwar, Consultant, Urology, Paras Hospitals, Gurugram.
On the other hand, there is no obvious reason for men to visit family planning clinics, says Dr. Niti Kautish, Director, Obstetrics and Gynaecology, Fortis Escorts Hospital, Faridabad. “Women are attracted to the health system because they need a prescription for contraception. Male contraceptive methods are condoms and vasectomy. Condoms are available over the counter in many stores; only a small number of men have a vasectomy, and only once,” she adds.
According to Dr. Kautish, sexual health clinics, obstetricians’ offices, hospitals and family planning services have traditionally focused on women. According to her, the main barriers to including men in reproductive health services are a) limited funding for services for men; b) predominantly female staff; c) negative staff attitudes; and (d) lack of staff training to meet men’s needs.
As such, male reproductive health has become a major issue. Just to put things into perspective, 40% of men in their 40s and 70% of men in their 60s suffer from erectile dysfunction. “So many, but not even a tenth, approach health care because of fear and image. This has wide-ranging and long-lasting psychological implications that affect both personal and professional lives. adds Dr. Talwar of Paras Hospitals.
Dr. Ajit Saxena, Senior Consultant, Urologist and Andrologist, Indraprastha Apollo Hospitals believes that this is the situation not only in India but also elsewhere. Some of the reasons, he says, 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’ve seen adults cry in my clinic because they can’t have children. It’s as if their virility was questioned. It’s a big ego problem in infertile men. One of the main complications is erectile dysfunction leading to a strained relationship,” says Dr. Saxena.
Incidentally, when it comes to infertility, the blame mostly lies with women or the problem is assumed to be with them. “India has a dominant patriarchal culture; therefore, unfortunately, women are often the ones who bear the burden of infertility. Both parties (husband and wife) contribute to the success of having a child. About one-third of fertility problems are male-dominated, one-third female-dominated, and one-third have unknown (unexplained) causes. Due to our patriarchal society, there are many stereotypes about women, especially when it comes to infertility or anything related to their reproductive health,” says Dr. Kautish of Fortis Escorts Hospital.
However, this should not be seen 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, the male reproductive cycle (sperm formation or spermatogenesis) occurs every three months, until a male is alive. Therefore, there are no alarming age-related concerns in male reproductive health compared to females.
“A woman’s eggs run out over time when she reaches menopause between the ages of 45 and 50. However, age has an impact (above 50) on count, motility due to declining testosterone hormone levels as one ages. Advanced age also contributes to the increased incidence of aneuploidy (numerical chromosomal abnormalities),” says Banga, adding, “There are various advanced reproductive technologies to address serious male factors (number, motility and morphology) such as ICSI, IMSI, microfluidics and P-ICSI.
Meanwhile, a recent study by researchers at the Indian Institute of Technology (IIT) Bombay found that even mild to moderate Covid-19 disease can alter the level of proteins related to male reproductive function that can impair fertility. .
“A study in India found that men recovered from Covid had significantly reduced sperm count and motility, and fewer normally shaped sperm. This has been attributed to angiotensin II converting enzyme (ACE2), a receptor allowing SARS-CoV-2 to enter host cells, which is also present in testis and prostate tissue and may possibly hinder sperm production. But more research is needed to establish this hypothesis,” says Dr. Kautish of Fortis Escorts Hospital.
“Covid-19 exerts adverse effects on the male genitourinary system in multiple ways. It can lower 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 semen following a Covid infection. not known if it is transmitted. Many cases have reported a lack of desire following the infection with Covid”, he adds.
The conundrum of contraception
The latest National Family Health Survey (NFHS) report has shed light on contraception and the notions that Indian men have about it. According to the NFHS-5 survey which was conducted among approximately 6.37 million households across the country, approximately 35.1% of men believe that contraception is a “women’s issue” while 19.6% of men think that women who use contraceptives can become promiscuous.
Additionally, 55.2% of men say that if a male condom is used correctly, it protects against pregnancy most of the time, according to the report.
Poonam Muttreja, executive director of the Population Foundation of India, says the data adds to the mountain of evidence that proves development is the best contraceptive. “It is concerning that female sterilization remains the most popular method of contraception, which shows that the responsibility for family planning continues to be on women,” she adds.
Advice for reproductive health care
- Consume antioxidant-rich foods like green leafy vegetables, citrus fruits, almonds, bananas, eggs, and nuts
- Avoid processed meat; it decreases sperm count
- Avoid foods rich in high-fat dairy products; it affects motor skills
- Avoid excessive consumption of soy; it decreases the concentration of sperm
- Avoid fried foods; it decreases sperm motility
- Exercise regularly for 30 minutes
- Directly avoid testosterone supplements
- Limit alcohol/smoking consumption
- Avoid prolonged sedentary working hours (need at least 15 minutes of walking after six hours of sedentary working)
- Avoid excessive use of laptops on the lap, as the heat generated by the laptop impairs spermatogenesis (sperm production) and therefore contributes to infertility
- Use adequate barrier contraception and avoid unprotected sex to prevent sexually transmitted diseases that could lead to obstructive azoospermia (blockage of outflow tract)
- Practice yoga and meditation for about 30 minutes a day
— Dr. Bhavna Banga, Associate Director – IVF, Max Hospitals, Delhi