January 30, 2023
There are various approaches available to men for male fertility preservation in cases of disease or other fertility-compromising decisions. We explore these options with Dr. Tsuari.
Reproductive potential in men can be affected by various disease, cancer, genetic syndromes and age.
According to the World Health Organisation, fertility affects about 20 percent of the population within childbearing age. Dr. Tsuari says W.H.O statistics project that by 2030, the need for fertility intervention will double.
In our previous article, Dr. Tsuari touched on the number of men who are also turning to elective fertility preservation. Age is now a recognized major factor in male infertility. To put this in perspective, a man’s sperm count starts to decline after the age of 40,” she says.
Evidence shows that a 45-year-old man is likely to take five times longer to achieve a pregnancy than a man in his late 20s.
Dr. Tsuari says studies into male infertility have revealed that men also face the risk of age-related chromosomal abnormalities in later age pregnancies. “The risk is equally spread between men and women and this is why we’re seeing both sides pursuing fertility preservation in their twenties.”
Male fertility preservation is indicated in both oncological and non-oncological conditions. Some of the drugs used in cancer treatment are toxic to reproductive tissue and therefore negatively impact fertility.
Professional and extreme athletes could also explore this route, especially with physical demands of being a professional athlete. Finally, there is also the social aspect of a man wanting to delay child rearing for reasons of career progression, academic commitments or perhaps not meeting the right partner.
“Male infertility is now an even bigger issue than female infertility.” Dr. Tsuari says lifestyle choices as well as a lack of education and the discourse around male fertility has been detrimental.
Weight, types of chronic medication administered, and detrimental life choices such as alcohol consumption, smoking and others are contributing factors to male infertility, she says.
Cancer of the reproductive system, such as testicular cancer present an oncological reason to pursue fertility preservation.
Genetic conditions such as Klinefelter syndrome which affects males, but is typically diagnosed later in life, are some of the causes of male infertility. Klinefelter syndrome is a chromosomal condition in boys and men that can affect physical and intellectual development Here, whilst there is still healthy testicular tissue in younger men, it is advisable to save their gametes(sperm) or testicular tissue, added Dr. Tsuari.
Dr. Tsuari says that sometimes testicular injuries, such as torsion, may drive the decision to consider fertility preservation. “In these cases, testicular torsion might compromise blood supply and create a loss of function in the testes even though the torsion can be reduced, and the anatomy can be restored.”
Testicular injuries that cause fertility problems might also arise from extreme sports like mountain bike riding or even cycling. “Because of the constant pressure on the reproductive system, the testes tend to suffer from constant pressure and calcifications may arise which causes the surrounding tissue to atrophy or die.”
With calcifications in the testes, a smaller area is left to store sperm, and this is what negatively impacts fertility. The constant pressure on the testis might also reduce their functionality.
“Hormonal changes induced by extreme athleticism and professional sports performance can compromise fertility due to a high level of stress caused by the nature of such high-level competition. Hormonal changes from the brain to the reproductive system can be temporary or permanent. And so, with those athletes, it is always advisable to discuss fertility preservation and that they be educated about the risks to their fertility potential.
Of course, fertility preservation is equally an option for men who want to delay childbearing for social and personal reasons.
For men, testicular tissue and sperm can be saved for use at a later stage. Dr. Tsuari that the procedures are reaching levels of technological advancement that was not possible 30 years ago. As with any type of elective treatment, discussing your outcomes with your physician is the first step.
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