Fertility problems are not always caused by women. Erectile dysfunction in men can also lead to subfertility
Problems "down there" are not confined to women. Men can suffer from erectile dysfunction (ED), also called impotence or impotency, which refers to an erection whose duration and rigidity is insufficient for successful penetration.
Men can also suffer from premature ejaculation (the man can initiate an erection, but ejaculates too fast, meaning before penetration). A lack of desire for sexual intercourse ("lack of libido") can be a problem as well.
The incidence of ED increases with age – the prevalence can be as high as 60 per cent at the age of 70. The problem of ED has not become more common but rather, awareness of this condition has increased. Men now more readily and actively seek treatment for ED. Also, as men live longer, the incidence of ED will increase as the condition is age-dependent.
There are no studies indicating that men in any particular profession are more at risk of ED. However, a high level of stress is not conducive to erection or sexual intercourse. It is essential that sexual intercourse be performed in an atmosphere of intimacy and in a stress-free environment.
ED and male subfertility
Failure to sustain an erection of sufficient rigidity and duration leads to failure of sexual intercourse. This in turn can lead to male infertility or, to use the preferred term, subfertility. Subfertility from ED can have congenital (inborn) and acquired causes, such as mumps (a viral infection). Other causes include drugs, radiation and injury to the testes. Sometimes, sperm quality might be impaired due to injury.
Typically, the male factor accounts for 30 per cent of subfertility, the female factor, another 30 per cent and combined male and female factors, 40 per cent. In other words, male infertility directly or indirectly explains 70 per cent of infertility cases. It is important that the man and woman be assessed together in cases of infertility.
To check for fertility, sperm samples are analysed. Blood tests which check whether the man has any hormonal imbalance are also performed. Some patients may have a condition called varicocele, or enlarged veins in the scrotum. Operating on the varicocele (called varicocelectomy) might help to improve the sperm quality.
Some conditions where the sperm transport is obstructed can be treated surgically. These procedures are done on the man alone. Assisted reproductive techniques (ART), such as artificial insemination, require both the man and the woman to be involved. They form another option for treatment.
Generally, the couple is advised to try for a year before taking other steps to have a child. However, if the couple is of more advanced age, especially the female, they should seek help earlier. The couple can be advised on ART. They can also consider adoption.
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