Impotence and infertility in India as well as globally have been rising steeply, and male fertility rates have gone by down around three times, over the past three decades. However, this issue is rarely discussed or paid any attention that it deserves. Impotence refers to a person's inability to perform sexually, ie, has issues like erectile dysfunction. Infertility, on the other hand, refers to the inability of a couple to conceive. It could be due to infertility issues in the man, woman, or both. While impotence can make it difficult to get pregnant, impotence does not cause infertility or vice versa, and the two are very different conditions.
INFERTILITY AFFECTS MEN MORE THAN WOMEN
Traditionally women have always been singled out in infertility cases, but studies have shown that men are more infertile than women. About 1.5 per cent more men than women are infertile, and only about 30 per cent of males in India, on an average, have normal sperm characteristics. Three decades ago the normal sperm count in a healthy man was 60 million sperms per ml of semen. It has now come down to 20 million per ml of semen. If this decline continues, soon India will become infertile, and becoming pregnant will become an expensive affair possible only with the help of medical technology.
WHY IS INDIA'S INFERTILITY RATE ON THE RISE?
Multiple factors are responsible for the declining sperm health in men. Since impotence and infertility are two different conditions, the causes and symptoms of each of them are different, but there are many common causes too.
About 40 per cent of men who come for fertility treatments are obese. Obesity causes testosterone production to fall while estrogen production rises. It can lead to erectile dysfunction and loss of sexual desire. The sperm count in obese men also tends to be lower. Since obesity also brings along the risk of heart disease and diabetes amongst several others, erectile dysfunction may be a symptom of some much serious underlying condition.
Stress might be the sole cause of impotence in several couples, as research shows. When men suffer from chronic stress, the level of the stress hormone cortisol in the body increases while serotonin production reduces. It causes a loss of libido, erectile dysfunction and may also affect the quality of sperm.
Unhealthy dietary habits
Diets consisting of high calorific intake, saturated fats, and trans fats, less amount of healthy fats from nuts and fish, red meat, fewer fresh fruits and vegetables, caffeine, and many others are more likely to cause impotence and infertility in men. These foods are said to directly affect sperm morphology, motility and overall sperm health. A poor diet will not have sufficient vitamins & minerals necessary for sperm production.
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Lack of activity
As India shifted from jobs in fields and other manual labour to desk jobs, life became more sedentary and monotonous. People barely get up from their work-stations all day and if they do, it does not fulfill their daily quota of required physical activity. Inactivity is said to be one of the leading causes of infertility and impotence in men because it brings with it stored fat in the blood vessels, increased risk of heart diseases, and other health conditions that are all related to impotence and infertility.
Due to the many chemicals present in them, research has shown exposure to pesticides and toxic substances to be a significant cause of erectile dysfunction & low sperm counts in males.
Depression and mental health issues
More and more people these days are suffering from depression that again causes the stress hormone cortisol to rise steeply while serotonin levels plummet. Depression is a very common cause of impotence, and even the medicines used to treat depression might lead to impotence.
Diabetes, heart diseases and other medical causes
The incidences of lifestyle and chronic diseases are on the rise contributing to reduced health and infertility. Diabetes can interfere with a person's ability to reproduce or even maintain an erection. Similarly, diseases of the heart or other conditions like high blood pressure, interfere with the way the heart pumps blood through the body and does not allow blood to reach the reproductive organs, thereby causing impotence.
Radiations from devices
Digitization is coming at a cost even though it has done a lot of good to the human race. The radiations from cellphones stored in pockets and the heat from laptops are major culprits when it comes to harming sexual health in men. Research shows that these devices affect sperm health and can interfere with one's ability to reproduce.
This one might be surprising but true. Fashion is changing these days, and people have developed a liking for skin-fit clothes like tight jeans and other garments that leave no breathing space and lead to increased heat, which is detrimental to sperm production. The testicles are placed outside the body so that the temperature is at least 1 degree lower and is more conducive to Sperm production. While these are some of the most common & treatable causes of impotence and infertility in Indian men, there may be several other causes like nerve damage, genetic disorders, old age, testicular abnormalities, hormone imbalance, comorbidities like cancer, reactions to medications, etc.
HOW HAS THE PANDEMIC CONTRIBUTED TO AN INCREASE IN MALE INFERTILITY?
Because of the COVID-19 pandemic, many other health issues have got relegated to the background. The same is true for men's fertility problems.
It has been proven that SARS-CoV virus can effect the cells in Testes and also Penile tissues. Multiple studies which have been done world over in 2020 and 2021, that have shown the following:
Coronavirus can attach to and infect the testicular and penile tissues of men.
Biopsies and autopsies of testicular and penile tissues have shown presence of the virus infection as well as inflammation, swelling and reduced sperm production as well as reduced sperm counts in infected people.
Reduced sperm counts and reduced erectile function have been demonstrated clinically and in lab tests of men affected with the SARS-CoV virus, to variable degrees.
Sperms of COVID-19 effected males were less healthy, less motile and showed more inflammation, to variable degrees.
Sperms of COVID-19 effected males had shown more markers of oxidative stress.
That said, the long terms effects have yet to be established. What happens to sperm health after 5 years or 10 years is yet to be seen.
It is no secret that the pandemic and its associated lockdowns, work from home and psychological implications have led to increased obesity, sleep problems, stress and other mental health conditions that will indirectly contribute to infertility. It can be assumed that the existing dangers ( silent non-infective epidemics in the waiting) like obesity, diabetes, vitamin D deficiency, etc. that already exist in massive proportions in India, have only been worsened. It becomes a vicious cycle.
Example 1 Increased stress leads to sleeplessness may cause, over time, a few pre-diabetics to become fully blown diabetics, which may lead to impotence.
Example 2 Excess weight / obesity because of 'work from home' and lockdown can contribute to poor health, which may over a period of time cause low sperm counts, low testosterone and erectile dysfunction.
Example 3- Being confined indoors because of the pandemic leads to low sun exposure, which worsens the existing vitamin D deficiency, which can have a direct negative effect on sperm production.
Many a reason can be given as causes to poor reproductive health, but what is most important is that everyone must be made aware of consequences of bad lifestyle choices, so that they can make a conscious attempt to improve the quality of their lives.
THE BOTTOM LINE
It is not definitely etched in gold that SARS-Cov virus causes infertility in all men affected by it. There is enough scientific evidence to show that it can affect sperm health and can cause infertility to variable degrees. The bottom line is that every individual should work towards a healthy lifestyle and speak up as well and take help and guidance from experts and doctors as regards their impotence or infertility issues. Remaining silent and sufferings in silence is detrimental to physical and mental health of not only the man but also will indirectly affect the mental health of his family. It is time we break the stigma and start speaking about infertility and impotence and how it can be treated so that more and more men and couples reach out for guidance, remedies and treatment.
(This article is authored by Dr Lalitha Reddy, Founder, ForMen & ForKids)