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The information in this article will provide an overview of the methodology and process involved in conducting hormone tests to assess male infertility. The article also talks about the significance of hormone imbalances in male reproductive health, discusses the various hormones commonly evaluated, and outlines the procedure for conducting these tests.
What is infertility?
Infertility is generally defined as a couple’s failure to conceive while engaging in frequent, unprotected sexual activity for a year (Leslie et al. 2023). As per the World Health Organization (WHO) globally, 1 in 6 people experience infertility in their lifetime (WHO 2023).
Male infertility is defined as the inability of a male to successfully carry a fertile female to term after at least 1 year of unprotected sexual activity (Leslie et al. 2023). Around 30% to 50% of cases of infertility are thought to be caused by male factors (Eisenberg et al. 2023). Men and infertility can both play a role in couples' struggles to conceive, necessitating a thorough evaluation of potential factors affecting their reproductive health.
Reasons for infertility
Important reasons for male infertility are listed below:
- Abnormal level of male fertility hormones affecting male sexual development and function (Babakhanzadeh E, et al 2020)
- Semen related abnormalities like low sperm concentration [oligospermia], poor sperm motility [asthenospermia], abnormal sperm morphology [teratospermia]) (Kumar and Singh 2015).
- Other reasons affecting male fertility includes genetic problems, age, disease, surgical history, medications, and exposure to environmental toxins (Leslie et al. 2023).
Understanding the physiology of hormones
Let us understand some terms that are associated with the hormones discussed in this article.
Pituitary gland: The pituitary is a pea-sized gland located in the base of the brain. Often termed the master hormone, it secretes hormones like FSH, LH, prolactin, etc (Carmichael 2023).
Hypothalamus: hypothalamus secretes various hormones like gonadotropin releasing hormone (GnRH), prolactin releasing and prolactin inhibitor hormones, etc. GnRH is responsible for the release of LH and FSH from the pituitary glands (Marques P, et al 2022).
Gonads: The testes in men and the ovaries in women are the gonads, which are the primary reproductive organs. The sperm and ova are produced by these organs.
Leydig cells: Leydig cells are present in the testis, and their main function is to produce testosterone (Huhtaniemi and Teerds 2018).
Sertoli cells: The seminiferous tubules of the male gonads, or the testes, contain Sertoli cells. The development of healthy sperm is assisted by Sertoli cells throughout the process of spermiogenesis (the final stage of spermatogenesis) (Wong and Khan 2023).
The association of the hypothalamus, pituitary, and gonads regulates reproduction. In the male, they relate to the LH and FSH, which maintain testicular testosterone synthesis and spermatogenesis (process of producing sperm cells). The synthesis of testosterone is stimulated by LH in Leydig cells, while the production of regulatory molecules and the nutrients required for maintaining spermatogenesis are stimulated by FSH in Sertoli cells in association with testosterone (Oduwole O, et al 2018).
How is male infertility detected?
Typically, the evaluation of infertility in men includes physical examination, reproductive and medical history (Ring et al. 2016), semen analysis (Barratt, 2007), hormonal analysis (Ring et al. 2016), and in some cases, genetic analysis (Pelzman and Hwang 2021).
Blood tests are used to look for hormonal and genetic factors that contribute to fertility issues.
Hormone Testing
If there is a low sperm count and concentration or clinical signs point to an endocrine issue or impaired sexual function, a fertility test for men is advised (Leslie et al. 2023).
Male fertility, puberty, male sexual development, and male sex hormone production all depend on sex hormones like follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, sex hormone-binding globulins (SHBG), and prolactin. A blood test analyzes the level of hormones and may also reveal abnormalities in other hormonal or organ systems that may possibly be a factor in infertility (de Kretser 1979).
Usually, for a hormonal test for male infertility a medical professional takes a patient’s blood sample. The hormonal system’s overall balance is then evaluated by a series of tests performed on the patient’s blood.
Follicle-stimulating hormone (FSH)
The normal range of FSH in adult males is 1.5 to 12.4 mIU/mL (Keskin, et al. 2015). FSH induces and maintains spermatogenesis in males (Orlowski and Sarao 2023). Unusual spermatogenesis is indicated by elevated FSH levels especially if associated with azoospermia (absence of sperm in semen) or severe oligospermia (Leslie et al. 2023).
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Follicle-stimulating hormone (FSH)
The normal range of FSH in adult males is 1.5 to 12.4 mIU/mL (Keskin, et al. 2015). FSH induces and maintains spermatogenesis in males (Orlowski and Sarao 2023). Unusual spermatogenesis is indicated by elevated FSH levels especially if associated with azoospermia (absence of sperm in semen) or severe oligospermia (Leslie et al. 2023).
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Luteinizing hormone or (LH)
The normal range of FSH in adult males is 1.5 to 12.4 mIU/mL (Keskin, et al. 2015). Similar to FSH, LH plays a role in spermatogenesis in males. Low LH can result in a low level of testosterone, which may affect sex desire and fertility in males. On the other hand, a high LH or FSH may indicate testicular failure or damage, which again affects male fertility (Oduwole 2021).
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Testosterone
The normal range of total testosterone is 249 to 836 ng/dL (Keskin, et al. 2015). Testosterone is the quintessential “male hormone”. High levels of testosterone are necessary for spermatogenesis (Dohle et al 2003). Low testosterone levels may affect fertility by causing erectile dysfunction and low sex drive.
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Prolactin
The normal values for prolactin in men (≥ 18 years of age) is 4.0 to 15.2 ng/mL (Mayo Clinic Laboratories 2023). Increased serum prolactin levels (hyperprolactinemia) have a negative impact on male fertility by preventing the release of gonadotrophins and having an immediate impact on spermatogenesis (Dabbous and Atkin 2017).
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Sex hormone binding globulin (SHBG)
SHBG is a protein synthesized primarily by the human liver. In males, SHBG binds to testosterone and reduces the level of free testosterone for the use of body tissue. A high level of blood SHBG means a low level of testosterone in the body, and vice versa (Selby 1990).
Infertility treatment for men
Before seeking fertility treatments, it is advisable to consider a comprehensive male fertility test to assess sperm quality and quantity. A male fertility test (reproductive hormone test), which measures hormone levels, can help diagnose the underlying causes of reproductive health issues in men. Doctors make a diagnosis and recommend treatments to increase fertility using the findings of a male fertility test. Infertility treatments for men can be nonsurgical therapy, surgical therapy, or treatment for unknown cause. Treatment of hormonal imbalance, which leads to fertility issues in men includes:
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Lifestyle Modifications:
Adopting a structured program that encompasses education, environment, nutrition, physical activity, and psychological support, along with the inclusion of nutraceutical antioxidants, can serve as a preventive measure against infertility. This approach may enhance the overall quality of life for couples, increasing the likelihood of spontaneous conception or optimizing their prospects for becoming parents (Ilacqua A, et al 2018).
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Medications:
Usually hormone replacement therapy and medications like clomiphene citrate (Dabaja and Schlegel 2014)
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Surgery
may be diagnostic or for improvement of sperm production and delivery (Lopushnyan and Walsh 2012)
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Fertility Treatments
To overcome fertility problems, techniques like intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) might be utilized (Merchant R, et al 2011).
Conclusion
Men and infertility are both factors that can be addressed through medical evaluation and lifestyle changes to improve the chances of conception. In order to identify and treat the underlying hormonal abnormalities that can seriously affect men's fertility, it is essential to use a fertility test for men. This provides hope for better reproductive health and the opportunity to realize the dream of fatherhood.
References
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