OVERVIEW

Infertility is the inability to produce a child or achieve conception by a couple after a whole year of cohabitation. The world view of the word “infertility” is mostly denoted to the female but is infertility solely in relation to the female or there are other factors? Conception can only be achieved when the sperm of a male and the egg of a female fuse to form a zygote.

Without the sperm, conception is impossible as long as scientific knowledge is regarded, so the male counterpart must also be an area of concern. The lens of this article is focused on the male. The amazing truth is that about 46% of infertility is found in males. A tone of reasons like infections, congenital abnormalities, damage of genes, radiations, and chemicals, etc can be linked to male infertility but we are narrowing ourselves on how extreme heat can affect the quality and quantity of the male sperms. Extreme heat exposure has a very high potential of causing low sperm count. It is estimated that the production of sperms reduces largely in periods of extreme heat. Low sperm count is mostly diagnosed clinically by analysis of the semen by a doctor. The management of low sperm count is mostly dependent on the root cause.

DEFINITION

LOW SPERM COUNT: This refers to a condition in which the number of sperms in a man’s semen per ejaculate is less than 15 million. The normal amount of sperms per milliliter of semen in an ejaculate is about 50 million and above. In the broader sense, low sperm count does not only deal with the number but also the viability (health, shape, and mobility) of the sperm cells. Some men may have enough number of sperm cells but with very poor quality.

INFERTILITY OF MALES: Infertility of males is defined as the inability of a male to impregnate a woman who is proven fertile. Low sperm count is the most prominent cause of infertility in males.

SOURCES OF HEAT EXPOSURE TO THE TESTIS

The testis is the organ responsible for sperm production in the male and they are bilaterally located in the scrotum, an environment suitable for sperm production. The testis needs an environmental temperature of 4 degrees Celsius below the body’s temperature to function best. When the environment of the testis is disturbed by exposure to heat, testicular physiology is affected and sperm production reduced. We group the sources of heat exposure to the testis into endogenous (internal) and exogenous (external) sources.

1. ENDOGENOUS SOURCES
This has to do with situations like diseases that expose the testes to extreme temperatures which can affect the quantity and quality of sperm production.

A. Undescended Testis: In this situation, one or both of the testes male refuse to descend from the abdomen into the scrotum. When the testis stays locked up in the abdomen for a long time, it is constantly exposed to the entire body temperature of about 37 degree Celsius which affects testicular physiology with a resultant low sperm count.

B. Varicocele: This refers to the unnatural and abnormal expansion of the veins that drain the testis. This enlargement causes enough stress and intense heat exposure due to the effect of blood stasis in these enlarged scrotal veins. This intense heat causes the testis to produce low number and low-quality sperms.

C. Fever: This physiological response to an infection or for any reason can increase the body temperature more than normal. If fever persists for a day and above it produces intense heat which affects the testes and its function.

D. Obesity: Fatty deposits around the scrotum and even on the testis cause a lot of heat to be generated and retained. This continuous exposure of heat around the testes affects its function and it can result in low sperm count.

 

2. EXOGENOUS SOURCES
A. Continuous usage of laptops on the laps.
B. Taking very hot showers every day.
C. Putting mobile phones in your trousers closer to your scrotum.
D. Wearing very tight clothes for exercise or cycling.
E. Working in an environment of extreme heat exposure Like; being a Chef.
F. Persistent exposure to extreme heat and sunlight especially in the summer.
G. Long distance drivers.

EFFECT OF HEAT EXPOSURE ON THE TESTES

Sperm production happens in the testes. There are small tubules inside of the testes which house the materials needed for sperm production. These tubules are called seminiferous tubules. These tubules contain stem cells needed to produce our matured spermatozoon cells. These stem cells are called spermatogenic stem cells. Actually, the testes and the tubules need a specific environment free of toxins and extreme heat to be able to produce enough and healthy sperms. The seminiferous tubules need a temperature which is about 4 degree Celsius lower than the normal body temperature in order to ensure a successful sperm production process. In addition, sperms are also very sensitive to heat and are easily denatured at extreme temperatures.

In summary, it is true that all metabolic or physiological processes require optimum environments with specific temperature and pH. High temperatures affect the process of sperm production enormously. The processes of sperm production (spermatogenesis) affected by heat are;

1. Differentiation of spermatogenic stem cells: Since this process takes place in the testes, an elevated temperature higher than (about 33 degree Celsius) affect the number of primary sperm cells formed from the stem cells. And this directly affects the number of sperm cells produced. This also affects the number of “Type A cells” which stay as stem cells to begin the next process of differentiation.

2. Meiotic division of primary sperm cell: Very high temperatures affect the cells in the tubules which house division process to form the secondary sperm cells. This causes low cell division and this affects the number of sperm cells produced.

3. Spermiogenesis: Heat also affects the process of sperm maturation. Increased temperatures affect the processing of spermatids into active mature tadpole-like structures (spermatozoa). It affects the shape of sperms produced. Heat causes sperms with abnormal shapes which are not functional.

4. Spermiation: This is the process in which the mature sperms are moved to the epididymis for final maturity. Sperm gets the ability to be effectively motile. Extreme heat in this stage affects the movement of sperm causing immobile sperms or sperms with low motility.

5. Killing of matured sperms: Lastly, heat kills the viable and matured sperm cells and reduce the number of sperm cells in semen.

STATISTICS

Male infertility records about 46% of all infertility cases. Low sperm count is one of the most common causes of male infertility. Heat is a key factor in low sperm count.

Though underlying conditions like varicocele cause extensive heat exposure to the testes, daily activities register as the most common source of heat to the testes.

The intense heat in summer reduces about 30% of sperm production. Looking at this, low sperm count is found mostly in males who work at places where they are constantly exposed to heat. These men have about 2.0 times the chances of having low sperm count or abnormal sperm quality. And even if they can, they mostly go through a lot of difficulties before they can get a woman pregnant.

PREVENTION OF HEAT EXPOSURE

Due to the sensitivity of the testis and sperms to heat, the body has its own mechanism of protecting the testes against heat. The cremaster muscle which surrounds the spermatic cord and the testis relax to draw the testes away from the body when the body is very hot and contracts to pull the testes close to the body when the body gets cold.

Other means heat exposure and low sperm count can be prevented are;

1. Avoid the prolonged usage of laptops on the laps.
2. Avoid wearing tight clothing for exercises and cycling.
3. Avoid taking very hot showers continuously.
4. Avoid the keeping of mobile phones in the pockets close to the scrotum.
5. Take breaks to rest from works that expose the scrotum to too much heat.
6. Do regular exercise to reduce body weight if obsessed.
7. Avoid occupations which involve exposure to extreme heat (e.g. baking, ceramics).

DIAGNOSIS OF LOW SPERM COUNT

1. History of infertility gives a reason for semen analysis.
2. Social history and a past medical history.
3. Semen analysis to check for,
a. The number of sperm cells per milliliter of semen.
b. The number of sperm in semen per ejaculation.
c. Shape or morphology of the sperm cells.
d. Motility and moving strength of the sperm cells.

MANAGEMENT OF LOW SPERM COUNT

A. To improve the number and quality of sperm these methods can help.

1. Icing of the scrotum is considered an effective therapy for increasing sperm production by reducing heat in the testes. The ice should be applied over a cloth but not directly to the skin of the scrotum.
2. Increased intake of vitamin E will help to reduce the damage caused by heat and stress and improve sperm production.
3. Surgery is done for conditions affecting the testes and exposing them to a lot of heat. Example; varicocele, undescended testes.
4. Antibiotics for the treatment of infections like; orchitis, epididymitis.
5. Antipyretic drugs to reduce fever immediately to prevent extensive heat exposure to the testis.
6. Hormonal therapy to help increase testosterone levels for sperm production.
7. Drugs that reduce the levels of estrogen and it’s effects on sperm production. Examples; Estrogen receptor modulators and Aromatase inhibitors.

B. To help treat infertility caused by low sperm count.
These methods aim at allowing viable sperms to reach the female egg for fertilization to occur.

1. Intrauterine insemination: Sperms are directly deposited into the uterine cavity by injection during ovulation of the female.

2. In vitro fertilization: Ovum of the woman is taken outside and fertilized in the lab and the resulting embryo is returned to the uterus. Sometimes a single sperm cell can be injected directly into the ovum of the female this is called intracytoplasmic sperm injection.

SUMMARY

High temperature has a very negative effect sperm production. It causes low sperm count and results in male infertility. Male infertility is about 46% of all infertility cases. Sperm production decreases by 30% during the summer. Continuous use of laptops, cell phones, and wearing of tight clothing expose a lot of heat to the testes which kill sperms and cause low sperm count. Semen analysis is the means of diagnosing low sperm count. Low sperm count can be prevented by reducing exposure to extreme heat and reducing body weight.