Pregnancy and childbirth are a major milestone for many couples, an undertaking that many view with both excitement and trepidation. However, for some couples, this comes to pass with much difficulty or even not at all, and they suffer from the condition known as infertility. This may be due to a problem of the female, the male, or both, and causes much frustration and also significant financial burden. Here we examine infertility, particularly in men, and ways remote patient monitoring may help in improving the chances of pregnancy.
What is infertility?
Infertility refers to the inability to get pregnant after at least one year of unprotected intercourse. This is differentiated from fecundity, which is the ability to carry a pregnancy to term. Getting pregnant involves several steps that progress without a hitch, which are namely: release of an egg from the ovaries, fertilization of the egg by the sperm, travel of the egg through the fallopian tubes to the uterus, and implantation of the egg to the endometrium. Carrying the pregnancy to term then next depends on proper growth and development of the fetus in the womb, and finally labor and delivery. A problem at any point in the pregnancy process may result in infertility.[1]
How common is infertility?
In the United States, the available data show that after 1 year of trying, around 1 in 5 (19%) heterosexual women aged 15-49 years old with no prior births are unable to get pregnant, with about 1 in 4 (26%) women having difficulty carrying the pregnancy to term. The chances are better for women who already had at least one childbirth, as only 6% are unable to get pregnant again.[1]
As pregnancy takes an egg and a sperm, a successful pregnancy requires both partners to be healthy, and as such, male factors can definitely contribute or be the cause of infertility. In 35% of cases of infertile couples, a male factor can be identified along with a female factor, while in 10% of cases, only a male factor can be found. In the United States, infertility in men aged 15 to 44 years old was around 12%.[2] Hence, infertility in men should not be overlooked in the evaluation of an infertile couple.
What causes infertility in men?
Infertility in men is usually evaluated with the use of a semen analysis, where sperm concentration, shape, and movement are examined. The causes of male infertility can be classified according to the following:[2]
- Hormonal or systemic disorders – 5 to 15%
- Defects in sperm formation – 70 to 80%
- Problems with sperm transport – 2 to 5%
- Idiopathic or unknown reasons – 10 to 20%
More often, a specific cause for the infertility or abnormal semen analysis is not identified (idiopathic), but in other cases, a cause can be isolated and proper management of the condition may lead to improved fertility.
Along with these causes, there are also other factors that increase the risk of infertility in men, such as advanced age, obesity, smoking, alcoholism, illicit drug use, use of steroids and certain other medications, environmental toxins, and exposure to radiation. An in-depth, comprehensive evaluation would not be complete without ruling out these factors. Of course, non-modifiable factors like age or genetics cannot be remedied, but other lifestyle-related, habitual, or environmental factors such as smoking, alcoholism or toxins may still be addressed to improve the chances of a successful pregnancy.
How can remote patient monitoring help men with infertility?
Although many of the disorders listed above require extensive testing that is specific to each disorder, there are some easily obtainable clinical parameters that can give a hint as to possible conditions that may contribute to infertility in men. And this is where remote patient monitoring comes in.
Remote patient monitoring (RPM) platforms, such as the DrKumo platform of connected medical devices, enable real-time monitoring of important clinical parameters such as weight, body composition, blood pressure, oxygen saturation, heart rate, and blood glucose. Monitoring of these patient parameters are facilitated by the use of wireless medical devices connected to a platform that patients and health care providers can view in real-time.
Obesity and Male Infertility
Several studies have been done examining the influence of obesity on male infertility. Compared to males who are of normal weight, overweight males may have lower testosterone levels, decreased sperm quality, and reduced fertility, with the odds of infertility increasing by 10% for every 9 kilograms a man Is overweight.[3] This can be due to obesity causing changes in the balance of sex hormones in males, leading to increased estrogen levels and decreased testosterone levels, and may be reversible once weight is managed properly. RPM may help detect this in males by providing the ability to measure body weight and body composition, as well as aid in addressing this condition by tracking weight changes throughout a structured weight loss program.
Hypertension and Male Infertility
As hypertension affects 30% of males in the US, it is the most common chronic illness among American men. Recent studies also show that hypertensive males were more likely to have one or more semen abnormalities than males with normal blood pressures. Men with hypertension had lower semen volume, reduced sperm motility, and decreased sperm count compared to men without hypertension.[4] As such, detection and proper management of hypertension may be instrumental in improving fertility. RPM enables regular and convenient assessment and monitoring of blood pressure levels and therefore may help in detecting infertility in men as well as helping in managing it.
Diabetes and Male Infertility
Another highly prevalent medical condition that can cause infertility in men is diabetes. Studies have also shown that diabetes negatively affects males’ reproductive capabilities. Adverse effects of diabetes include impaired sperm production, reduced testosterone levels and decreased semen volume, low libido, erectile dysfunction and ejaculation problems.[5] Hence, early detection and proper management of diabetes and blood glucose levels may lead to addressing infertility in males, and RPM can definitely help in this regard, primarily by utilizing the glucometer device to monitor blood glucose levels.
Thyroid Disorders and Male Infertility
Thyroid disorders, either hypothyroidisim or hyperthyroidism (low or high thyroid hormone levels, respectively), are also associated with decreased fertility. These hormonal disturbances may affect testosterone and gonadotropin levels, and detection of these conditions may improve the chances of pregnancy. One sign of a thyroid disorder is an abnormal heart rate, either elevated in hyperthyroidism (heart rate > 100 bpm), or low in hypothyroidism (heart rate < 60 bpm). RPM devices such as the oximeter and smartwatch are capable of monitoring heart rate, and as such may alert patients to the presence of these abnormal rhythms, and lead to early detection of a thyroid disorder.
Takeaway
Although the majority of causes of infertility in men may be anatomical or idiopathic, a significant proportion of male infertility may be due to specific medical conditions. Remote patient monitoring may be instrumental in detecting and managing these conditions, and help address infertility in men and improve the chances of a successful pregnancy. RPM devices included in the DrKumo platform may be utilized in the evaluation and management of medical disorders that may cause infertility in men.
References:
- Infertility FAQs. Centers for Disease Control and Prevention. Mar. 1, 2022.
- Anawalt, B. and Page, S. Approach to the male with infertility. Uptodate. Nov. 30, 2021.
- Katib, A. Mechanisms linking obesity to male infertility. Central European Journal of Urology. 2015; 68(1): 79-85.
- Guo, D., et al. Hypertension and male fertility. The World Journal of Men’s Health. 2017 Aug; 35(2): 59-64.
- Ou Zhong, et al. Association of diabetes and obesity with sperm parameters and testosterone levels: a meta-analysis. Diabetology & Metabolic Syndrome. October 16, 2021.
