Written by Ben Bunting: BA(Hons), PGCert.
A hernia is a pretty common problem that affects approximately 27% of the male population. A hernia is the weakening of the wall of organs containing a cavity, and thus the organ protrudes out. It generally means weakening of the abdominal wall.
If the part of the abdominal wall weakens, naturally, organs contained in it would protrude out, particularly intestines along with the blood vessels.
Although it is not a life-threatening condition, sometimes, these protruding parts of the intestine become strangled, which is a medical emergency. Fortunately, such complications are rare.
In this article we will look at the following points:
- What's a hernia?
- The relationship between hernia and fertility
- Treatment concerns
- Plastic mesh
- Irritation and inflammation
What's a hernia?
Hernia often occurs due to inherited weakness of the abdominal wall or due to certain types of physical activity like lifting weights. In addition, it may occur due to other reasons like chronic cough, which increases the pressure in the abdominal cavity.
This increase in abdominal pressure may cause small tears in abdominal muscles, forming pouch-like structures.
Some of the common hernia sites are groins, belly button region, and even upper stomach.
What is the relationship between hernia and fertility?
Now that we have understood what 'a hernia is, it is logical to ask how it can affect fertility at all?
Well, most hernias wouldn't. But then the fact is that more than 80% of hernias are inguinal hernia or of the groin region. As one can see, this hernia is located very close to the genitals.
To understand more about how it may possibly affect fertility, one needs to understand the anatomy of the inguinal region a bit (see image above).
The problem is that the male spermatic cord passes through the inguinal region, which is most prone to hernia. Thus, theoretically, there is always the risk that it may get involved somehow in hernia and cause infertility.
The male spermatic cord travels from testicles back to the pelvic floor, from where it takes a long route toward the penis via an inguinal canal.
The inguinal canal is quite thick and robust. Thus, the chances are slim that it would ever get caught in the hernia pouch.
It means that even an inguinal hernia does not cause any damage to testicles, spermatic cord, and has no effect on male hormones. Thus, the inguinal hernia does not cause male infertility. But, there is more to it.
It seems that it is not a hernia, rather its treatment that causes male infertility in some.
The primary treatment of hernia is the surgical correction or repair of the abdominal wall. It is one of the most common surgeries and is pretty simple. In addition, hernia surgery is very safe and rarely causes any life-threatening complications.
All that a surgeon needs to do is carry out a small incision at the place of the hernia and then remove the organs from the hernia pouch. After that, they can apply stitches to the site to strengthen the wall.
However, they need to apply really tight stitches at the place. But this creates some problems like stitches may break, resulting in the failure of the surgery.
Thus, surgeons came up with so-called low-tension stitches. It is a procedure in which they don't use very tight or high-tension stitches. Instead, stitches are relatively kept loose to avoid tears in skin and muscles. Instead, they use plastic mesh to strengthen the abdominal wall in the inguinal region.
This plastic mesh is biodegradable but not entirely. It remains in the body for years. Doctors would often use polypropylene mesh that the body can absorb in about 20 years.
As one can see, there could be many reasons for male infertility due to inguinal hernia. Studies show that there are about 0.3% chances that the inguinal canal and thus spermatic cord may get damaged during surgical procedures. That is not a very high risk, never the less a considerable risk.
Additionally, studies show that even testicles may be damaged in some cases, resulting in testicle atrophy. However, testicles damage and resulting atrophy are extremely rare these days—nevertheless a possibility.
Fortunately, men have two spermatic cords. Thus, it would rarely result in complete infertility. Moreover, in most cases, testicles are not damaged and working properly. However, one may suffer from azoospermia or no sperm ejaculation.
Further, things do not end here. It appears that the modern technique of using plastic mesh to repair an inguinal hernia is associated with much greater male infertility.
This method is much more effective than other procedures that do not use mesh, but it poses a greater risk of male infertility.
Additionally, it is vital to understand that the risk is always greater when a hernia is bilateral. After all, there are two spermatic cords, and damage to one would not result in complete infertility, though it would cause reduced fertility.
So, why is that hernia repair using mesh has greater risk?
Irritation and Inflammation
Well, it seems that these plastic meshes, though relatively safe, are not entirely safe. They cause considerable local irritation and inflammation. Once the mesh is at the place, it keeps causing low-grade inflammation and the formation of connective tissues.
Once these connective tissues have formed near the mesh, they start obstructing the spermatic cord and thus the movement of sperms. As one can imagine, this complication occurs slowly over a period of weeks or even months.
New studies show that surgical correction using meshes has a severalfold greater risk of causing male infertility than techniques that do not use mesh.
Theoretically, surgeons can remove these fibrotic tissues and restore fertility. However, that isn't very easy in practice as these fibrotic tissues are attached to all the adjoining tissues.
To conclude, it would be correct to say that hernia does not affect male fertility, but its surgical treatment does.
Surgical procedures using mesh are good as they strengthen the abdominal wall well and prevent the reoccurrence of the hernia. However, it is also associated with greater infertility risk.
Thus, men undergoing surgical correction for inguinal hernia need to know these risks and discuss them with a surgeon before agreeing to a specific treatment option.