Liver Disease and Male Infertility

 Written by Ben Bunting: BA(Hons), PGCert.

--

If you are looking to create a family, you may wish to know if any underlying conditions will prevent you from doing so.

Male infertility is high amongst western males and on the increase, this can be due to a lack of exercise, a poor diet, or even genetic conditions.

One area that may be of concern is if you have liver disease, this could be caused by alcohol abuse, hepatitis, or other viruses.

In this article we shall cover the following points:

• What's liver disease?
• Process of liver disease
• Liver disease rates
• Complications surrounding liver disease
• Signs and symptoms
• Measures to prevent liver disease
• Male infertility
• Does liver disease cause male infertility?
• Conclusion

What is Liver Disease?

Your liver is a critical organ, which is engaged in hundreds of tasks related to metabolism, energy storage, and waste filtering. You digest food and convert it to energy before your body requires it.

This is where your liver comes into play. Its role includes digesting and processing your food. It turns nutrients in to chemicals that your body needs.

Additionally, it helps clear toxic substances out of your bloodstream.

Types of Liver Disease

There are many types of liver diseases. Some viruses cause illnesses, such as hepatitis which is an infection that damages your liver. Among the most common causes of hepatitis are:

Hepatitis A

A lot of people get it by eating and drinking something that's tainted by faecal matter.

Hepatitis B

It's something you get from someone else, like unprotected sex or sharing needles when taking drugs such as anabolic steroids, heroin, or prescribed medications.

Hepatitis C

HIV causes hepatitis C in humans which may be contracted through the shared use of shared hypodermic needles for drug use or abuse.

HIV can be transmitted through shared blood or other fluids because of injuries or sexual contact.

Hepatitis D

Hepatitis D is a liver infection that can lead to lifelong liver damage and even death and is a development of hepatitis B.

Often referred to as 'hepatitis delta virus', this is the most severe form of hepatitis.

Hepatitis E

The majority of cases of Hepatitis E are caused by drinking contaminated water.

Viruses

Viruses and bacteria are harmful to your immune system. It can also cause serious harm to your organs, such as your liver, particularly as the liver acts as a detoxifier.

Inflammation

Autoimmune hepatitis inflames your liver. The condition may also lead to liver failure or other disorders.

Fatty Liver Disease

Fat build-up in the liver can lead to the development of fatty liver disease. There are two types of fatty liver disease. Both types can manifest solo, and overlap each other:

Hepatic steatosis

Heavy alcohol consumption causes an alcohol-related liver disease called fatty liver disease.

The damage is caused by breaking down the alcohol for removal. By doing so it can create harmful substances that can harm your liver. By drinking more alcohol, you are damaging your liver, because prolonged alcohol abuse doesn’t allow the liver cells to regenerate.

Non-alcoholic fatty liver disease (NAFLD)

The cause of NAFLD is hard to pin down. However, that said, there does appear to be an association of NAFLD and people that are obese, have type 2 diabetes, high blood pressure, high cholesterol and suffering from metabolic syndrome.

NAFLD seems to affect a quarter of the world’s population, and as chronic diseases such as diabetes rise, so does the incidence of NAFLD.

When both types of fatty liver disease are mismanaged, either will result in liver damage, cirrhosis, or liver failure.

Diet changes and other lifestyle changes can often improve symptoms and reduce complications.

Primary biliary cholangitis

Primary biliary cholangitis damages the tiny tubes in your liver called bile ducts. Bile is a chemical that helps digest food.

If the ducts are injured, the bile will back up inside you and scars your liver. More and more women are affected than men by this.

Primary sclerosing cholangitis damages your bile ducts and blocks them later. Bile builds up within your body, and that makes it harder for your liver to function.

Cancer

Cancer most likely surfaces in your liver because it has spread from other parts of the body, such as your lungs, colon, or breasts. There are few cancers that may start in the liver and it is usually caused by other conditions.

The disease affects women much more than men, and black people more frequently than whites. The doctor may refer to it as hepatocellular carcinoma.

If you have hepatitis or drink too much, it's more likely that you can suffer from liver cancer.

Genetic

Liver cancer isn't necessarily hereditary, however, there may be certain risk factors that may increase a person’s chances of developing liver cancer such as metabolic syndrome, or alcoholism.

Excess iron

Athletes and those with heavy exercise regimes can experience high nutrient turnover, this means that their bodies use and excrete high levels of nutrients.

The iron that you consume will either be used by your body to help produce haemoglobin which carries oxygen to your muscles and organs in the blood stream.

If you have too much iron, it is stored in your body during hemochromatosis. Extra iron accumulates in your liver, heart, or other organs.

It can lead to life-threatening conditions, such as liver disease, heart disease, or diabetes.

Good sources of iron are leavy greens and red meat, although the iron from red meat is absorbed better. To increase the absorption of iron from plant sources, pair it with vitamin C such as orange juice.

Copper

Wilson disease is a rare genetic disorder that causes excess copper to accumulate in different body tissues, notably liver, brain, and eyes. When left untreated, the disease may cause liver (hepatic) disease, central nervous system dysfunction, and death.

It's not only harmful to your liver, but it may also cause nerve and mental problems.

Alcohol and Drugs

Problems may be caused by drugs or alcohol consumption. A liver injury or scar tissue can lead to cirrhosis.

Overdoses from drugs. Too much acetaminophen or other medications can harm your liver.

➡️READ: Natural treatments for male infertility

Process of Liver Disease

The term liver disease covers anything that affects the function of your liver. There may be different causes for these conditions, but they can all damage your liver and effect its function.

Many people with liver disease don't look or feel sick even though their liver is damaged.

Some cases of liver disease can be treated through lifestyle modifications, which can include changes to diet (to lose fat mass) and withdrawing from alcohol or drug exposure.

Medications can often help as well, but the liver must be carefully monitored.

The progression of liver disease can become irreversible at a certain point, and lead to liver failure, liver cancer, or death.

Liver Disease Rates

England is experiencing an increase in liver disease death rates. In contrast, liver disease deaths are down in many EU countries.

Whereas there has been a decline of other chronic diseases in England, liver disease hasn't followed this trend.

Many of the causes of liver disease can be avoided. While about 5% of liver disease is caused by autoimmune disorders (disorders of the immune system that cause abnormal functioning), most liver disease occurs due to three main risk factors: alcohol, obesity, and viral hepatitis

Over a third of liver disease deaths are associated with alcohol. Yet, a majority of those who inject performance enhancing drugs (such as anabolic steroids) are infected with hepatitis C.

Obesity is an important risk factor for non-alcoholic fatty liver disease (NAFLD), which is a term used to describe the accumulation of fat within the liver that is not caused by alcohol consumption. Obese or overweight people typically exhibit this condition.

NAFLD is often without symptoms, but a minority may have advanced to a more serious form known as non-alcoholic steatohepatitis.

Complications surrounding Liver Disease

Other health issues may arise from chronic cirrhosis, such as:

Hypertension in the portal vein

Blood goes through the portal vein to your liver from your intestines and spleen.

Cirrhosis slows blood flow. This raises the pressure inside the portal vein.

Portal hypertension may cause abnormal blood vessels in the stomach (called portal gastropathy and vascular ectasia) or enlarged veins in the mouth, stomach, and oesophagus (called varices).

Thin walls and higher pressure are more likely to cause the blood vessels to burst and cause severe bleeding. This can lead to renal disease or failure.

Bleeding can become severe. This happens when your liver stops making proteins needed to clot your blood.

Diabetes type 2 is common

During cirrhosis, insulin resistance occurs when your body does not use it properly.

The pancreas tries to keep up with insulin by making more, but blood sugar (glucose) builds up.

Signs and Symptoms

About three-quarters of patients who will die from cirrhosis are unaware they have liver disease.

Most can take normal liver blood tests, yet most will only know they have an issue when they are hospitalized in an emergency.

Between 2001 and 2020, the number of deaths of people under 75 due to alcoholic liver disease has increased by almost 35% within the UK.

Skin discoloration

The yellow discoloration of the skin due to elevated bilirubin levels in the bloodstream.

Weight loss

You may notice significant weight loss. This could be due to muscle atrophy (muscle wastage) due to deficiency of protein production.

Gallstones

After eating a greasy (fatty) meal, a person with gallstones may experience right upper abdominal pain and vomiting.

Hormones

Males may exhibit gynecomastia or enlarged breasts due to an imbalance in the hormones that affect them.

Erectile dysfunction (ED), due to a significant increase in oestrogen.

Changes in sex drive and shrinking testicles are the result of reduced testosterone production.

Cognitive issues

Ammonia may cause confusion and lethargy when the bloodstream levels rise (ammonia is a waste product formed from protein metabolism and requires normal liver cells to remove it).

Measures to Prevent Liver Disease

Reduce alcohol consumption

Ensure you do not drink excessive quantities of alcohol.

A guideline on diagnosis and management of cirrhosis recommends that very heavy daily drinkers (men drinking up to 50 units per week or women drinking 35 units per year) should be screened and checked for any liver damage.

Alcohol-related liver damage increases with increased alcohol consumption.

Obesity

Alcohol becomes more toxic when you have excess weight. For people with a BMI of 35 or more, one bottle of wine is equivalent to two bottles.

As such, if a person is carrying too much fat mass, dietary changes should be put in place and an exercise program introduced.

Hepatitis vaccinations

In order to protect yourself from hepatitis, you should get vaccinated.

A hepatitis B vaccination is available for all ages and recommended.

Full protection requires 3 vaccinations.

There's also a hepatitis A vaccine, however, this is not as common due to the lower risk.

Male Infertility

Male infertility is a complex disorder that can lead to reduced fecundity, problems with fertility resulting in males, and sexual dysfunction.

Fertility tests can play a role in diagnosing and helping the patient, such as evaluating semen quality, sperm number, and motility.

In at least half of all cases of infertility, a male factor is a major or contributing factor. As a result, about 10% of all men in the United States who are attempting to conceive are infertile.

Causes

For men, there are a number of causes that can contribute towards infertility.

These can include smoking, obesity, diabetes, drugs, heat from things such as laptops, hormonal, and previous surgeries can lead to fertility problems. Sometimes it is simply a genetic disorder.

If no sperm is found in the semen, small testes suggest a hormonal or testicular cause, while normal testes indicate an obstruction such as varicocele.

Does Liver Disease Cause Male Infertility?

Around 1 in 8 hetrosexual couples in the USA suffer from infertility with around 9% of males suffering from some form of infertility.

Testicular hormones and spermatogenic function are dictated not only by the testis itself, but also by the integrity of the hypothalamus and anterior pituitary.

In addition to the effects of systemic diseases, there have been various mechanisms that have been shown to affect male gonadal function, such as decreased libido, erectile dysfunction, and infertility.

Does liver disease affect sperm?

Decreased Leydig cell function causes a deficiency of testosterone; disorders affecting spermatogenesis may lead to infertility.

Alternatively, acute and chronic illness may compromise the hypothalamic-pituitary axis and lead to reduced testicular function.

Abnormal functions of endocrine organs are expected in patients with liver cirrhosis.

Clinically, hypogonadism is commonly observed in patients with liver cirrhosis.

In addition to gynecomastia, decreased blood libido, signs of feminization, testicular atrophy, low testosterone levels, and reduced spermatogenesis.

Patients with cirrhosis may suffer from hypogonadism due to the inhibition of dioxide triphosphate.

What does the research say?

There aren't a huge number of studies available looking at the effects of liver disease on male fertility, but this is what we found.

This 2017 study looking at the sperm quality and hormone status showed that those with NAFLD had reduced sperm quality and lower testosterone compared to a control group.

A review of 132 articles found that the correlation between NAFLD and male sexual and reproductive dysfunction is growing.

Conclusion

There's plenty of evidence that links the risk factors associated with causing liver disease and male fertility problems.

This includes alcohol or drug abuse, which is documented to cause male infertility, both can also cause liver disease.

Obesity and poor dietary choices are a contributory factor towards male infertility, and can also result in liver disease

So, while there isn't a huge amount of study into the direct relationship between liver disease and male infertility, what is available unsurprisingly associates non-alcoholic fatty liver disease with reduced sperm numbers, quality and testosterone.