Male Infertility
Infertility means you cannot get pregnant (conceive). Primary Infertility refers to couple who have not become pregnant after at least 1 year having sex without using birth control methods.
About
In 50% of cases, male factor is responsible for infertility.
Hence a good semen analysis from a trained Andrologist is a must.
Along with it, thorough history and genitalia examination throw light on erectile, ejaculatory and other problems like varicocele, etc.
Semen Analysis
The male partner is asked to provide a semen sample.
or a good semen analysis, one should abstain from sexual intercourse for 2-3 days. Lesser or greater abstinence may affect the report.
Intake of alcohol, caffeine or any sort of medications should be avoided for 2-5 days.
No lubricant should be used as it affects the motility.
Ideally the sample should be collected in a sterile, wide-mouth, labeled, tissue culture graded container within the hospital premises. However, if collected at home, it should reach the hospital within 30 mins and should be maintained at body temperature.
What is assessed in semen analysis?
- Liquefaction
- Viscosity
- Volume
- Colour
- pH
- Sperm Concentration
- Motility
- Vitality
- Morphology
- Leukocytes
Other Tests
Certain specialized tests like Sperm Function Test, DNA fragmentation rate and Mitochondrial assay are done in specialized circumstances so as to enhance the result.
Sperm function test gives an idea of the capacity of sperm to fertilize an egg.
DNA fragmentation rate gives an idea of genetically normal sperms. High fragmentation rate is associated with higher rates of abortion.
Causes and Treatments
A) Low Sperm Count
-
Low sperm count is a condition in which the sperm count is below 15 million/ml, that is oligospermia.
-
When there are no sperms in the sample, it is called Azoospermia.
-
Azoospermia can be obstructive or non-obstructive.
-
Obstructive azoospermia is due to block in the passage that the sperm has to travel. Ex -Absence of Vas deferens.
-
Non-obstructive azoospermia is due to very low production or non-production of sperms.
Common Causes of Low Sperm Count
- Genital Surgeries.
- Undescended testis in adolescence.
- Disease of genital tract.
- Past history of Mumps.
- Causes leading to increased heat in genitalia- Testis are placed outside the human body as they need lower than body temperatures to survive. Excessive heat can lead to damage to sperm production. Ex- Obese men (due to sagging layers of fat), truck drivers, tight underclothing, excessive sauna, etc.
- Smoking especially more than 20 cigarettes per day.
- Excessive ejaculation- 2 to 3 times a day.
-
Genetic causes like CBAVD (Congenital bilateral absence of Vas Deferens), Y chromosome microdeletion, etc.
Treatment Options for Low Sperm Count
- Treating Infections with antibiotics: Infections if present should be treated with the help of antibiotics.This is not always helpful.
- Medications can be given to correct hormonal issues.
- Correctable surgeries- Varicocele or an obstructed vas deferens may be repaired.
- In persistent oligospermia, IVF treatment offers good pregnancy results. To attain pregnancy via IVF treatment, even low sperm counts are sufficient.
- In Azoospermia, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
- In PESA (Percutaneous Epididymal Sperm Aspiration), sperms are usually recovered from the epididymis by puncturing it with a fine needle.
- In TESA or testicular sperm aspiration (also known as TESE, or testicular sperm extraction), testicular tissue is sucked out through a fine needle, under local anesthesia. The sperm are then liberated from tissue and used for ICSI.
- In case no sperms can be extracted through surgical procedure, semen sample from a matched donor can be used for IUI or ART treatment.
B) Low Sperm Motility
- Sperm motility treatment refers to the movement of sperm. Poor sperm motility means that the sperm do not swim properly, which can lead to male infertility.
- Normally atleast 32% of the sample should show forward progressive motility.
Treatment Options for Low Sperm Motility
- LifeStyle Modifications :
- Reduce chemical exposure.
- Improve diet.
- Exercise regularly.
- Take nutritional supplements- Antioxidants to reduce stress.
- Stop Smoking, tobacco, alcohol, marijuana.
- Stop using any anabolic steroids including any testosterone supplements.
- IUI (Intrauterine Insemination) :
- Intra-uterine insemination (IUI) also known as Artificial Insemination is a process in which the washed/processed semen is placed into the uterine cavity with the help of a catheter in and around the time of ovulation (release of egg from the ovary).
- The purpose of IUI treatment is to introduce the best and the most motile sperms high up in the uterine cavity i.e. as close to the ovum as possible so that the sperms have to travel the least distance.
- Procedure and details are described separately.
- IVF with ICSI treatment has delivered most promising results in male infertility.
C) Erectile and Ejaculatory Dysfunction
- Erectile and ejaculatory dysfunction require details history taking and counselling. At time, it can be corrected with the help of medications or use of vibrator.
-
If not correctable, Sperm sample can always be obtained by surgical procedures and ICSI treatment done to attain pregnancy.