What is Male Infertility: Types, Causes, Symptoms
Male infertility is on the rising trend and is responsible for approximately 50% of causes of couples being unable to conceive.
What are the causes of male infertility?
SYSTEMIC ILLNESS
- Diabetes
- Liver / Renal Disease
- Cancer
TESTICULAR
- Varicoceole
- Cryptorchidism
- Sertoli cell syndrome
- Testicular torsion
- Primary testicular failure
HYPOTHALAMIC-PITUITARY
- Endocrinopathies -thyroid dysfunction, hyperprolactinemia
- Disorders of FSH and LH hormone
- Pituitary insufficiency
- Pituitary tumors
- Craniopharyngiomas
GENETIC CAUSES
- Klinefelter’s Syndrome (47,XXY)
- Y chromosome micro deletions
- Kallman Syndrome
INFECTIONS
- Mumps , Tuberculosis
- Male accessory gland infection Gonorrhea, Chlamydia
EXPOSURE TO TOXINS
- Heat exposure
- Heavy metals
- Smoking
- Radiation, Chemotherapy
- Pesticides
- Drugs like cimetidine, antiandrogens, alcohol
OBSTRUCTION IN THE REPRODUCTIVE TRACT
- Prior surgeries like vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries can cause damage and prevent sperm from being present in the ejaculate.
- Epididymal obstruction -post infective / idiopathic / epididymal cyst
- Congenital bilateral absence of Vas deferens
PROBLEMS WITH SEXUAL FUNCTION
Difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction)
SEMEN ANALYSIS:
This is the first step in evaluating the male partner in patients who have difficulty in conceiving. It is a simple test which gives a lot of information on the male gamete which is the sperm.
Semen sample should be collected by masturbation after 2–5 days of abstinence in a widemouth sterile plastic container provided by the laboratory. The specimen may be collected at home or at the laboratory conducting semen analysis. The specimen should be kept at room or body temperature (should not be refrigerated) during transportation and examined within 1 h of collection.
The semen analysis is done at our fertility centre at Chembur and Vashi by an experienced embryologist in a standardised laboratory where quality control is assured. By standardizing protocols and methods in laboratories, it is possible to reduce the interlaboratory variation. To achieve this purpose, we perform the test according to the last edition of the “World Health Organization’s Laboratory Manual on the testing and processing of human sperm”.
Normal values of semen analysis is as follows:
Parameter | Lower Reference Limit |
|---|---|
| Semen Volume | 1.5 ml |
| Sperm concentration | 15 million/ml |
| Total Sperm number | 39 million/ejaculate |
| Progressive motility | 32% |
| Total motility | 40% |
| Vitality | 58% |
| Sperm morphology, normal forms | 4% |
| pH | >/= 7.2 |
| Leucocyte | <1 million /ml |
What are the various abnormalities in the semen analysis?
Sperm count is low – Oligozoospermia
Motility is below normal – Asthenozoospermia
Abnormal morphology – Teratozoospermia
All 3 parameters are affected – Oligoasthenoteratozoospermia
Absence of Sperms – Azoospermia
TREATMENT OF MALE INFERTILITY
Treatment of male factor infertility depends on the severity and cause of infertility.
FURTHER EVALUATION IN CASE OF AN ABNORMAL SEMEN ANALYSIS REPORT
1) Hormonal testing with FSH, LH, Testosterone, PRL
2) Genetic testing – karyotype, Y chromosome micro deletion in case of severe oligospermia/azoospermia
3) Imaging with Ultrasound
4) Sperm function test, Sperm DNA Fragmentation test.
The treatment modalities usually are as follows:
- ANTIOXIDANT SUPPLEMENTATON – A combination of COENZYME Q10, LYCOPENE, L-CARNITINE, GLUTATHIONE.
- VITAMIN C , VITAMIN E AND ZINC
- Usually given for a period of 3 months.
- Hormonal therapy with oral medications like Clomiphene Citrate/Letrozole and injectable Gonadotropins can also be given in some forms of male infertility.
- Quitting Smoking and recreational drugs, reduction in alcohol intake
- Weight reduction and regular exercise
- Reduction of stress
- Reduction of caffeine intake
- Reduction of exposure to environmental toxins and work related factors.
- IntraUterine Insemination (IUI) – Husband – In Mild to moderate cases of male infertility, when the total motile sperm count is > 5 million/ml. The semen is washed and prepared and the good, motile sperms are inserted into the uterine cavity with a fine catheter.
- Intrauterine Insemination (IUI- D) – In cases of severe oligospermia/ azoospermia when IVF is not possible, IUI using donor semen can be used.
In Vitro Fertilisation (IVF) – In moderate to severe forms of male infertility when total motile sperm count is < 1 million/ml
Intra Cytoplasmic Sperm Injection (ICSI) – In severe forms of oligospermia, only few sperms are required as one sperm is injected in one egg for fertilisation.
In cases of azoospermia both non obstructive and obstructive, when sperms are retrieved surgically using methods like Testicular sperm aspiration / extraction (TESA, TESE) or micro dissection TESE , percutaneous epididymal sperm aspiration (PESA) where the retrieved sperms are used for performing ICSI.
SURGERY
Varicocoele – Grade 3 clinically palpable varicocoele with abnormal semen parameters can be surgically corrected in certain set of patients especially if other factors of infertility are ruled out.
Surgery for relieving obstruction in certain cases of obstructive azoospermia can be done in certain select patients.
Due to excellent results with ART procedures, IVF/ICSI is usually suggested as the first line treatment option as the time to pregnancy is generally lesser with ART rather than surgery.
All these procedures are offered at Dr Sudha Tandon Fertility, IVF, Gynaec Endoscopy and Maternity Centre, Chembur and Vashi.