ENDOWORLD HOSPITAL # 723, In front of Airport, Chikalthana, Aurangabad – 431007, Maharashtra, India.
Incidence of infertility:
Worldwide the incidence of infertility is 10 to 15 % of married couples. Male factor: 30% Female factor: 30% Both factors: 30% Unexplained infertility: 10% This means both partners are equally responsible for infertility. So both male and female partner requires simultaneous investigation and treatment.
Causes of male infertility: Male infertility is caused by
1. Abnormal sperm production and function
occurs when the testis fails to descend from the abdomen into the scrotum during fetal life. This leads to total absence of sperm production.
This consists of dilated and tortuous testicular veins that contain stagnated blood. This leads to impaired sperm production in testes.
This consists of collection of fluid in coverings around the testis. This may lead to impaired sperm production.
This can be caused by sexually transmitted diseases, prostatitis, urethritis, etc.
Chromosomal disorder like Klinefelter’s syndrome having 47xxy karyotype can cause low sperm count or azoospermia.
Sperm antibodies can form in individual’s blood that can lead to infertility.
2. Impaired delivery of sperm: Impaired delivery of sperms to the female genital tract can be due to
Medical conditions can be associated with infertility such as:
Risk factors & life style issues:
Investigations:
History & examination:Male partner is interviewed and examined by the infertility specialist. Examination of genital system is done and necessary investigations are advised.
Semen analysis: Semen analysis is the most important and easy investigation for male partner. You should have abstinence of at least three days before giving semen for examination. Semen is usually given by self manipulation (masturbation) in a sterile semen collection container in laboratory. Laboratory usually has well maintained semen collection room with adequate privacy.
Analysis of semen usually includes the following components: Sperm volume is the total amount of semen in a single ejaculation. Sperm concentration is the number of sperms present in one ml of semen. Sperm motility is the ability of sperm to move. Morphology indicates the structure of sperms.
Evaluation of male hormones: Testosterone, Follicle stimulating hormone (FSH), Luteinising hormone (LH), Prolactin (PRL), Dehydroepiandrosterone sulphate (DHEAS)
Other hormones: Thyroid hormones (T3, T4, TSH), Prolactin
Scrotal sonography & Color Doppler: this can diagnose hydrocele, hernia or varicocele.
Testicular biopsy: when semen analysis shows absent sperms in repeated semen samples and testicular size is normal, then testicular biopsy is usually indicated to know the cause of azoospermia. In this procedure a small piece of one or both testis is taken for histopathological examination under local or general anesthesia.
Genetic karyotyping: This test is done when some genetic disorder is suspected in male partner or in patients with severe sperm defects. This is also requires before proceeding for IVF or ICSI.
Minimal requirements for male fertility:
Semen volume: more than half ml
Sperm concentration: more than 20 millions/ml
Total sperm count: more than 40 millions/ml per ejaculate
Motility:more than 50% sperms having grade 3 to 4 motility (forward progression)
Morphology: more than 30% normal sperms
Changing the life style:
Treatment of abnormal sperm production or function:
Fertility drugs: These are given to increase sperm production and motility
Hormone replacement therapy: to correct hormonal problems.
Antibiotics: to treat infections
Surgical treatment: varicocele is corrected by venous ligation and embolisation.
Treatment of hormonal problems: Hormone replacement therapy
Treatment for erectile dysfunction:
Treatment of azoospermia due to vassal or epididymal blocks
When semen analysis shows absent sperms but testicular biopsy shows production of sperms in testes then various surgical sperm retrieval techniques are used to retrieve the sperms from testes or the collection system. ICSI treatment is done with these surgically retrieved sperms to achieve the pregnancy. These techniques are:
Intrauterine insemination of semen (IUI): IUI is done to improve the fertility before opting for IVF or ICSI. IUI increases the sperm motility and sperm concentration in a given sample.
Donor IUI (Intrauterine insemination of donor semen): When the male partner is azoospermic or has some transmissible genetic diseases, with the consent of the couple, donor IUI is done. The donor semen is taken from authorized semen bank. Complete matching of donor is done with male partner i.e. blood group, color of skin, eye & hair, ethic& intellectual background, built of bones & height, etc. The donors are screened for HIV, hepatitis, syphilis, and other sexually transmitted diseases.
IVF: IVF is useful for patients with good sperm count and motility, unexplained infertility.
ICSI: ICSI is useful for patients with low sperm count or motility. (Refer to section on female infertility for details)
Adoption: This can be an initial option or useful for couples with repeated IVF or ICSI failures.
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