Male Infertility

It is estimated that about 15% of the couples are infertile.  It means they are unable to conceive a child despite having had unprotected sex frequently for a year or longer.  However, infertility has historically been attributed to woman.  Sometimes, infertility may be due to more than one factor, so instead of blindly assuming that the problem is with the female partner, it is always better that you both see the doctor.  Just like women, men can also be infertile.  Studies suggest that one out of every three cases of infertility is due to the problems related to male fertility.  It might take a number of tests to single out the exact cause of infertility.

Getting diagnosed with male infertility can be one of the toughest challenges a man can face.  It can be traumatic for some.  He may even have a feeling that he is failing at one of his most cardinal responsibilities.  However, medical science has progressed so far that it can offer real help to males suffering from infertility.  A wide variety of both conservative and modern medical treatments are available to get rid of male infertility in the shortest possible time.

Symptoms of male infertility:

Other than the inability to make your partner pregnant within a stated period of time or the inability to deliver a live-born infant, in majority of cases, infertility has no other outward symptoms. 

Inability to conceive a child is the main symptom of infertility.  Ironically, there may be no other telltale signs or symptoms.  In some cases an underlying health condition, such as a genetic disorder, hormonal imbalance, dilated veins around the testicle or something that blocks the passage of sperm can be the cause that leads to infertility.  It should be noted that the majority of men suffering from infertility does not notice significant symptoms other than the inability to conceive a child.  Signs and symptoms that flag male infertility include:

  • Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
  • Pain, swelling or a lump in the testicle area
  • Recurrent respiratory infections
  • Inability to smell
  • Abnormal breast growth (gynecomastia)
  • Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
  • A lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)

It’s time to see a doctor…

It is appropriate to see a doctor if you are unable to father a child even after a year of frequent unprotected sex or if you have any of the following conditions:

  • Erection or ejaculation problems, low sex drive or other problems with sexual function
  • Pain, discomfort, a lump or swelling in the testicle area
  • A history of testicle, prostate or sexual problems
  • A groin, testicle, penis or scrotum surgery

Causes of male infertility:

About half the time, the “male factor” contributes to infertility and about one third of the time it is the principal cause of infertility.  Generally, the issue lies in the process of either making or moving the sperm.  A man can suffer from low sperm count or abnormal sperm due to any of the following causes:

  • Varicocele — an abnormal collection of bulging veins above the testicle; they’re the most common cause of correctable male infertility, accounting for 38% of cases
  • Undescended testicle
  • Infections in the testicle (orchitis), the prostate (prostatitis) or elsewhere in the body that causes a fever
  • Chemotherapy for cancer
  • Medicines such as anabolic steroids or anti-seizure medicines
  • Genetic abnormalities
  • Hormone problems

In majority of cases the problem can be undone.  An evaluation by an experienced physician is the only way to sort it out.  At times, making the sperm problem is not the real issue, but getting the sperm where they need to go.  Men suffering from this type of infertility have normal sperm in their testicle, but sperm in the semen are either abnormal, very low in count or complete absence of sperm (azoospermia).  This type of infertility can be the result of one of the following factors:

  • Retrograde ejaculation: In this condition, semen ejaculates backwards into the bladder instead of out of the penis.  Previous surgery is the main reason.
  • Absence of vas deferens: This condition is a genetic problem.
  • Obstruction: An obstruction can occur anywhere in the area between the testicles and the penis.
  • Anti-sperm antibodies: Antibodies can abnormally attack a man’s own sperm on their way to the egg.

It is estimated that upto 25% of male infertility is idiopathic, which means there is no clear-cut reason for abnormal or low sperm count.

Diagnosis of male infertility:

General physical examination and medical history:  This begins with conducting a thorough examination of the genitals and the patient will be asked questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could adversely affect fertility.

Semen analysis:  Sample for semen analysis can be taken in a couple of ways.  The easiest way is to masturbate or ejaculate into a special container at the doctor’s clinic.  The semen taken then will be sent to a laboratory to check the number of sperm present.  Any abnormalities in the semen in the shape (morphology) and movement (motility) is looked into.  In the lab your semen will also be checked for any signs of problems such as infection.  It should be understood that the sperm count fluctuates vastly from one specimen to another, so in order to ensure accurate results more than one specimen is checked.  If the test comes out with normal results, your female partner may be requested to undergo fertility tests before undertaking further fertility tests on you.

You may be requested to have further tests to help figure out the cause of your infertility.  These can include:

Scrotal ultrasound:  High-frequency sound waves are used to produce images inside your body.  These images can throw light on the presence of varicoceles or other problems in the testicle and the adjacent structures.

Hormone testing:  Sexual development and sperm production is influenced by hormone produced by the pituitary gland, hypothalamus and testicles.  Apart from this, anomalies in other hormonal or organ systems also might lead to infertility.  In order to figure it out, blood tests may be conducted to assess the level of testosterone and other hormones.

Post-ejaculation analysis:  Sperm content in your urine can reveal if your sperm is travelling backward into the bladder instead of out your penis during the ejaculatory phase (retrograde ejaculation).

Genetic tests:  When concentration of the sperm is very low, there are chances of a genetic cause being responsible for that.  A blood test can throw light on subtle changes in the Y chromosome – something that signals a genetic disorder.  In order to unravel congenital or inherited syndromes, a genetic testing may be carried out.

Testicular biopsy:  Samples from the testicle will be taken out with a needle.  If the results come out normal, the problem could be the result of a blockage or something that is related to transportation of the sperm.

Specialized sperm function test:  A number of tests can be conducted to check how well your sperm is post ejaculation, to check its ability to penetrate an egg and if there is any issue in mating to the egg.  These tests are not routinely performed as it does not lead to any significant change to the treatment.

Transrectal ultrasound:   A small lubricated wand is inserted into your rectum, with which your doctor can check your prostate and find out if there are any blockages of the ejaculatory ducts and seminal vesicles that carry semen.

Treatment options for male infertility:

The principal objective of male infertility treatment is to provide pregnancy.  Ideally, the cause of the infertility is reversible and in most cases conception is made possible through natural sex.   Treatment for male infertility includes looking for signs of hormone deficiency such as increased body fat, decreased muscle mass and decreased facial and body hair.  Doctor may ask about your past medical history, including past injury to the testicles or penis, recent high fevers and childhood diseases such as mumps.  A thorough physical examination can lead to identification of issues such as infection, hernia, or varicocele.  You may also be asked to give a sperm sample to check for the quality and quantity of the sperm.  Other tests may include measurement of hormones in the blood, a biopsy of the testicle or genetic screening.  Measures to repair male infertility are taken based on the underlying cause of the problem.  However, if there are no identified abnormalities, evidence-based treatments that improve fertility may be recommended.

If the culprit is varicoceles, they are operatively repaired to unblock the abnormal veins.  This will lead to a great improvement in making the person fertile.  However, if the infertility is due to hormonal abnormalities, it can be undone with medicine or surgery.  Moreover, if there is obstruction in the plumbing system, surgery may be required to rectify it.

Gone are the days when the above-mentioned treatments do not yield the required benefit, it often meant lifelong infertility.  In this day and age, assisted reproductive techniques (ARTs) offer powerful new options.  With the help of these high-tech male infertility treatments, the sperm can be given a booster shot to get into an egg.  These advanced treatment facilities have made conception possible for males with very low or abnormal sperm.  The first step of this treatment is to collect the sperm via ejaculation or by a needle from the testicle.  The sperm thus collected are processed and introduced to eggs by various methods.

Intrauterine insemination (IUI):  Direct injection of the sperm into the uterus is done during the time of ovulation.  Generally, medicines are given to the woman first to increase the quantity of eggs she releases.

In-vitro fertilization (IVF):  This is the most widely used assisted reproductive technique.  Sperm is mixed with multiple eggs collected from the female.  After fertilization, the eggs are them placed in the uterus.

Intracytoplasmic sperm injection (ICSI):  This is a procedure that requires very high precision as a single sperm is injected through a tiny needle into an egg.  Post fertilization, the egg is deposited in the uterus.  This procedure is generally performed when the sperm counts are either abnormal or very low.

PICSI:  PICSI is an extension of  Intra-cytoplasmic sperm injection  and stands for Physiological Intracytoplasmic Sperm Injection .  PICSI is normally used when a man’s sperm count is very low, or if sperm motility is restricted in some way or sperm is otherwise abnormal.  It involves the selection of motile sperm for injection, but rather than simply using established techniques, it involves choosing mature sperm which bind to hyaluronic acid.  PICSI can lead to improved embryo quality and live birth rates as well as decreased miscarriage rates.

IMSI:  Intracytoplasmic morphologically selected sperm injection is a variation of ICSI that uses a higher-powered microscope to select sperm. This allows the doctors to look at the sperm in finer detail (including the nucleus which contains the sperm’s genetic material).  Some studies show that this technique can select better quality sperm and results in higher pregnancy rates and lower chances of miscarriage rates compared to conventional intracytoplasmic sperm injection.

Using a combination of assisted reproductive techniques for some months, there is a good chance of making an infertile male fertile.

Simple steps to boost male fertility:

There are some simple steps that you can adopt to increase fertility apart from paving the way for a healthy body.  First step is avoiding illegal drugs, tobacco and alcohol drinks as these harm sperm production.  Men should try to minimize taking hot baths as the high temperatures slow down the production of sperm.  In fact, our testicles are placed in a separate pouch outside the main body to make the sperm immune to normal body temperature.  Taking some over-the-counter androgen may also impair the sperm production.  Having adequate sleep and intake of proper nutrition pave the way for fertility. The bottom line is living right helps boost fertility and anything that impacts the overall health positively is ideal for keeping you more fertile.

Apart from the above, one can also do the following to increase male fertility:

Increase frequency of sex:  Having frequent sexual intercourse (possibly everyday or every other day) beginning at least four days before ovulation enhances your chances of getting your partner pregnant.

Have sex when fertilization is possible:  Ovulation is the right time for women to be pregnant, that is in the middle of the menstrual cycle between periods, so it is a good idea to time the intercourse accordingly.

Avoiding use of lubricants and lotions:  Products such as lubrications and lotions can get in the way of sperm movement and function.  Consult your doctor about sperm-safe lubricants.

For enquiries related to male infertility, send a message to www.kjkhospital.com/contact

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