Male Inferlity

OVERVIEW

Finding out that you are unable to have children is one of the most stressful things that a couple has to face. However it is doubly difficult for women who have to carry the burden of guilt or blame for infertility when quite often the fault may lie with the male partner. It may come as a surprise to many people, that in 60% of all couples experiencing infertility, a male factor is involved. In 40% of these couples it is primarily due to the male partner, in 40% it is primarily due to the female partner and in 20% it is a combination of both male and female causes.

CAUSES

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. Infertility in men is most often caused by

• Sperm Count - problems making sperm i.e. producing too few sperm or none at all
• Sperm Motility - problems with the sperm's ability to reach the egg and fertilize it i.e. abnormal sperm shape or structure prevent it from moving correctly.
• Blockages - Blocks in the ducts that carry sperm (vas deferens) can be due to vasectomy or injury or can also be congenital.
• Hormonal Problems - Disorders of the testicles or abnormalities affecting other hormonal systems like the pituitary, hypothalamus, thyroid, and adrenal glands
• Genetic Disorders – Such as cystic fibrosis.
• Lifestyle & Environmental Factors - Alcohol, drugs, environmental toxins, smoking, radiation treatment and chemotherapy for cancer and age related issues.
• Miscellaneous Factors - Varicocele, Infections like Gonorrhoea, Syphilis, Chlamydia or Mumps

Contrary to what most men would like to believe, the existence of andropause is now a recognized phenomenon. Men go through a change very much like women in their middle years, they like women, experience complex hormonal rhythms that affect their sexuality, mood, and temperament. Infact a recent WHO report states that “male androgens progressively decline with age” Androgen levels at the age of 70 years may be only 10% of what they are during youth.

TREATMENT

The good news is that over 50% of men will have a treatable cause of male factor infertility. These factors include varicoceles, infections, hormonal abnormalities, abnormalities in the seminal fluid, ductal blockages, and difficulties with erections and ejaculation. When these conditions are treated, either through medication or surgery a man will often see a significant improvement in his semen analysis. Men with idiopathic or unexplained infertility can make lifestyle changes that may result in improvement in his semen analysis.

LIFESTYLE MODIFICATIONS

• Quit Smoking
• Stop Taking Recreational Drugs
• Anabolic Steroids (male hormones) use has reached almost epidemic proportions. 6.6% of 12th grade males use or have used them to build muscle mass and improve athletic performance. These male hormones suppress the testes ability to make testosterone. This decreases the intratesticular testosterone level. Anabolic steroids also depress testicular production of testosterone and, thus, levels of testosterone inside the testes itself. This may cause severely diminished spermatogenesis or complete absence of sperm (azoospermia). When taken, these steroids cause a persistent depression of the hypothalamus and pituitary that may be irreversible, even when the steroids are stopped.
• Reduce Alcohol
• Avoid Lubricants

Most vaginal lubricants, including K-Y Jelly, Surgilube, and Lubifax are toxic to sperm. Couples should avoid their use during the fertile time of a woman's cycle.

• Exercise
• Avoid High Temperatures
• Take Vitamins (Antioxidants)

ASSISTED REPRODUCTIVE TECHNOLOGY

Men with poor semen analyses whose conditions are not treatable or unexplained may still have the option of using advanced reproductive techniques to achieve a pregnancy. Even those men with no sperm in the ejaculate are able to have some living sperm procured from them through surgical methods and achieve a pregnancy using the conventional technique of ICSI or the more advanced IMSI in which the digitally enhanced, magnified images of the sperm allow the embryologist to detect any structural alterations and abnormality that are otherwise hard to locate with conventional methods. Surgical sperm retrieval techniques like TESA (Testicular Sperm Aspiration), PESA (Percutaneous Epididymal Sperm Aspiration) & Micro TESE (Microdissection Testicular Sperm Extraction) ensure that even men who have no sperms in the ejaculate can opt for ART.

Testicular Sperm Aspiration (TESA)

This procedure is performed for men who need to have sperm retrieved for IVF/ICSI. It is done under local anesthesia and is usually done on the day of Oocyte retrieval. A needle is inserted in the testicle and tissue/sperm are aspirated. TESA is performed for men with obstructive azoospermia (s/p vasectomy). It is done as an out patient procedure and usually takes about 15 – 30 mins. Occasionally, TESA doesn’t provide enough tissue/sperm and an open testis biopsy is needed. No special preparation is required for the procedure.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is similar in everyway to TESA except that PESA involves passing a fine needle through the skin into the epididymis to obtain sperm. It is also done under local anesthesia or sedation and performed as an out patient procedure and no special preparation is required.

Microdissection Testicular Sperm Extraction (Micro TESE)

This is a microsurgical procedure designed to retrieve sperm directly from the testicles when sperm are absent. A small incision is made in the scrotum.  With the help of a microscope the surgeon will locate and carefully extract seminiferous tubules, which are the tiny tubes within the testicles where sperm are produced. 

The sperm extracted through TESE, PESA or Micro TESE are invariably used for Intra Cytoplasmic Sperm Injection (ICSI) during the IVF-ICSI cycle. It can be used in the same cycle or frozen and used in subsequent cycles.  

DNA Fragmentation Index (DFI)

During the last decade, DFI (DNA Fragmentation Index) has emerged as an important biomarker in the assessment of male fertility potential. The test allows us to determine the ratio of healthy normal sperm to those sperm with DNA fragmentation Elevated DNA fragmentation rate has been shown to be more common in infertile men with unfavorable reproductive outcome as compared to fertile men.

Male infertility treatment of the highest quality is now available to those who have so far been hesitant to visit a specialist. Ruling out a male factor problem can move the process along and save a couple valuable time and financial resources. The really exciting news is that most of male infertility cases can be  resolved with a combination of lifestyle changes and medical techniques.

This is a brief overview of male infertility. If you have any further queries, please reach us at info@milann.co.in or to schedule an appointment with one of our doctors call +91- 9513311897. We would be happy to be of assistance.