Male infertility problem has been on the rise in the past couple of decades owning largely to better recognition and changing lifestyles and are often the cause of much individual stress, poor self-image, and marital discord.
Fertility diagnosis and treatment is the lengthy, time-consuming and expensive proposition. The process can frequently be eased and shortened by both partners working together with their doctor from the beginning. In addition to the tests done on a woman, a simple test like semen analysis can ensure that the male partner has sufficient normally functioning sperm for pregnancy to occur. For the other, there are additional tests and a whole gamut of therapeutic options to choose from the based on the cause.
Less than a decade ago, treatment for severe male factor was limited to insemination or IVF using donor sperm. Today, exciting advances in male infertility have introduced innovative therapeutic options that offer men, including those who with no sperm in their ejaculate due to genetic conditions, a greatly improved chance to conceive their own biological offspring. In this blog, we will explain the process that goes into conception and childbirth, contains detailed instructions for semen collection and helps in understanding the causes of infertility and the strategies available for its treatment.
The doctor and staff at IVF Sir Gangaram Hospital are trained in dealing with male and female problems.
Let’s talk about Human reproduction:
Human reproduction is a complex process that involves mainly two processes:
- The union of male gamate (sperm) with the female gamate (oocyte)inside a long tunnel like structure in female called the fallopian tube.
- And successful implantation of the resulting embryo in the female uterus.
The sperm is produced in the tests in males in huge numbers daily and travels through a complex convoluted channel called epididymis, through many other ducts, to be finally ejaculated into the vagina through urethra during intercourse.
Once in the vagina, the actively motile sperm find their way up through the cervix (the mouth of the uterus) and uterus into the fallopian tube where it meets with the oocyte that would have been picked up by the broad trumpet shaped the end of the fallopian tube. It is important to know that while a man produces millions of sperms every day, the woman produces only one egg in her entire menstrual cycle, this time usually being the middle of her menstrual cycle. For a woman who menstruates every 28 to 30 days, ovulation occurs around the 14th to 16th day. This is the most fertile period of her cycle when intercourse is likely to result in pregnancy. Only good numbers of actively motile normal sperm that are expected to reach the oocyte (egg) can fertilize it.
Fertilization is the process that involves the sperm entering into the oocyte, and fusion of genetic material of two gamates. Once fertilization occurs, the resulting zygote starts to multiple by dividing into the cells. On day 5-6 days after ovulation, the embryo which has by now grown enough to contain a fluid filled cavity and hence be called a blastocyst reaches the uterine cavity and begins a process of burrowing into the ripe uterine layer called endometrium. This process is known as implantation which would finally be complete by day 11 of ovulation. After a successful implantation, one can ascertain pregnancy by a blood test called the Beta hCG or a urine test using commercially available UPT kits.
Frequently Asked Questions on Male infertility:
What is infertility?
The inability of a couple to conceive despite one year of regular, unprotected intercourse may be labelled as infertility. 15% of a couple do not conceive at the end of the year and therefore may need an evaluation. However, if a couple feels that they need to be evaluated earlier due to known previous cause or advanced age of partners, one can seek consultation earlier.
In what percentage is the male partner responsible?
30% are infertile solely due to male factor and another 20% due to combined male and female factors.
What causes male infertility?
The problem can lie anywhere from semen production to sperm deposition in the vagina. It can be divided into three categories:
- Problems with erection
- Obstruction in the path of semen travel
- Defects with sperm production
Problems with erection, ejaculation or intercourse, although not very frequent, form a significant reason for a couple’s infertility. And the only way for a doctor to know this is through an interview with the couple. Unless you come out with this problem, the doctor will not know it and ends up orderings battery of tests that may not be needed after all. Sometimes the cause for detective sperm production could be identified as environmental, as results of working in warm surroundings; a hormonal disturbances or toxic drugs ingestion; smoking or tobacco consumption in any form; generalized conditions like varicocoele, testicular tumours, torsion, previous surgeries, testicular trauma etc. but in more than half the cases the cause remains unknown.
How does one ascertain that infertility is due to the male partner?
By obtaining a complete past medical, surgical and reproductive history, by a complete physical examination and by a semen analysis, one would know grossly if the male partner is responsible for infertility. If semen examination is abnormal, tests like hormonal tests, ultrasound, chromosomal analysis, testicular biopsy or other blood tests may be required.
Is semen deficiency correctable?
Semen deficiencies can be cured only if the cause can be found. Medicines can be used to correct conditions such as deficiency of pituitary hormone production (hypogonadotropic hypogonadism) or infection of the genital and urinary tract. Surgical correction can be done if required. However, most defects are irreversible and administered with drugs to improve the quality of semen or sperm is not effective.
What steps can be undertaken to boost fertility for both couples with near normal or slightly deficient sperm or semen?
If the female partner is normal reassurance and timed intercourse is the first step. However, if the couple is worried and wants treatment, 4 to 6 cycles of IUI is a good option.
What steps can be undertaken to increase fertility for couples with deficient semen?
Measures to seek and correct any possible causes for lowered fertility wherever feasible may be undertaken. If no cause has been found; in men with subnormal semen usually taken to be a concentration of less than 20 million/ml or a motility of less than 50%; intrauterine insemination of wife with processed and concentrated husband’s sperm is helpful especially if no cause for reduced fertility has been found in the female.
Empirical treatment with testosterone, clomiphene, bromocriptine, antibiotics, pentoxifylline, Vit C, E, Zinc and other antioxidants has been tried with very little improvement if any. Taking testosterone for prolong periods may actually depress sperm production. It is important to take these medicines only on prescription
What can be done if there are no sperm in the semen?
No sperm in semen or azoospermia is defined when two semen samples collected on two different occasions have been shown to be devoid of any sperm. If no sperm are found even after centrifuging the semen sample then surgical retrieval of sperm from the testis by techniques such as PESA, TESA or TESE can be attempted. Such retrieved sperm can be successfully used for conception by IVF ICSI. They cannot be used for procedures like IUI due to the paucity of the number. However, if no sperm can be found in the testes or the couple afford IVF-ICSI (which is a high-cost treatment) then donor semen can be used to artificially inseminate the wife for achieving a pregnancy.
What is PESA, TESA, TESE?
PESA, TESA and TESE are acronyms for sperm retrieval techniques from the testes with the help of a needle. This is done when no sperm are found in the semen. They are usually done under local anesthesia and do not require admission. Mostly no cuts or stitches are incurred on the skin.
Is there a possibility of any an abnormality in the child with the use of testicular sperms?
In 10-15% of men with azoospermia or severe oligozoospermia, the male offspring resulting from the use of testicular sperm can inherit the same semen defect as his father. But apart from that, children born out of IVF-ICSI are not any different from children born normally.
Genetic counseling and tests are available at IVF Sir Ganga Ram Hospital for detection of abnormalities such as the congenital bilateral absence of the vas deferens, Kleinfelters syndrome, Y-Chromosome microdeletions etc.
What to do when one cannot produce a semen sample before IUI or during IVF?
You need not be disheartened. If the semen was going to be used for IUI, and could not be produced, there is the option of natural intercourse for conception. Remember you are not infertile, the only sub-fertile. IUI was only going to improve the chance of pregnancy slightly above what you had naturally.
If semen could not be produced on the day of IVF, then there is the option of using drugs like Viagra to facilitate in easy ejaculation. If that does not help a PESA or TESA can be done. If you wish to avoid this situation and feel that giving semen on the day of IUI or IVF may be a problem, you could have semen preserved in the IVF laboratory, a few days prior to the IVF procedure, when you are most likely to be stress-free
What can be done to ensure good reproductive health?
Keeping weight in healthy range for your height is usually a good start-up measure. Smoking and tobacco consumption in any form affects semen quality and must be given up or reduced. Consumption of 30-60 ml of alcohol per day may not affect male reproductive health but large amounts may interfere with libido and chronic consumption can even hamper liver function. If one is on medicines for high blood pressure, diabetes or neurological conditions that reduce fertility potential then needs to consult the doctor to change them. Wearing loose cotton undergarment and cold baths have seen known to maintain good sperm production. Eating foods rich in anti-oxidants like green leafy vegetables, nuts and fruits may maintain fertility better. Use of laptops and mobile phones for long periods might lower sperm counts and motility.