Male infertility refers to a male’s inability to cause pregnancy in a fertile female.
Male factor usually is not spotlighted as much as it should be. In fact, as there are hardly any symptoms, it is more likely to go unnoticed until a man tries to have a baby. Generally, male fertility problems have to do with the quantity or quality of the sperm, though there can also be issues with ejaculation/ erection or other sexual dysfunctions noticed by you, sometimes which can be age related. The truth is, the male partner plays as much of a role in a couple’s ability to conceive as the female counterpart. Male infertility is a factor in 40 percent of infertility cases, and male factor infertility is the sole cause 15 percent of the time. Therefore evaluating the male partner at early stages of fertility treatment simultaneously with the female assessment is always helpful. You will initially be assessed by a thorough medical history, physical examination, a sperm analysis, and may further be subjected to testing with hormones, genetic tests or certain specialized tests as per the case. Nearly half of all male factor infertility cases can be successfully treated or reversed with right medical intervention in time.
Historically speaking, problems with fertility were generally assumed to originate with the female partner, and early infertility treatments almost always revolved around the woman. These days, we know that male factor plays role in nearly 40% of the couples who struggle to conceive in some or the other way.
Which factors are associated with fertility issues in male?
While the causes of infertility may vary, the root cause of a man’s infertility may not be easy to establish. For up to 50% of men diagnosed with male factor infertility, it is hard to attribute it to any specific cause. Following factors are more likely to be associated with the male fertility issues-:
- Poor semen quality with immotile sperms or low sperm counts or morphologically poor sperms which fail to penetrate the egg (Oligoasthenoteratozoospermia) (OAT). These problems can mean that the sperm has a hard time reaching or penetrating the egg.
- Blockage/obstruction in the reproductive tract that prevents sperm from reaching the semen, Prior groin/ scrotal or testicular surgeries like hernia repairs, vasectomy or injury
- Variococeles where there are abnormal bulging veins in the testicles and can result in low sperm production and poor sperm quality.
- Infections, STIs and tumors, Rise in the scrotal temperature
- Trouble with sexual intercourse like Retrograde ejaculation, premature ejaculation, erectile dysfunction, impotence. These may be due to chronic diseases, anatomical abnormalities or psychological problems or trauma to spinal cord.
- Over exposure to harmful chemicals, radiation and x-rays, smoking, alcohol or drugs
- Obesity, wearing tight or restrictive underwear.
- Hormonal imbalances and chromosome disorders, Anti-sperm antibodies
- Congenital absence of the vas deferens- In some cases, the tubes which transport sperm to the penis in the event of ejaculation do not develop before birth. A patient who has this condition may actually be producing viable sperm in the testes. A genetic condition called as cystic fibrosis needs to be ruled out.
Who should seek evaluation and treatment?
- Often they are without any symptoms.
- Change in sexual desire or problems with coital problems, change in hair growth, excessive breast growth or lump/ pain in the testicles can at times make these males visit a doctor. A fertility specialist is usually the first one to note these and/or abnormal semen tests.
- It is important to understand that even a man with normal sexual performance may suffer from infertility which may go unnoticed until he visits a fertility specialist.
- Cancer treatment can cause male infertility (men preparing to undergo radiation or chemotherapy are strongly advised to consult a reproductive endocrinologist or oncologist regarding fertility preservation guidance.
How can one test for male fertility?
Basic fertility check :
- Medical history: Diabetes, high blood pressure and other acute or chronic illnesses. Current medications, puberty history and changes noted if any, family history, infections like mumps, trauma or surgeries, coital history, Addictions if any. This gives an overview about a patient’s overall health.
- General physical examination and local examination: Obesity, tight underwear, increased breast size, Local examination of scrotum, testicular size& consistency, Varicocele, hernias
- Semen testing provides information pertaining to the number of sperm that have sound structure and shape (morphology), the quantity of production, sperm motility (movement), and sperm quality
If the basic check mentioned above identifies any deviations, it may be necessary for some men to undergo special tests like Hormone levels ( FSH, TSH, Testosterone) which can comment that sperm production is functioning at normal levels, antibody testing to confirm that antibodies are not killing sperm , genetic tests to confirm or rule out possible chromosomal issues, ultrasounds to assess abnormalities of the internal reproductive organs, biopsies to evaluate the presence of infection or malignancies, or rarely some sperm function tests to determine how well the sperm function and survive following ejaculation, and to determine if sperm are intact and moving the way they should.
Andrological evaluation in certain cases, helps to identify and treat subtle problems and forms a part of the comprehensive diagnostic service at Anmol Fertility &IVF Centre.
What does the treatment of male fertility involve?
There are a number of ways that a fertility clinic can treat male infertility, depending on the source of the problem.
As a clinic that offers infertility treatment in Mumbai, Anmol fertility & IVF Centre helps you and your partner expand your family in the best way possible using expertly designed, tailor-made treatment protocols.
The key principles and practices are:
- Making better lifestyle choices: Minimizing negative health habits such as smoking, being overweight and having an unhealthy diet would certainly help combat male fertility issues. Low levels of vitamin C and zinc can cause sperm to clump. It’s best to maintain a healthy diet with a healthy balance of vitamins. Optimizing overall health is the primary focus. Counselling is beneficial in such cases.
- Treatment for infections: It is important to diagnose and treat infection-related problems early to avoid lasting damages. Infections in the reproductive tract, sexually transmitted diseases or mumps as an adult sometimes causing scarring or blockage in the reproductive organs. Antibiotics as first line treatment and in more extreme cases, surgery is the best option for correcting scarring or blockages interfering with sperm production or ejaculation.
- Treatment for sexual dysfunction: Medication and counseling can often help men with this problem.
- Medical treatments: If high or low levels of certain hormones cause infertility, hormone medications are initiated. Antioxidants can improve the motility of sperms to a certain extent. Such medicines are usually prescribed for 3-6 months. However, it is important to remember that the efficacy of medicines would only be known after 3 months so it is futile to repeat the semen analysis before that.
- IUI: Collection, washing and concentrating healthy sperm that are then placed directly into the uterus.
- Surgeries: Varicocele repair, Vasectomy reversal, vaso epididymal anastomoses can help in selected cases.
- Surgical Sperm retrieval: For men who are unable either to produce sperm or to ejaculate, there are several methods for a doctor to retrieve sperm. These various techniques include retrieval through a needle and syringe or a small incision in the testes. The retrieved sperm is then used in combination with IVF-ICSI.
- Sperm donation: Use of another male’s sperm to fertilize a woman’s egg for IUI (D) or opting for IVF treatment process using donor sperms is an alternative approach.
By far the best and most successful treatment for most cases of sperm problems is escalating to IVF & ICSI, which is an advanced assisted reproductive technique (ART) and can be supplemented with further specialized techniques. It can help the couples to find answers to the daunting questions and help to realize the dream of parenthood.