In the last few decades, male infertility in India has been on a steady rise. At the international conference on Challenges in Infertility Management (CIIM) in 2014, experts observed that male infertility now contributes to 6 in 10 of all infertility cases in the country. In most cases, low sperm count is the underlying cause.
Being diagnosed with infertility can be particularly hard for a man to cope with. The ability to father a child is still believed to be a man’s greatest virtue, and failure to do so can leave him feeling heartbroken, even depressed.
Since a large number of men avoid discussing the issue openly, male infertility is often confused with impotence. While impotence means the inability to attain or sustain an erection during sexual activity, infertility is the inability to have a child, often caused by problems with sperm production. Thus, a man can be sexually active and yet be infertile.
Unlike impotence, male infertility may present no physical symptoms, and therefore can go undiagnosed for a long time.
Causes of Male Infertility
Sperm related problems are identified as the main cause of male infertility worldwide, and may be classified as follows:
- Oligospermia: The number of healthy sperm produced is abnormally low (less than 20 million/ml).
- Azoospermia: No sperm is produced at all.
- Asthenospermia: Poor sperm motility. Motility is the ability of the sperm to swim and move forward in a straight line through the female reproductive system to reach the oocyte (the egg).
- Abnormal sperm morphology: When a sperm has abnormal shape, size or structure, it cannot fertilize the egg.
These anomalies are detected through a detailed semen analysis, which is the first step in the treatment of male infertility. Semen analysis is preceded by a thorough physical examination of the male partner and complete medical history of both partners.
Based on the findings of the semen analysis, further investigation is undertaken to determine the root cause of the problem.
Factors which may inhibit sperm production and healthy functioning of the male reproductive system include:
· Varicocele, a condition marked by enlargement of veins present in the scrotum, the sac that holds the testicles.
· STDs (sexually transmitted diseases) can cause scarring of the male reproductive organs and obstruct sperm production and movement.
· Viral infections such as smallpox and mumps and diseases such as tuberculosis, prostatitis, liver disease and renal disease also impact sperm production.
· Alcohol, smoking and drug abuse are known causes of male infertility.
· Genetic disorders, structural abnormalities or birth defects in the male reproductive organs can impair reproduction.
· Hormonal imbalance such as low levels of testosterone may alter sperm production.
· Exposure to heavy metals, toxins, chemicals or medications can affect sperm function.
· Aging affects sperm production, motility and quality.
· Excessive stress. In a recent article, we discussed how stress can impact the natural reproduction process click here
· Some studies link poor sperm production to non-medical factors such as poor lifestyle, unhealthy diet, increased consumption of processed foods, and the burgeoning trend of late marriage. For example, obesity is known to alter hormonal levels, which in turn affects sperm production.
Challenges in treating Male Factor Infertility in India
• Social stigma attached to male infertility discourages men from confronting the problem and seeking treatment.
• Most people believe that infertility clinics treat only female infertility.
• Impotence is often mistaken for infertility, leading men to resort to alternative treatments such as herbal products to improve sexual performance.
• Most couples delay treatment assuming the problem would resolve itself over time, which only worsens the situation.
• Delayed treatment of male infertility reduces the chances of successful conception.
• As male infertility is still largely misunderstood, many infertility treatment centres still rely on conventional treatment via medicines and injectables. In severe male infertility, such treatments often prove futile.
• Driven by the desperation to conceive, patients tend to pressurise the fertility doctor to prescribe magic pills to improve sperm count. Unnecessary medication causes delay in appropriate treatment of the root cause.
Male Infertility Treatments Gaudium
Gaudium IVF centre employs advanced technologies to treat both male and female infertility. Whenever necessary, treatment for male factor infertility is combined with women’s infertility treatments such as IUI (intra-uterine insemination), IVF (in vitro fertilization), ICSI (intracytoplasmic sperm injection) and GIFT (gamete intra-fallopian transfer).
In such cases, both partners undergo simultaneous procedures where high quality sperm are selected, prepared and combined with the female egg for fertilization. Fertilization may occur in a lab dish (IVF/ICSI) or in the womb (IUI).
IUI (Intrauterine Insemination)
IUI is a simple and cost-effective treatment beneficial for men with mild male factor infertility. In IUI, the semen obtained from the male is ‘washed’ to remove seminal fluid and any dead sperm. The healthy sperm thus obtained are placed into the woman’s uterus using a thin tube called a catheter. The procedure is timed to coincide with the woman’s ovulation.
For IUI to be successful, it is first ensured that the woman’s fallopian tubes are free of blockage.
TESA (Testicular Sperm Aspiration)
In case of nil sperm, TESA-ICSI is known to be the one of the most effective treatments in helping couples conceive. As no sperm is present in the ejaculated semen, a small needle is used to collect a small piece of tissue from the testes.
The sperm retrieved from the tissue is ‘prepared’ and injected directly into the egg retrieved from the female’s ovary. This procedure is known as ICSI which is an advanced form of the conventional IVF treatment.
ICSI is particularly beneficial for men with low sperm count as injecting high quality sperm directly into the egg maximizes the chances of successful fertilization.
A noteworthy example is of a 31-year-old Gaudium patient who reported to us with nil sperm in the semen sample. The couple had been married for more than nine years and were trying to have a baby for the past five years. Gaudium fertility specialists counselled the couple about TESA-ICSI. The wife underwent IVF and on the day of the egg-retrieval, TESA was done for the husband. After successful fertilization in the lab, embryo transfer was performed through ICSI. The patient conceived and delivered a healthy baby in the very first attempt.
PESA (Percutaneous Epididymal Sperm Aspiration)
This is a simple technique often combined with ICSI. PESA is performed for men who have a blockage in the vas deferens (the tube that transports sperm from the testicle to the urethra).
The procedure of sperm aspiration is similar to that of TESA; the only difference is that the seminal fluid is collected from the vas deferens instead of the testes. This is followed by ICSI procedure as explained above.
Sperm production is affected by the levels of the hormones testosterone and estrogenin the body. In such cases where hormonal imbalance is detected, medication may be prescribed to restore normal hormone levels.
Some men require surgery to remove a blockage that may be affecting production or release of the sperm. Common surgeries for this purpose include varicocelectomy, epididymovasostomy and vasovasostomy (vasectomy reversal).
In a rare case when male infertility is found to be incurable, couples may choose to use donor sperm to achieve pregnancy. As the sperm is in frozen state, it is first thawed and then implanted into the uterus using IUI.
Today several treatment alternatives are available for men diagnosed with male infertility. Gaudium infertility specialists have successfully treated mild-to-severe male factor infertility for thousands of couples. Since 2009, Gaudium Infertility Clinic has assisted more than 6,000 couples have a child of their own.
For a consultation with Dr. Manika Khanna, India’s leading infertility specialist, please click here.