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 Challenges
•
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.
Medical Challenges
•
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.
Medication
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.
Surgery
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).
Donor Sperm
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.
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