There are many causes of male infertility, from deficiencies in the semen, low sperm production, abnormal sperm function to blockages or obstruction in the passages which prevent the delivery of sperm.
When it comes to infertility, there are misconceptions galore. Combine this with the social norms in India which put a lot of emphasis on child-bearing, and the end result is women are invariably blamed for their inability to conceive. However, the truth is, according to WHO, the prevalence of infertility in the general population is 15 to 20 per cent, and male infertility factor contributes 20 to 40 per cent to this rate. Studies put the prevalence of male infertility in India at around 23 per cent. The bottom-line is infertility among men has been rising steadily in India over past few years.
What is infertility?
Infertility is a disease of the reproductive system defined by failure to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. —International Committee for Monitoring Assisted Reproductive Technology, World Health Organization (WHO)
There are many causes of male infertility, from deficiencies in the semen, low sperm production, abnormal sperm function to blockages or obstruction in the passages which prevent the delivery of sperm. Such blockages could be caused by injuries or infections of the genital tract. However, there could also be several external factors that contribute to infertility: smoking, excessive alcohol consumption, poor diet, lack of exercise, obesity, stress, exposure to certain chemicals and pesticides. Illnesses, injuries, chronic health problems, lifestyle choices can contribute to male infertility.
When symptoms arise, the social mindset in India delays timely help from being sought—in many cases, it is commonly seen that men are reluctant to get themselves tested due to misconception or embarrassment. This is why it is important for men and women to be equally aware of their bodies. Men should not shy away from seeking treatment for problems with sexual function. Difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction) could all contribute to male infertility. Additionally, abnormalities such as pain, swelling or a lump in the testicle area are something to watch out for.
How To Diagnose Male Infertility
The good news is the sooner you approach a specialist and establish a diagnosis, the sooner you can solve the issue. Diagnosis starts with a full medical history, physical examination, blood tests, general hormone tests, and semen analysis.
Semen analysis can show the level of sperm production and sperm motility (whether sperm are functioning well and are moving). Regardless of the result, even if the semen test shows low sperm numbers or no sperm, there are a variety of treatment options available.
Further tests such as transrectal ultrasound, testicular biopsy (to zero in on the cause of infertility as well as collect sperm for use in assisted reproduction techniques), hormonal profile, post ejaculation urine analysis to detect whether sperm are travelling backwards into the urinary bladder may be advised.
One of the major advancements in technology that has helped diagnose male infertility is the sperm DNA fragmentation test. This test is done to assess any problems in the genetic material of the sperm as it can find out if there is any DNA damage in the sperm. The Sperm Aneuploidy Test (SAT) is a diagnostic test to study the genetic background or cause of male infertility. It pinpoints chromosomal abnormalities in a sperm sample.
First and foremost, doctors advice addressing external factors with steps such as quitting smoking and alcohol, making lifestyle changes that control diabetes, obesity etc. Next, in case of any infection in the reproductive tract, antibiotic treatment can be suggested. Treatments for sexual intercourse problems in the form of medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation. Problems such as azoospermia (zero sperm count), oligospermia (few sperm are produced), due to blockage in the testes can be addressed with testicular sperm extraction, a technique where doctors can retrieve sperm from the testicles.
The various advancements in Assisted Reproductive Techniques (ART) have come as a boon to thousands of couples dealing with infertility across the world. Among the most popular techniques of assisted reproduction for the treatment of male infertility are intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). The treatment involves obtaining sperm through normal ejaculation, surgical extraction or from donor individuals. In IVF, the egg retrieved from the ovaries and fertilized by sperm in laboratory conditions, and the fertilized egg (embryo) is put back into the woman’s uterus. IUI involves placing the sperm into the woman’s uterus using a special tube. This method is often used when the man’s sperm count is low, sperm has low mobility or there is retrograde ejaculation. (ICSI) is a procedure in which sperm and eggs are retrieved from both partners, and then a single sperm is injected into an egg. The fertilized egg is then implanted into the woman’s uterus.
Advanced techniques such as Micro-TESE, IMSI and Sperm VD Cryopreservation Device are also available to help couples facing male infertility issues.
(Dr Hrishikesh Pai is Consultant Gynaecologist & Infertility specialist attached to Lilavati Hospital)
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