It is a fact that over 8 to 10 million people in India alone are infertile and many of these couples are unable to deal with the enormous stress which is related to the condition. The incredible staff at Genesis my basic work up clinic for infertile couples and at ‘The centre of IVF and Human Reproduction’ at Sir Ganga Ram Hospital New Delhi take an initiative to reduce the stress level of such couples as well as work together with the patient and their partner as a team to develop a scientific treatment plan that will make the best use of the resources available to solve their problem as quickly, safely and inexpensively as possible. Infertility is the inability to conceive after one year of trying with unprotected intercourse for couples in which the female is under 35 years of age and six months of trying for couples in which the female is over 35 years. However, if the couple feels that they need to be evaluated earlier due to a known previous cause or advanced age of partners, one can seek consultation earlier. Approximately one in six couples are infertile and there are a number of factors, both male and female, that can cause the condition. In fact, in only one-third cases of infertility, the cause is attributed to the female. In another one-third the male partner is responsible. The final one-third of the cases are of unexplained infertility where no obvious cause is identified in the initial visits. Once the cause of infertility has been determined, a plan can be customized for the patient to fit their unique situation and move them along on the path to conceiving a child. In fact, nearly 90% of infertility cases are treatable with medical therapies such as drug treatment, surgical repair of reproductive organs to resurrect their pelvic anatomy & function coupled with assisted reproductive techniques such as intra uterine insemination (IUI) and in vitro fertilization (IVF). A common myth related to infertility is that the woman is almost always to blame. In fact, for infertile couples, male reproductive issues account for roughly 30 percent to 40 percent of problems. An issue with sperm can be the sole problem of infertility, or it can simply be one of many factors.
We can determine whether “male factor infertility” is a reason for concern. During the initial screening, we evaluate the male partner completely and perform a semen analyses. The man’s medical and surgical history is very important especially surgeries around the genital area in the past as well as any coital difficulties which he may be facing. During the semen analysis, the doctor could spot abnormalities and recommend a more thorough examination by a specialist. Problems include low sperm count or motility or unhealthy morphologically abnormal sperms. Both diagnoses and treatment techniques have come a long way when it comes to male factor infertility. In addition to in vitro fertilization, therapies are available to help a man boost his sperm count and overall sperm health. With in vitro fertilization, the sperm need not worry about the long trek to the egg, and a specialist can actually insert the sperm into the egg (ICSI), making fertilization that much easier. My IVF lab is fully equipped and able to conduct a full evaluation
1. What causes male infertility? The problem can lie anywhere from semen production to semen deposition in the vagina. They can be divided into three broad categories:
Mostly the cause could be identified as hormonal problems, ingestion of toxic drugs, smoking or tobacco consumption in any form, generalized conditions like liver or kidney insufficiency, or local conditions like varicocoele, testicular tumors, torsion, previous surgeries in the genitalia, testicular trauma etc. but in more than half the cases the cause remains unknown.
2. How does one ascertain that infertility is because the male partner?
By taking a thorough history of ingestion of toxic drugs, viral infections or surgeries around the genital area in the past, by doing a complete physical examination and semen analysis, one would know grossly if the male partner is responsible for infertility or not. If semen examination is found to be abnormal, further tests like, hormonal tests, ultrasound, chromosomal analysis, testicular biopsy or other blood tests may be needed.
3. Is semen deficiency correctable?
Semen deficiencies can be corrected only if a correctable cause can be found. Hormone replacement therapy in cases of pituitary gonadotropin deficiency (hypergonadotropic hypogonadism), antibiotics for 6 to 12 weeks for genital tract infections & withdrawal of medications interfering with fertility or causing erectile and ejaculatory dysfunction are the different treatment options available. Empirical treatment with testosterone, clomiphene citrate, bromocriptine, pentoxiphyline, Vitamins C, E, Zinc and other antoxidants has been tried with very little improvement if any. Surgical correction can be done for some types of blocks in the path of semen travel and severe varicocoele. However, most semen defects are irreversible and empirical treatment administered with drugs to improve semen quality is ineffective.
4. What measures can be undertaken to enhance fertility for couples with near normal or slightly deficient semen?
Reassurance and timed intercourse is the first step if the female partner is normal. However, if the couple is stressed and wants treatment, 4 to 6 cycles of intrauterine insemination is a good option.
5. What measures can be undertaken to enhance fertility for couples with severely deficient semen?
Such patients are better suited for in-vitro fertilization with intra-cytoplasmic sperm injection (IVF-ICSI).
6. What can be done if there are no sperms in the semen?
If no sperms are found even after centrifuging the semen sample during analysis, then sperms can be retrieved from the testes by techniques such as PESA, TESA or TESE and can be successfully used for conception by IVF- ICSI. However, if no sperms can be found in the testes or the couplecannot afford IVF- ICSI (which is a high cost treatment), then donor semen can be used with IUI in the wife for achieving a pregnancy.
7. Is there a possibility of any genetic abnormality in the child with the use of testicular sperms?
No, the baby is as normal as in an IVF conception with normal sperms. However, azoospermia or severe oligo-spermia may be associated sometimes with chromosomal abnormalities in the male partner which could lead to the same semen defect in the male child. Genetic screening is at present available only for detection of few abnormalities such as cystic fibrosis gene mutation (in congenital bilateral absence of the vas deferens), Kleinfelters syndrome, and Y-chromosome micro deletions. The results will help to prognosticate the genital status of the offspring.
8. What can I do to ensure good reproductive health?
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 larger 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 we may need to consult our doctor to change them. Wearing loose cotton undergarments and cold baths have been 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 for long periods might lower sperm counts and motility.