50% of all couples with fertility problems have male factor issues partially or completely. Most of the male fertility problems can be reversed potentially. Even if you have a nor-mal semen analysis, your fertility potential might be lower than it could be.
Recently, an emerging concern has been raised about the overall increase in male infertility rates. Common causes contributing to male fertility issues are-
Abnormal sperm function & quality: Conditions that cause irregular shape (morphology) & movement (motility) of the sperm negatively affect fertility. For example, anabolic steroids, increased ROS production, as in diabetes, hypertension, renal disease, etc.
Hormonal disorders: Abnormalities in hormone production by the pituitary gland, hypothal-amus, & testicles may cause less or no sperm production.
Environmental & lifestyle factors such as smoking, excessive alcohol intake, obesity, etc., also affect fertility. Further, exposure to environmental pollutants & toxins can be directly toxic to gametes, resulting in decreased sperm production and poor quality.
Sexual dysfunction: problems with ejaculation (premature ejaculation or retrograde ejacula-tion), reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction) due to excessive stress, hormone imbalance, or nerve damage.
Obstruction of the reproductive tract: Low or absent semen ejection can occur due to blockage in the tubes that carry semen (such as ejaculatory ducts and seminal vesicles). Blockages are commonly due to injuries or infections of the genital tract.
Testicular failure: Unable to produce sperm due to genetic disorders and treatments that im-pair sperm-producing cells like chemotherapy/radiotherapy.
• Pain, swelling, or a lump in the testicle area
• Recurrent upper respiratory infections
• Inability to smell (anosmia)
• Abnormal breast growth (gynecomastia)
• Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
If you have been unable to conceive a child after a year of regular, unprotected intercourse, you can consult with a fertility doctor. Also, if you have any of the following:
• Erection or ejaculation problems, low sex drive, or other problems with sexual function
• Pain, discomfort, a lump, or swelling in the testicle area
• A history of any malignancy or treatments
• A groin, testicle, penis, or scrotum surgery
• A partner over age 35
Doctors will review your health history, do a physical exam, & ask for a semen analysis test-
• Semen analysis: After an abstinence period of 2-7 days, semen analysis is advised. Semen will be checked for the amount (volume), viscosity, color, pH, fructose, sperm concentration, total sperm count, motility, morphology, pus cells, etc.
• Specialised semen tests: vitality staining, sperm survival test, Reactive Oxygen Species (ROS) test, and DNA Fragmentation Index (DFI) are advised only in selected cases considering history and semen analysis report.
• Blood tests: Hormone levels are checked if low or absent sperm count is detected on semen analysis and if there is a history of sexual dysfunction or any sign suggestive of hormonal deficiency.
• Ultrasound imaging: ultrasound may be used to look for testicles, blood vessels, and struc-tures inside the scrotum.
Various treatment options are available to treat male infertility, depending on your problem.
Hormone treatment in the form of oral medication or injection may be prescribed if you have a hormone deficiency or imbalances causing infertility. Antibiotics, along with antioxidants, can be prescribed in case of any infection or high DNA fragmentation.
• Artificial insemination: In this method, a semen sample is prepared to concentrate high motility healthy sperm with the removal of dead cells and debris before putting inside the female partner's uterus at or near the ovulation time. These highly motile sperm can then make their way to the fallopian tubes to fertilize the egg.
• In-vitro Fertilization (IVF): In this technique female partners eggs (in natural/controlled ovarian stimulation cycle) are usually collected through transvaginal aspiration and mixed with prepared semen sample to facillitate fertilisation by its own inside the embryology labor-atory. Later, on the developed embryos were transferred into the female partners uterus to allow for implantation and continuation of pregnancy.
• Intracytoplasmic Sperm Injection (ICSI): In the process, collected eggs of female partners are injected with selected sperm from prepared semen samples with the help of micromanipulators inside the lab. This procedure is especially effective in severe male factor infertility.
3) Surgery: Surgery can help in the form of sperm retrieval techniques directly from the testis or epididymis in case of no sperms present in semen (Azoospermia). Surgery may be helpful in clinical varicocele affecting semen parameters and causing infertility. Also, surgery for correc-tion and anastomosis of the outflow tract in case of obstruction can be helpful in some cases.
Surgical Sperm Retrieval Techniques- Sperms aspirated directly from the origin site or testicular tissue retrieved and either frozen to be used later or used at the same time for ICSI.
• Percutaneous Epididymal Sperm Aspiration (PESA)- Sperms are aspirated with the help of a fine needle from the epididymis.
• Testicular Sperm Aspiration (TESA)- Sperms or tissue are aspirated directly from the testis.
Both the above procedures are usually recommended in Obstructive azoospermia (where the sperm production is normal but not coming out due to some blockage in the tract)
• Testicular Sperm Extraction (TESE) - This is done with a small incision in the testis, and tissue is taken to find the sperms, when there is a problem with sperm production or PE-SA/TESA fails.
• Microdissection TESE (micro-TESE) - It is a recommended procedure when there is a problem with sperm production (Non-Obstructive Azoospermia). It is performed with the help of a surgical microscope to get testicular tissue.
Check with your healthcare or fertility doctor for any questions or concerns about your condition.
