Male Factor Infertility

Infertility is not just a disease that affects women, men suffer as well. Many infertile men have surgically or medically correctable disorders that, if properly diagnosed and treated, can be overcome to allow natural conception. In others, there may be mild semen abnormalities which are amenable to Intrauterine Insemination (IUI). If all the above is futile or fails, In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) offers men a realistic chance to father children. Donor sperm remains an option of last resort.

  • Can Infertility be a male problem?

Yes, the incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 10-30% of the cases. Problems common to both partners are diagnosed in 15-30% of infertile couples. After thorough medical investigations, the cause of the infertility remains unexplained in 5-10% couples.

  • What are the risk factors for men regarding infertility?

The following is a list of risk factors related to male:

    • History of prostatitis or genital infection

    • Testicular trauma or torsion

    • History of precocious puberty (puberty occurring at a young age) or delayed puberty (puberty occurring at an older age)

    • Exposure to toxic substances or hazards on the job, such as lead, cadmium, mercury, ethylene oxide, vinyl chloride, radioactivity, and X-rays

    • Cigarette or marijuana smoking

    • Heavy alcohol consumption

    • Exposure of the genitals to high temperatures

    • Hernia repair

    • Undescended testicles

    • Prescription drugs for ulcers or psoriasis

    • DES taken by mother during pregnancy

    • Mumps after puberty

  • How is male Fertility evaluated?

The initial step in the evaluation of the male partner is a physical examination and a complete medical history. After this, a Semen Analysis is performed. The Semen sample is normally collected in a sterile container by masturbation; preferably the sample should be collected at the center where the semen analysis is being performed.  The semen test gives information about the volume of semen the number of sperms, movement etc. You can refer to the WHO guidelines for normal semen analysis given on the link Click Here. If the Sperm Count is normal and the sperms exhibit normal mortality, male factor can usually be excluded. If the results are abnormal, the test should be repeated after a gap of about 10 weeks to reconfirm previous findings. Hormonal blood tests may then be used to further evaluate the male partner. If semen analysis is not within normal limits you may be advised to seek opinion from an andrologist

  • What is the treatment for male factor infertility?

There is a range of treatment options currently available for male factor infertility. Treatment may include:

    • Assisted reproductive technologies. This type of treatment may include the following:

    • Artificial insemination (IUI): This procedure involves the placement of relatively large numbers of healthy sperm either at the entrance of the cervix or into the partner’s uterus, bypassing the cervix, to have direct access to the fallopian tubes.

    • IVF: In vitro fertilization (IVF) has been used for the treatment of male infertility. As is the case with artificial insemination, offers the opportunity to prepare sperm in vitro, so that oocytes are exposed to an optimal concentration of high quality, motile sperm.

    • Microsurgical fertilization (microinjection techniques, such as intracytoplasmic sperm injection). This treatment is used to facilitate sperm penetration by injection of a single sperm into the oocyte. Fertilization then takes place under the microscope.

    • Drug therapy. A small percentage of infertile men have a hormonal disorder that can be treated with hormone therapy. Hormonal imbalances caused by a dysfunction in the mechanism of interaction between the hypothalamus, the pituitary gland, and the testes directly affect the development of sperm (spermatogenesis). Drug therapy may include gonadotropin therapy, antibiotics, or another medication deemed appropriate.

    • Varicocele Surgery.  is designed to overcome anatomical barriers that impede sperm production and maturation or ejaculation. Surgical procedures to remove varicose veins in the scrotum (varicocele) can sometimes serve to improve the quality of sperm.

    • TESA (Testicular Sperm Aspiration), TESE (Testicular Sperm Extraction),     PESA (Percutaneous Sperm Aspiration), Micro TESA.

 

  • What is Artificial Insemination (IUI) and what is its role in treating Male Infertility?

Intrauterine Insemination (IUI) is one of the most commonly used Assisted Reproductive Techniques (ART) to treat infertility. The IUI procedure bypasses the cervix and places sperms directly into the uterus, closer to the fallopian tubes, around the time of ovulation. This ensures a better chance that more sperm will make their way closer to the egg. IUI is commonly used when the male partner has a low Sperm Count, poor Motility, problem in developing an erection or inability to ejaculate. IUI is generally combined with Controlled Ovarian Hyperstimulation so that the number of eggs available to fertilize is greater than in normal circumstances.

  • What does Sperm Preparation mean?

For IUI, the semen sample is processed by one of the various techniques – centrifugation & washing layering or selecting the best sperm by making them swim though a denser medium and using those that succeed. The process of sperm preparation filters progressively motile & morphologically normal sperm and removes the immotile sperm, immature germ cells, leukocytes & infective agents.

  • What is ICSI and what is its role in contemporary management of Male Infertility?

Intracytoplasmic Sperm Injection (ICSI) involves the insertion of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a special microinjection pipette (glass needle). For couples with severe male factor infertility, this procedure is preferable to IVF. ICSI frequently permits the establishment of pregnancy in even the most difficult types of Male Infertility. ICSI is recommended for you based on the results of the semen testing and a few other risk factors.

  • What is TESE or MESA?

In TESE (Testicular Sperm Extraction), Sperms are collected from the testicles after operation.
In MESA (Microsurgical Epididymal Sperm Aspiration), sperms are collected out of the epididymis after operation.
If sperm cells are obtained, an ICSI procedure will follow. When the testicles make no sperm cells all, TESE or MESA is not possible.

  • What is IMSI? Is it a miraculous new treatment for Male Infertility?

IMSI stands for ‘Intracytoplasmic Morphologically Selected Sperm Injection’. It involves examining the semen sample under an extremely powerful microscope to pick out the best appearing sperm, which are then used in the ICSI protocol. An efficiently performed ICSI, carried out by a competent embryologist already ensures that good quality sperms are picked up. Evidence based medicine is yet to conclusively prove the advantages of IMSI over ICSI in terms of pregnancy rate sand long term outcomes.

  • What are the effects of smoking and recreational drug use?

Smoking recreational drugs and even anabolic steroids are associated with reduced sperm quality.