- 50% of all Couples with fertility problems have male factor issues, partially or completely.
- The majority of male fertility problems are potentially reversible.
- Even if you have a normal semen analysis, your fertility potential might be lower than it could be.
Let’s find out the causes of fertility problems in males, the available tests and the right treatment options.
In recent years, an emerging concern has been raised regarding the overall increase in male infertility rates.
Common causes contributing to male fertility issues are-
Abnormal sperm function and quality: Conditions that cause abnormal shape (morphology) and movement (motility) of the sperm affect fertility negatively.
For example, anabolic steroids increase ROS production as in diabetes, hypertension, renal disease, etc.
Hormonal disorders: Abnormalities in hormone production by the pituitary gland,
hypothalamus, and testicles can cause less or no sperm production.
Environmental and lifestyle factors such as smoking, excessive alcohol intake,
and obesity can affect fertility. In addition, exposure to environmental pollutants
and toxins can be directly toxic to gametes, resulting in decreased sperm
production and poor quality.
Sexual dysfunction: problems with ejaculation (premature ejaculation or
retrograde ejaculation, reduced sexual desire, or difficulty maintaining an erection
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 the 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 impair sperm-producing cells, such as chemotherapy/radiotherapy.
-Apart from the inability to conceive by the female partner, there may be
other symptoms like:
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
–When to see a doctor?
Consult with a fertility doctor if you have been unable to conceive a child after a
year of regular, unprotected intercourse or earlier 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
–How is male infertility diagnosed?
Your doctor will review your health history, do a physical exam, and 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.
Specialized semen test: 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 structures inside the scrotum.
–How is male infertility treated?
Various treatment options are available to treat male infertility, depending on your
problem.
1) Medical treatment:
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.
2) Assisted Reproductive Techniques (ART):
Intrauterine insemination (IUI): In this method, a semen sample is prepared to
concentrate high motility healthy sperms with the removal of dead cells and
debris before putting it inside the female partner’s uterus at or near the
ovulation time. These highly motile sperms 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 collected through transvaginal aspiration and mixed with a prepared semen sample to facilitate fertilization inside the embryology laboratory. Later on, the developed embryos were transferred into the female partner’s 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 correction and anastomosis of the outflow tract in case of obstruction can be helpful in some cases.
Surgical Sperm Retrieval Techniques- Sperms are 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 due to some blockage, sperm are not able to travel down the tract)
Testicular Sperm Extraction (TESE)- This is done with a small incision in the testis and tissue are taken to find the sperm, when there is a problem with sperm production or PESA/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 obtain testicular tissue and retrieve sperm.
Please check with your healthcare or fertility doctor for any questions or concerns about fertility.
Dr. Lavi Sindhu
Fertility & IVF Specialist