Historically, infertility has largely been attributed to the female. However, in reality , it affects men and women almost equally. Female related factors account for 40% of infertility , with male related factors accounting for another 40%. A combination of male and female related factors account for about 10% of infertility , while the remaining 10% of infertility is due to unexplained causes. Thus, the male may contribute to infertility in about 50% of couples . Therefore, it is important for both partners to understand the problems and discuss treatments with their doctors as a couple.
Male infertility may be caused by a number of factors, including problems with sperm production, blockage of the sperm delivery systems, antibodies against sperm, injury to the testicle, problems relating to hormone production , anatomical problems or the presence of a varicose vein around the testicle (varicocele) - all of which may affect sperm quality and quantity. Past illnesses, infections, various diseases and medications can also cause infertility.
Whatever the cause, coping with infertility is never easy. Many men believe that society views infertility as a sign of inadequacy and thus, may suffer from feelings of poor self-esteem. Some men feel robbed of their masculinity and virility as well. These feelings are normal. The key to resolving these issues is communication. Whether the difficulty in conceiving is related to the male or female , infertility should be approached as a couple's shared challenge. Supporting each other and working together can strengthen the relationship while overcoming the challenge of infertility.
It is important to note that about 70- 80% of all infertility can be traced to specific causes that can be treated. Many treatment options are available to treat male infertility. These options range from medical therapy to surgical procedures, and success rates are steadily improving.
There will be a decrease in fertility if the sperm are:
Not being produced in adequate numbers (or not at all)
Being produced, but facing an obstruction that prevents them from reaching the outside world
Being produced, but not swimming very well
Stimulating antibody production in either partner by causing an allergic reaction
Some of these causes can be treated surgically, but in most cases assisted conception or donor sperm are the best options.
"Andrology" means science developed to study and help Male Reproductive Malfunction. In Pune city, IVF- PUNE provides state-of-the-art diagnostic andrology services. Our procedures more than comply with current World Health Organization standards." IVF-Pune"has all the systems required to help the Infertile Male Parttner viz.Expert clinical work-up, Endocrine tests, Imaging including Ultrasound of Scrotum, Trans rectal imaging of Seminal Vesicals & Prostate,Colour Doppler studies for Varicocoele and Erectile Disorders, Testicular Biopsy , Epididymal & Testicular Sperm Retrieval in Azoospermic males,IVF & ICSI in severe male factor infertility, Genetic Counselling, guidance for marital and sexual problems and anxieties, frozen semen (AUTOLOGOUS/ HOMOLOGOUS).
The semen analysis
Testing for male infertility is a very straightforward process and it's another service we can offer.
A semen analysis will examine three factors:
Sperm count - the number of sperm per ml of ejaculate
Sperm motility - the sperm's ability to swim
Sperm morphology - the shape of the sperm.
A 'normal' sperm count will have:
An overall volume of at least 2 mls
A sperm density of more than 20 million sperm per ml
A motility of 50% or better ( the percentage of sperm cells present that are moving )
A proportion of normal forms of 15% or greater
That is not to say that couples will not get pregnant, even with a much lower count (after all, it just takes one sperm), just that the chances of pregnancy are reduced by low sperm counts or sperm that do not swim well.
The complete absence of sperm in the ejaculate (azoospermia) can be either because of a blockage in the epididymis or vas deferens, or a problem with the actual production of sperm in the testicles. A blockage can sometimes be overcome by microsurgery, and even if sperm are not being produced, it may be possible to surgically extract enough sperm cells from the testes to use for ICSI.
If all else fails, using donated sperm can be an option.
Morphology and motility
Abnormal morphology (what the sperm looks like) and poor motility can prevent the sperm from reaching the egg. The sperm need motility to be able to swim well and survive for a number of hours in the female reproductive tract. If they do meet, abnormal-looking sperm might be incapable of fertilisation.
Anti sperm antibodies
Antibodies are the body’s natural defence against foreign objects. They are part of the immune system. Sometimes a woman’s immune system can recognise her partner’s sperm as foreign and develop antibodies against them. Men can even develop antibodies against their own sperm! This is most common in men who have had a vasectomy reversal.
The antibodies can attack the sperm by paralysing them, causing them to clump together or coating them so that they can’t fertilise the egg. Antibodies will be found in the semen, the cervical mucus, or either partner’s blood.
The following male fertility tests can be performed at IVFPune.
Semen analysis -Tests the overall appearance, acidity/alkalinity and volume of the semen, measures the sperm concentration, motility and vitality, and assesses morphology.
Semen microbiology - Detects bacterial infections of the urinary tract that might affect sperm function.
Trial wash - Evaluation of semen for various assisted conception procedures. Depending on the quality and number of sperm, different methods of assisted conception can be recommended (this is a test to see “how the sperm cells scrub up”!).
Retrograde ejaculation evaluation - Determines whether ejaculation is in fact retrograde and whether sperm can be successfully isolated from the urine for an assisted conception procedure.
Genetic tests -Ffor men with severely depressed sperm counts, a genetic basis can be identified, and the likelihood of passing the condition on to the children can be assessed.
Antisperm antibodies - Tests can be performed on the semen, the cervical mucus or the blood of either partner to detect the presence of antisperm antibodies.
Sperm-cervical mucus interaction tests - Look at the ability of the sperm to survive in and to penetrate the cervical mucus. This can be done either by mixing the semen and mucus together in the laboratory, or by taking a sample from the cervix after sex.
Assisted conception treatments
Assisted insemination - If the sperm count is high, assisted insemination can have some success. Careful washing and preparation of the sperm activates them so that they enter into the high energy state needed to fertilise the egg.
Donor insemination - For more serious cases of male infertility, donor insemination was for a long time the only answer. This is where the sperm of another man is used to inseminate your partner. The child is genetically that of the donor, but legally that of the couple. Donor insemination is still available, although today we have methods of overcoming even very severe male infertility.
In vitro fertilisation - IVF can be effective for lowered sperm counts because the sperm and egg are brought together in the small space of a special plastic dish, improving the chance of fertilisation.
Sperm microinjection - Since the development of ICSI (intra-cytoplasmic sperm injection), fertilisation can be achieved even when there are hardly any sperm in the ejaculate. A single sperm is injected directly into the body (cytoplasm) of the egg, bypassing most of the barriers to fertilisation.
Surgical sperm extraction - When there are no sperm in the ejaculate or if the sperm are severely affected by antisperm antibodies, sperm can now be retrieved directly from the testes (testicular sperm extraction - TESE) or the epididymis, which joins the testis to the vas deferens (epididymal sperm aspiration - ESA). ESA or TESE can be used in conjunction with ICSI to achieve fertilisation, even when there is only one sperm per egg! Immature and poorly swimming sperm are also usable with ICSI because they don't need to swim to the egg in order to fertilise it.