What is Male infertility?
Infertility is a common problem that can occur both in females as well as in males. A couple is said to be infertile if they are unable to conceive even after a year of regular unprotected intercourse. Conception is a complicated process and there are many obstacles. Though the psychological and physical consequences of not being able to bear a child is most of the time borne by women due to patriarchal nature of the society, 30% of the times, the case might be due to infertility issues in males. Fortunately, having an infertility issue doesn’t automatically mean that you won’t be able to have your own child. With early diagnosis and treatment, male infertility can be cured.
CAUSES OF INFERTILITY IN MALES
Male infertility can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm.
SIGNS AND SYMPTOMS:
- Problems with sexual function –
- Difficulty with ejaculation
- Small volumes of fluid ejaculated
- Reduced sexual desire
- Difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling/ lump in the testicular region
- Recurrent respiratory infection
- Any sign of chromosomal or hormonal abnormality
A lower than normal sperm count ( i.e Oligozoospermia or Azoospermia)
DIAGNOSIS:
- General physical examination and medical history – this includes asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgery that could affect fertility, examination of genitals.
- Semen analysis – semen samples should be provided by masturbating and ejaculating into a container obtained from the doctor’s clinic which is examined for the number of sperm present (Sperm Count), any abnormalities in the morphology and movement (Sperm Motility) in a lab. The lab will also check the semen samples for presence of any infections (increase in WBC count).
- Ultrasound – Scrotal or Transrectal USG to look for presence of any varicocoele, check for the status of the prostate, any blockages of the tubes that carry semen.
- Hormone testing – hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Blood tests are done to measure the level of testosterone and other hormones which when abnormal can lead to infertility.
- Post – ejaculation urinalysis – sperm in your urine can indicate sperm are travelling backwards into the bladder instead of out your penis during ejaculation (Retrograde ejaculation).
- Genetic tests – when sperm concentration is extremely low or nil, it could be due to genetic cause. Specialised blood tests and DNA Fragmentation tests on the semen samples can be done to rule out any congenital or inherited genetic abnormalities.
- Testicular biopsy – this involves removing samples from the testicles with a needle. If the results of the testicular biopsy show that the sperm production is normal, your problem is likely caused by a blockage or another problem with sperm transport.
- Specialized sperm function tests – like how well the sperm survives after ejaculation, how well they penetrate the egg, problem in attaching to egg etc. Rarely used and usually don’t significantly change the treatment protocols.
TREATMENT:
Even if an exact cause of infertility is not found, a doctor might still be able to treat both male and his female partner so that they might conceive. Treatments for male infertility include –
- Lifestyle changes like quitting smoking, alcohol, maintaining an ideal weight, healthy diet
- Surgery (in case of varicocele, obstructed vas deferens),
- Treatment of infections,
- Hormonal treatments,
- Treatment of sexual intercourse ( in the form of counselling or medication for erectile dysfunction/ premature ejaculation),
- ART (Assisted Reproductive Treatment)- extraction of sperm and direct injection into the female genital tract in Intrauterine Insemination ( IUI), Intracytoplasmic Sperm Injection ( ICSI), In – vitro Fertilisation (IVF).
What to do if the treatment doesn’t work?
Very Rarely there may not be any solution for the condition and it might be impossible for a man to father a child. In such cases, the doctor might suggest that the couple might consider using a donor sperm or adopting a child.
