By Dr Nirmal Bhasin

Whenever, we speak of infertility the woman is blamed in our society. She is treated as a curse in the family. Of 100 infertile couples, approximately 30 report with problems in the female partner, 30 with problems in the male partner and 40 report with problems in both the partners. The male counterpart contributes to 50% of the causes of infertility. In our clinical practice we see patients coming with multiple tests conducted on the female and a single semen analysis in the male is not done. In about 90% of infertile patients the husband does not accompany them to the clinic. The denial to accept their problem makes it very difficult to treat the couple.

How does conception take place?

Although conceiving a child may seem to be simple and natural, the physiological process is quite complicated and depends on the proper function of many factors:

Production of healthy sperms in the man

Production of healthy eggs in the woman

Unblocked fallopian tubes that allow the sperm to reach the egg.

The sperms ability to fertilize the egg

The ability of the fertilized egg to implant in the uterus (womb) of the woman

Adequate embryo quality

What are the risk factors for men regarding infertility?

• History of genital infections or prostatitis

• Testicular trauma or torsion

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

• Occupational hazards such as exposure to toxic substances like lead,cadmium,mercury,radioactive and X-rays

• Smoking of cigarettes or Marijuana. Intake of drugs like opium, tobacco, zarda and khaini.

• Heavy alcohol consumption.

• Exposure of genitals to high temperatures

• Undescended testicles and hernia repair

• Mumps after puberty.

What causes male factor infertility?

• Sperm disorders: Production and maturation of sperms are affected due to different factors. Sperm may be immature, abnormally shaped or unable to move.Or, normal shape sperm may be in very low numbers or absent. The conditions causing these problems are listed below:

1) Anatomical problems: Obstruction of the genital tract, presence of varicose veins in the scrotum, immotile cilia syndrome (non motile sperms), other factors like premature ejaculation or impotence.

2) Infections such as the mumps virus

3) Endocrine or hormonal disorders

4) Immunological disorders where men produce antibodies to their own sperm

5) Environmental and lifestyle factors

6) Genetic diseases i.e. cystic fibrosis (absence of the vas deferens), sex reversal syndrome (a male who has the sex chromosomes of a female instead of a male XX instead of XY), androgen receptor gene mutations (the man is genetically male but has a defect in the receptors for the male hormone testosterone), Klinefelter’s syndrome (Men with an extra X chromosome-46, XXY), chromosomal derangements (deletion of the Y chromosome) It is important to understand that men who have genetic problems can pass this problem to their sons.

How is male infertility diagnosed?

In addition to a complete medical history and physical examination, diagnostic testing for male infertility includes the following: Multiple semen analysis-at least two semen samples are collected on separate days to examine the volume, consistency, pH, sperm count, motility and morphology (shape). Hormonal tests –In case of very low count or absent sperms. Ultrasound and surgical opinion in case of varicose veins What is the treatment for male factor infertility?

Treatment for male factor infertility is based on: The age, overall health and medical history, extent of the disease, tolerance for specific medications, procedures, or therapies Patient’s opinion or preference

 Treatment options for male factor infertility: Assisted reproductive technologies (ART)

• Artificial insemination-it involves the placement of large number of healthy sperms into the female partner’s uterus bypassing the cervix to have direct access to the fallopian tubes.

• Donor insemination – it is the same as artificial insemination but involves the placement of sperms from a donor with the consent of both partners.

• IVF and other techniques: In vitro fertilization offers the opportunity to prepare the sperms at optimum concentration, of high quality and allow them to fertilize with the oocytes outside the body.

• Microsurgical fertilization (ICSI-Intra Cytoplasmic Sperm Injection): This treatment is used to facilitate sperm penetration by injection of a single sperm into the cytoplasm of a single oocyte under the microscope. Fertilization is assessed under the microscope after 48 hours and the fertilized embryo is transferred into the uterine cavity.

• Drug therapy: Some hormonal disorders can be treated with hormonal therapy

• Surgery: Surgical therapy is designed to overcome anatomical disorders like varicose veins, which when removed can improve the sperm quality.

(The author is a Chandigarh-based infertility specialist)

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