Male Factor Infertility

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Male Factor Infertility

It is widely accepted that male factor alone accounts for about 40% of the causes of infertility and in 20% of cases there is combined male and female factor.
A couple seeking help for conception usually contacts a gynecologist or fertility centre where male factor as a cause of infertility is usually diagnosed on a simple
Semen Analysis.
Is there any male infertility specialist?
Urologist is a perfect doctor to assess the male partner as he completes the examination evaluation and management may it be medical, surgical or managing sexual problems if they are the cause.
The male partner has to undergo simple semen analysis twice within a period of 2 weeks to draw conclusion.
What is a good semen sample?
WHO has defined a set of parameters against which every semen sample is judged.
Latest WHO criteria
Vol (ml) – 1.5v ml
Sperm count – 15 million/ml
Total S.C. – 39
Total Motility – 40 %
Progressive Motility – 32% (A+B)
Vitality (% alive) – 58%
Morphology – 4%
Leukocyte – <1.0% If the sperm count is less than 15 million then it is termed as oligospermia. The chances of pregnancy decrease as the sperm count, if there are no sperms it is called azoospermia. Similarly, if movement (motility) of sperm is affected then it is called asthenozoospermia. If majority sperms are dead, it is termed as necrospermia. The WHO criteria refer the low normal cut off values of sperm parameters, the more the values of total number, progressively motile and normal morphological sperms, the healthier is the semen and more are chances to conceive. The male evaluation regarding fertility must go far beyond counting spermatozoa and assessing motility and morphology. It has to be supplemented with a proper clinical examination, a comprehensive history taking and relevant endocrine genetic or other investigations. Every couple attempting to conceive for > 1 yr. of unprotected intercourse or less in cases where female partners is > 30 yrs. Deserve medical evaluation that must include both partners irrespective of the semen analysis results.
It is known that 30% of men misdiagnosed as having unexplained male infertility according to normal semen parameter present sperm deficiencies that can be identified by sperm function tests such as assessment of DNA integrity, oxidative stress and antisperm antibodies.

What if male has poor semen parameters?
Complete evaluation by fertility specialist and urologist.
History :- The reproductive history should include coital frequency, timing, and childhood illness like mumps, developmental history and medical illness like diabetes, prior surgeries, diet, drug abuse, pesticide environment exposure tobacco use, air pollution, heat exposure (Occupational).

Physical Examination :- Ex. Of penis including location of urethral meatus (urinary orifice palpation of testis and measurement of thin size)
Presence and consistency of both vasa and epididymis
Presence of varicocele
Secondary sex characteristic including body habits, hair distribution and breast development.
Hormonal Evaluation :- These are part of initial assessment of male if there is low sperm concentration or Azoospermia or impaired sexual functions or specific endocrinopathy

  • FSH
  • Testosterone Level
  • Estradiol levels
  • KARYOTXPE in cases of Azoospermia

Specialized Tests on semen and sperm

  • Levels of Antisperm Antibodies
  • Sperm DNA damage
  • Genetic test
    • Karyotyping
    • Y chromosome microdeletion.
    • Cystic fibrosis gene mutation tests.

Conditions that can affect semen parameters
A. VARICOCELE: – These are dilated veins around the testis which are detected on physical examination and need treatment of varicocele are palpable or semen parameters are affected.
B. Environmental Factors: – environmental pollutants pesticides excessive heat has been linked to poor semen parameters.
C. Occupational Hazards: – People exposed to chemicals the head, (industries) Lindane, plastics, phthalates (used in plastic industry) are prove to be affected and these toxics can cause decreased in semen parameter.
D. Lifestyle Factors: – Diet, Obesity – Men who can classified as obese based on BMI (BMI>25) are at increased risk of infertility due to decrease in sperm concentration and increased DNA fragmentation obesity decreases circulating testosterone and increased estradiol level.
E. Smoking: – Tobacco smoke contains 4000 harmful substances that generate ROS and reactive nitrogen species that cause low sperm count, decreased motility and poor morphology.
F. Cell phone Radiation: – Microwaves produced by mobile phones significantly lead to oxidative stress and decreased level of antioxidant enzymes can lead to male infertility.
G. Heat, Stress, Exercise: – It is well known that testicles should be cooler than the rest of the body for optimal Spermatogenesis. Various recreational and occupational activities can increase testicular temperature like cycling, hot tubes or prolonged baths, long distance driving, furnace operators.

Treatment Modalities
Antioxidant Therapy
Oxidative stress occurs when there is an overabundance of ROS, a group of highly reactive chemical molecules that can oxidatively modify biomolecules. When high levels are present in the seminal fluid ROS can damage sperm by altering their membrane integrity thereby affecting motility, morphology and ultimately lead to sperm cell death. Antioxidants like NAC, Vitamin E, and Vitamin C, Selenium, Carnitine etc. help in different ways in improving sperm quality and improve the number in a selective group of patients. Different Antioxidants play different roles but the aim of giving these antioxidants in combination is to improve our results of ART. We should not expect that very poor semen parameters will improve and become normal and patient may conceive spontaneously. There should be a reasonable time and couples should not hesitate to resume to ART techniques because delay may not benefit them and may harm them instead by increasing mental stress, increasing age of female partner, chances of developing a problem in the female with time.

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