Male Infertility: Expert Diagnosis and Treatment Options
Infertility is a problem that is linked to the reproductive health of males and females. Male infertility is a situation that affects many happy couples across the world, where a man is unable to conceive after one year of regular, unprotected intercourse with a fertile female partner. This can be mainly due to poor sperm motility, abnormal sperm morphology, or low sperm count.
Male infertility is an important cause of infertility that directly impacts the psychology and physiology of the happy couple. According to WHO males with sperm parameters below the given normal values are considered to have infertility factors with the expert guidance of Dr Ravi Gupta.
Out of all infertility cases, approximately 40–50% are due to “male factor” infertility. There are no reliable figures for the global prevalence of infertility, but estimates suggest that nearly 72.4 million couples across the world experience fertility problems. As per the WHO estimates 60–80 million couples globally suffer from infertility. In India it was estimated that 40% of infertility cases were related to men, 40% of women, and 20% of both sexes. In Indian couples seeking treatment, the male factor is the cause of approximately 23%. A report on infertility in India estimated that nearly 50% of infertility is related to reproductive disorders in the male.
Causes of Male Infertility
I. Medical conditions
Varicocele –
A varicocele is a situation where swelling of the veins occurs that drains the testicle. It is the common reversible cause of male infertility. However the main reason that varicoceles cause infertility is not known, it can be due to abnormal blood flow. Varicoceles mainly lead to reduced sperm quantity and quality.
Hormonal Imbalance –
Infertility may be due to disorders of the testicles or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid, and adrenal glands. Low testosterone levels and other hormonal problems are also affecting the male infertility rate.
Genetic disorder –
Genetic disorders like Klinefelter’s syndrome in which a male is born with two X chromosomes and one Y chromosome (rather than one X and one Y) result in abnormal growth of the male reproductive organs. More genetic syndromes related to male infertility consist of cystic fibrosis and Kallmann’s syndrome.
II. Lifestyle factors
Smoking and Alcohol use – By smoking man is having less sperm count as compared to without smoking men. Smoking directly reduces the sperm count. By drinking alcohol men get lower testosterone levels, which cause erectile unfit and decrease sperm production. Liver-related disease due to excessive drinking may lead to fertility problems.
Diet and obesity – Obesity in males directly causes hormonal imbalance which leads to problems in sperm count and testosterone level. A healthy diet is also needed to maintain the body fit and have good values of hormones.
Stress and mental health – A cheerful person has good mental health and stress levels are also less, making a body more capable of maintaining hormonal levels.
III. Environmental factors
⮚ Exposure to toxins and chemicals
These environmental factors lead to reduced sperm production or sperm function, which affects the fertility of men.
⮚ Radiation and heat
Exposure to radiation and heat are causes of reduction in sperm production. High doses of radiation directly reduced sperm production permanently.
Diagnosis of Male Infertility
❖ Initial Evaluation –
a) Medical History and Physical Examination
This examination includes asking questions about genetic disorders, conditions, chronic health problems, injuries, surgeries, or diseases. It may also include questions related to sexual habits and puberty period changes in sexual growth.
b) Semen Analysis
Initially, Semen samples are collected under this process by using different ways as comfortable to the patient. Then this semen sample is sent to a laboratory to measure the sperm count present find any problem in the shape (morphology) and movement (motility) of the sperm and check for any infection.
❖ Advanced Diagnostic Tests
a) Hormone evaluation
Hormones formed by the pituitary gland, hypothalamus, and testicles play a vital role in sexual growth and sperm production. Any disorder in other hormonal or organ systems may result in infertility. A blood test is needed to measure the level of testosterone and other hormones.
b) Genetic testing
When sperm count is very low, it may be due to genetics. A blood test can figure out any subtle changes in the Y chromosome which are signs of a genetic abnormality. This testing also helps in finding various congenital or inherited syndromes.
c) Imaging studies (ultrasound, MRI)
Ultrasound helps to find varicocele or other problems in the testicles and supporting structure by producing a high sound wave which gives a picture or image of the inside of the body.
d) Testicular biopsy
This test involves the removal of a small portion of testicles with a needle. If the results of the testicular biopsy show that sperm production is normal then the problem is due to blockage or any other problem with sperm transportation.
Treatment Options for Male Infertility
❖ Medical treatments:
- Medication (hormone therapy, antibiotics) –The pituitary gland in the brain releases hormones ‘gonadotropins’ which stimulate the testicles to produce sperm. By medication hormone levels can be maintained in the body which boosts sperm production. Antibiotics are also taken to maintain the hormonal imbalance in the body.
- Lifestyle changes (diet, exercise, quitting smoking)– By some changes in regular habits a man can achieve a good hormonal level with a healthy body. A proper diet with regular exercise leads to a healthy body. Smoking should be quit, because it reduces the sperm count directly.
● Surgical Interventions
- Varicocelectomy – A varicocele is a condition where an enlargement of the veins in the scrotum happens. This can block the blood flow to the rest of the reproductive system. This leads to the enlargement of veins in the scrotum, which further decreases the sperm count. Varicocelectomy is a surgery process that is performed to remove those enlarged veins. This process restores the proper blood flow in the reproductive organs.
- Vasectomy reversal – This process is done to undo a vasectomy. During this procedure, a surgeon reconnects each tube (vas deferens) that carries sperm from a testicle into the semen. After a successful vasectomy reversal, sperm is present in the semen, and pregnancy chances increase.
- Surgical sperm retrieval – Surgical sperm retrieval is a procedure that is used to collect sperm from the male reproductive system in a condition of male factor infertility, where there no sperm present in the ejaculation process. This process is mostly used in conjunction with in vitro fertilization (IVF) to help couples get pregnant.
● Assisted Reproductive Technologies (ART)
- Intrauterine insemination (IUI) – Intrauterine insemination (IUI) is a process that treats infertility in men. IUI boosts the chances of being pregnant by placing specially prepared sperm directly in the uterus (where the baby develops). With IUI, the sperm are placed around when an ovary releases one or more eggs. Which leads to the union of the sperm and eggs in the fallopian tube.
- In vitro fertilization (IVF) – During the in vitro fertilization process, mature eggs are collected from ovaries and fertilized by sperm in the laboratory. Then a process is done to place one or more of the fertilized eggs, called embryos, in a uterus. One full cycle of IVF takes about 2 to 3 weeks.
- Intracytoplasmic sperm injection (ICSI) – Intracytoplasmic sperm injection (ICSI) is a process of treating infertility. In this process, direct transfer of live sperm is done into the person’s egg in a lab.
Emerging and experimental treatments – This consists of various therapies some are listed as
● Stem cell therapy
● Gene therapy
● New medication and protocols
Psychological and emotional support
● Impact of infertility on mental health:
- Anxiety and depression
Infertility increases the mental stress level in men and women. About 40% of women suffer from anxiety during infertility. It increases the hormonal imbalance in the body which leads to depression.
- Relationship stress
Mutual understanding is responsible for mental support in infertility conditions. Due to infertility, the couple’s relationship gets disturbed, and misunderstanding happens, which leads to an unhappy relationship status.
Counseling and support group
The proper counselor should be appointed for consulting the personal problems of patients. Because the mental and emotional support increases the patience level in this situation.
Coping strategies and resources
Some patients are using the methods or strategies suggested by experienced couples.
Conclusion
In the initial stage, the couple should consult with a doctor because early treatment and diagnosis result in more chances for pregnancy without any big problems. Day-by-day research is done in this area to help the patient suffering as easily and comfortably as it can. Modern technology is very helpful in curing infertility. Couples should be encouraged to consult with a top urologist in Jaipur and share all personal problems without any hesitation.