Male Factor Infertility

By Author: Gautam Nandkishore
Total Articles: 3
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Infertility is not just a disease that affects women, men suffer as well. Many infertile men have surgically or medically correctable disorders, that, if properly diagnosed and treated, can be overcome to allow natural conception. In others, there may be mild semen abnormalities which are amenable to Intrauterine Insemination (IUI).

If all the above is futile or fails, In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) offers men a realistic chance to father children. Donor sperm remains an option of last resort.

Can infertility be a male problem?
Yes. The incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 10-30% of the cases. Problems common to both partners are diagnosed in 15-30% of infertile couples. After thorough medical investigations, the cause of the infertility remains unexplained in 5-10% couples.

How is male fertility evaluated?
The initial step in the evaluation of the male partner is a physical exam and a complete medical history. After this, Semen ...
... Analysis is performed. The semen sample is normally collected in a sterile container by masturbation. The semen test gives important information about the number, movement and shape of sperm. If the Sperm Count is normal and the sperms are of normal shape and exhibit normal motility, male factor can usually be excluded. If the results are abnormal, the test should be repeated after a gap of about 10 weeks to reconfirm previous findings. Hormonal blood tests may then be used to further evaluate the male partner.

What is IUI and what is its role in treating Male Infertility?
Intrauterine Insemination (IUI) is one of the most commonly used Assisted Reproductive Techniques (ART) to treat infertility. The IUI procedure bypasses the cervix and places sperms directly into the uterus, closer to the fallopian tubes, around the time of ovulation. This ensures a better chance that more sperm will make their way closer to the egg. IUI is commonly used when the male partner has a low Sperm Count, poor Motility, problems in developing an erection or inability to ejaculate. IUI is generally combined with Controlled Ovarian Hyperstimulation so that the number of eggs available to fertilize is greater than in normal circumstances.

What does Sperm Preparation mean?
For IUI, the semen sample is processed by one of the various techniques – centrifugation & washing, layering, or selecting the best sperm by making them swim through a denser medium and using those that succeed. The process of sperm preparation filters progressively motile and morpholigically normal sperm and removes the immotile sperm, immature germ cells, leukocytes and infective agents.

What is ICSI and what is its role in contemporary management of Male Infertility?
Intracytoplasmic Sperm Injection (ICSI) involves the insertion of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a special microinjection pipette (glass needle). For couples with severe male factor infertility, this procedure is preferable to IVF. ICSI frequently permits the establishment of pregnancy in even the most difficult types of Male Infertility. Your Fertility Physician at Rotunda will advise you if ICSI is recommended for you based on the results of the semen testing and a few other risk factors.

What is TESE or MESA?
In TESE (Testicular Sperm Extraction), sperms are collected from the testicles after operation.
In MESA (Microsurgical Epididymal Sperm Aspiration), sperms are collected out of the epididymis after operation. If sperm cells are obtained, an ICSI procedure will follow. When the testicles make no sperm cells at all, TESE or MESA is not possible.

What is IMSI? Is it a miraculous new treatment for Male Infertility?
IMSI stands for ‘ Intracytoplasmic Morphologically Selected Sperm Injection’. It involves examining the semen sample under an extremely powerful microscope to pick out the best appearing sperm, which are then used in the ICSI protocol. An efficiently performed ICSI, carried out by a competent embryologist already ensures that good quality sperms are picked up. Evidence based medicine is yet to conclusively prove the advantages of IMSI over ICSI in terms of pregnancy rates and long term outcomes.

What are the effects of smoking and recreational drug use?
Smoking, recreational drugs and even anabolic steroids are associated with reduced sperm quality.

Like many aspects of our health, a man’s fertility is improved by adopting a healthy lifestyle. Maintaining an ideal weight, a diet rich in antioxidants (found in fruits and vegetables), as well as multi-vitamins may improve the quality of sperm. Reducing stress and controlling chronic medical conditions such as high Blood Pressure and Diabetes may also improve a man’s chances of impregnating his partner. Remember that any such changes in the man’s lifestyle will take almost three months to show an improvement in sperm. A complete evaluation and counseling are the first steps to the treatment of male infertility.

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