Male Fertility Diagnosis and Treatment in India
What are male fertility problems?
There are several causes of fertility problems in men.
Infertility can be defined as the failure to achieve pregnancy after regular unprotected sex (without the use of any contraception) for at least a year.
‘Primary’ infertility means failure to achieve a first pregnancy, ‘secondary’ infertility means failure to achieve a subsequent pregnancy.
Primary infertility is an extremely common problem, affecting more than one in seven (15 per cent) couples attempting their first pregnancy.
Among those experiencing difficulty with conception, a male fertility problem is considered important in around 40 per cent of couples. In 15 per cent of couples it will be solely a male fertility problem and in around 25 per cent, there will be a problem in both partners.
Why do men get fertility problems?
There are several causes of fertility problems in men. They include:
- obstructive problems (blockages in sperm-carrying tubes)
- testicular injury and disease
- sperm disorders
- genetic disorders
- problems with erection) and ejaculation
- hormonal problems
- general medical disorders that reduce fertility
- drugs that reduce fertility
- environmental toxins and radiation.
A blockage in a sperm-carrying tubes has many potential causes. The most common are outlined below.
- Groin surgery (including hernia repair and fixation of undescended testicles).
- Trauma to the scrotum sack covering the testicles (even fairly minor sporting injuries).
- Infection (particularly chlamydia, gonorrhoea and tuberculosis).
- Previous vasectomy (a form of contraception that involves tying the sperm-carrying tubes).
Some men have congenital (present at birth) absence of the vas deferens on one or both sides. The vas deferens is the tube that conducts the testicular component of semen to the urethra, which then carries semen through the penis to the outside world.
About 10 per cent of men with an obstructive cause for their infertility will have this problem. The seminal vesicles (where other semen components are made) are often absent too.
Another rare obstructive cause is Berry-Perkins-Young syndrome, in which sufferers have a chronic chest disease (bronchiectasis), chronic sinusitis and obstructive infertility.
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Testicular injury and disease
A blow to the testicles, which may occur in sport or during a fight, can cause swelling of the testicles, or bleeding in or around them. This probably causes the blood supply to the testicles to fail, resulting in permanent damage to the sperm production mechanism.
Torsion of the testicles (twisting of a testicle on its cord) can have a similar effect if it is not treated very quickly with surgery. Mumps virus can cause inflammation of the testicles (orchitis, which usually appears as painful swelling of the testicles) and failure of sperm production.
Mumps is the best-known cause, but is not the only one.
Mumps will only affect fertility if it causes orchitis and, even then, only rarely.
Undescended testicles (cryptorchidism) are another common cause of failure of sperm production.
Male infants and children are routinely examined to identify this problem, as future fertility can only be preserved if surgical treatment to fix the testicles in the scrotum is performed in early childhood. Even surgery in infancy does not guarantee future fertility.
A varicocele is a dilation of the testicular veins in the spermatic cord that leads from the testicles to the abdomen.
The role of this condition in causing infertility is uncertain and highly controversial. Varicoceles occur in 15 to 20 per cent of fertile men and 30 to 40 per cent of men with fertility problems. They can occur on either or both sides, but are far more common on the left.
They are best identified when the man is standing up and are often described as feeling like ‘a bag of worms’.
Experts suggest that the varicocele either heats up the testicles or impairs their blood supply resulting in a build-up of body waste products, thus affecting fertility.
The co-existence of other risk factors, such as smoking, with varicocele seems to have a greater effect on the risk of infertility.
Disorders of sperm numbers, movement and shape are common in men with infertility.
Prolonged abstinence from ejaculation can affect sperm motility. Modern techniques can identify structural and biochemical abnormalities within the individual sperm.
Problems with chromosomes (packages of genetic material) occur in about 2 to 20 per cent of infertile men and can affect their fertility in two ways:
- chromosome disorders can affect the development of the testicles. These are usually disorders of the sex chromosomes, by far the most common being Klinefelter’s syndrome. In this disorder, instead of having 46 chromosomes, including one X and one Y chromosome (46XY), the man has an additional X chromosome (47XXY).
- chromosome abnormalities can disrupt cell division and sperm production.
Problems with erection and ejaculation
Problems with sex are the principal cause of infertility in about 5% of couples. This can be due to:
- erectile dysfunction (inability to attain or maintain an erection adequate for intercourse)
- premature ejaculation
- failure to ejaculate
- Inability to achieve vaginal penetration for other reasons.
Testosterone deficiency can reduce fertility and may be caused by problems with testicular testosterone production, or problems with the pituitary gland or hypothalamus in the brain, which control testosterone production.
Overproduction of prolactin (hyperprolactinaemia), a hormone produced by the pituitary gland, may also reduce fertility.
General medical disorders that reduce fertility
There are several conditions that may reduce fertility:
- Fever: influenza (flu), pneumonia, or even a severe cold can cause a high fever, which will adversely affect sperm production and quality. These changes usually recover over a few weeks.
- Diabetes: in the longer term, diabetes can cause problems with erection and ejaculation through causing damage to the function of the ‘automatic nervous system’.
- High blood pressure: hypertension (high blood pressure) can cause problems with erection, either directly or as a side effect of medication.
- Coronary artery disease: coronary artery disease can cause problems with erection. This could be due to generalised hardening of the arteries, in the penis as well as the heart, or to drugs used in the treatment of heart problems.
- Neurological disorders: multiple sclerosis, stroke, and spinal cord injury and disease can all cause problems with erection and ejaculation.
- Kidney disease: chronic renal failure, which results in a buildup of waste products in the body, can adversely affect sperm quality and fertility. It can also cause erection problems.
- Cancer: cancers that affect the genital tract or endocrine (hormone-producing) systems may directly reduce fertility. Otherwise, drugs and radiation used to treat cancer may severely reduce sperm production or even stop it altogether. Stress (see below) may also have an effect.
- Alcoholism: alcohol is toxic to sperm and overuse of alcohol can reduce sperm quality and fertility.
- Stress: stress causes several hormonal changes in the body that can affect fertility. Stress can have many causes, including anxiety over fertility problems.
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Steps of Male Fertility Treatment in India with IVF-ICSI CENTER, Delhi
Male Infertility Evaluation :
Traditionally, the health care response to a couple with infertility has been for the female partner to visit the gynecologist for an evaluation. The male partner may also be asked to give a semen analysis.
Get a Second Opinion :
Although medical advice can get complex, for the most part, the discussion that you have with your doctor should make sense to you and you have a right to have all of your questions answered so that it does make sense to you.
Male Fertility Preservation :
The select Clinic understands the importance of preserving and restoring male fertility and has developed a comprehensive, streamlined evaluation for affected men.
Sperm production is hormonally driven. Brain hormones govern sperm production and are precisely controlled. The male genitalia are responsible for sperm and ejaculate production.
Oligospermia is a male fertility issue defined as a low sperm concentration in the ejaculate. Low sperm concentration or “sperm count” is the number of sperm in a prescribed volume of ejaculate.
Azoospermia is the complete lack of sperm in the ejaculate. It occurs in 5% of infertile men. If this is the case, then one or both of two conditions may be present.
A testis biopsy is helpful in many cases of azoospermia. If an evaluation of azoospermia is not clearly showing whether there is a problem with sperm production or one of a blockage in the ducts of the reproductive tract, then the next step is to examine the testis itself and assess sperm production.
Non-Surgical Male Fertility Treatment
Only about 20% of young men actually know the exact time to have sex during the female cycle to achieve a pregnancy. The critical period can be assessed by either basal body temperature charting or home kits that detect the LH surge in the urine immediately (24 hours) prior to ovulation.
Surgical Male Fertility Treatment
Surgical treatment options include varicocele repair, ejaculatory duct resection and vasectomy reversal. What is nice about surgical treatments for male infertility is that they can “cure” the problem and allow for conception at home and not in the laboratory.
Sperm retrieval procedures are designed to collect sperm from organs within the male reproductive tract. First developed in 1985, sperm retrieval combined with in vitro fertilization (IVF) and ICSI are invaluable for allowing infertile men without ejaculated sperm the opportunity to be fathers.
Varicoceles are enlarged veins (varicose) in the scrotum; they are the most commonly corrected reason for male infertility.
Ejaculatory Duct Resection
Ejaculatory duct obstruction is presenting itself as a semen analysis with a low volume, ejaculatory duct obstruction is the cause of male infertility in 1-5% of men.
Male Fertility treatment in India with Us:
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