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Male Infertility

Incidence of Infertility in India:

  •  Doctors from the All India Institute of Medical Sciences reported that over 12–18 million couples in India are diagnosed with infertility every year.
  • They have reported that while the sperm count of a normal Indian adult male used to be 60 million/ml three decades ago, it now stands at around 20 million/ml

Risk factors:

Following is a partial list of environmental risk factors to male fertility:

  • exposure to toxic substances or hazards on the job, such as lead, cadmium, mercury, ethylene oxide, vinyl chloride, radioactivity, and x-rays
  • cigarette or marijuana smoke, heavy alcohol consumption
  • prescription drugs for ulcers or psoriasis
  • DES(Diethylstilbisterol) exposure in utero
  • exposure of the genitals to elevated temperatures -- hot baths, whirlpools, steam rooms

Medical risks to male fertility include:

  • hernia repair
  • undescended testicles
  • history of prostatis or genital infection
  • mumps after puberty
    • This is due to excess environmental heat which increases the temperature of the scrotum, causing a negative effect on sperm production.
    •  A 1° elevation in testicular temperature leads to 14% depression of spermatogenesis

What are sperm abnormalities:

The single most most important test to evaluate male fertility status is Semen analysis which evaluates: sperm count, sperm motility & sperm morphology.

  • Sperm morphology — the size and shape of sperm — is one factor that's examined as part of a semen analysis to evaluate male infertility. Sperm morphology results are reported as the percentage of sperm that appear normal when semen is viewed under a microscope.
  • Normal sperm have an oval head with a long tail. Abnormal sperm have head or tail defects — such as a large or misshapen head or a crooked or double tail. These defects might affect the ability of the sperm to reach and penetrate an egg.

Prevention

Many types of male infertility aren't preventable. However, you can avoid some known causes of male infertility. For example:

  • Don't smoke.
  • Limit or abstain from alcohol.
  • Steer clear of illicit drugs.
  • Keep the weight off.
  • Don't get a vasectomy.
  • Avoid things that lead to prolonged heat for the testicles.
  • Reduce stress.
  • Avoid exposure to pesticides, heavy metals and other toxins.

Incidence of male infertility:

  • According to a 10-year comparison study on sperm quality and quantity (2000–2001 to 2010–2011), the percentage of semen ejaculation, which is considered less than normal (below 4 ml), increased from 34% to 65% and the most suitable ejaculation volume (more than 4 ml) went down from 15% to 3%.
  •  As far as the morphology of sperm was concerned, in 2000–2001, 26% of the sperms showed above 60% normality, whereas in 2000–2011 this was reduced to 7%.
  • However, a similar study in Calcutta, which included semen analysis of 3729 men presenting with infertility problems in two distinct decades, that is, between 1981–1985 and 2000–2006 concluded a significant decline in the sperm motility parameters and seminal volume in the present decade, but no change in overall sperm concentration
  •  A decline was seen in sperm motility with increasing age in both decades

Causes of male infertility :

Male infertility is usually caused by problems that affect either sperm production or sperm transport. Through medical testing, the doctor may be able to find the cause of the problem. About two-thirds of infertile men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that are made do not work properly.Other less common causes of infertility include: sexual problems that affect whether semen is able to enter the woman’s vagina for fertilisation to take place (one in 100 infertile couples); low levels of hormones made in the pituitary gland that act on the testes (one in 100 infertile men); and sperm antibodies (found in one in 16 infertile men) . In most men sperm antibodies will not affect the chance of a pregnancy but in some men sperm antibodies reduce fertility.

Treatment of Male infertility:

The ultimate goal of male infertility treatment is to create a pregnancy. Some common modes of treatment are : Varicoceles are repaired with surgery to block off the abnormal veins. This seems to result in a significant improvement in fertility, although some studies disagree.

  • Hormonal abnormalities can sometimes be treated with medicine or surgery.
  • Obstructions in the sperm transport plumbing can sometimes be surgically corrected.

If the above methods didn’t work, it often meant lifelong male infertility. Today, assisted reproductive techniques (ARTs) offer powerful new options. These high-tech and expensive male infertility treatments give sperm an artificial boost to get into an egg. ARTs have made conception possible even for men with very low or abnormal sperm. ART techniques comprise of – IUI or Intrauterine insemination& IVF/ICSI(Intracytoplsmic sperm injection) in which a single sperm is injected into an egg to facilitate fertilization.