The SAD COWBOYS

February 2019

SPECIAL FOCUS ON THINGS YOU SHOULD KNOW ABOUT MALE INFERTILITY

By Dr. Nidhi Jha

One in eight couples struggle with infertility, and in half those cases, male infertility plays a part. As couples work with us through the process of diagnosing and treating infertility, it's important to understand the role of male health.

Q. HOW COMMON IS MALE INFERTILITY?

Infertility affects both men and women in nearly equal measures Roughly 1/3 of infertility cases are related to the man and roughly 1/3 are related to the woman. The remaining 1/3 of infertility cases are related to both partners or their cause can't be identified.

Q. WHAT CAUSES MALE INFERTILITY?

Male fertility is a complex process. For pregnancy to happen, the following must occur:

• Production of healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of the testicles must be functioning correctly, and the body must produce testosterone and other hormones to trigger and maintain sperm production.
• Sperm have to be carried into the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
• There needs to be enough sperm in the semen. If the number of sperm in the semen (sperm count) is low, it decreases the odds that one of the sperm will fertilize the partner's egg. A low sperm count is fewer than 15 million sperm per millilitre of semen or fewer than 39 million per ejaculate.
• Sperm must be functional and able to move. If the movement (motility) or function of the sperm is abnormal, the sperm may not be able to reach or penetrate the partner's egg. The problem at any of these levels can result in infertility.
• Medical causes of male infertility. Several physiological factors can negatively impact sperm production, motility and delivery. One of the most common is a varicocele, a swelling of the veins that drain the testicle. Varicocele reduces the quality of the sperm. Other factors may include infections, blockages caused by tumours, chromosomal defects, or hormonal imbalances. It's important to know that many of these factors are treatable, or don't interfere with the ability to retrieve sperm for use with assisted reproductive techniques such as in-vitro fertilization.
• Overexposure to certain environmental conditions can negatively impact male fertility, too. Some industrial chemicals, heavy metals, radiation and/or heat may inhibit sperm production. Damage from environmental factors may be reversible by reducing or eliminating exposure.
• The use of anabolic steroids, cocaine, marijuana or other illicit drugs may reduce sperm count and quality. Excessive alcohol use may also reduce sperm count and cause erectile dysfunction, and tobacco use can inhibit sperm production as well. Stress and obesity can impact sperm and cause hormone changes that inhibit fertility, too. The good news is that lifestyle changes can often improve male fertility.

Q. WHAT ARE THE SYMPTOMS?

The main sign of male infertility is the inability to conceive a child. Although most men with male infertility do not notice symptoms other than the inability to conceive a child, signs and symptoms associated with male infertility include:

• Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction)
• Pain, swelling or a lump in the testicle area
• Recurrent respiratory infections
• Inability to smell
• Abnormal breast growth (gynecomastia)
• Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality A lower than normal sperm count (fewer than 15 million sperm per millilitre of semen or a total sperm count of less than 39 million per ejaculate)

Q. WHEN TO SEE A DOCTOR?

See a doctor if you have been unable to conceive a child after a year of regular, unprotected intercourse or sooner if you have any of the following:

• Erection or ejaculation problems, low sex drive, or other problems with sexual function
• Pain, discomfort, a lump or swelling in the testicle area
• A history of testicle, prostate or sexual problems A groin, testicle, penis or scrotum surgery

Q. DOES LIFESTYLE HAVE A ROLE IN MALE INFERTILITY?

Certain habits, such as smoking, excessive alcohol intake, poor sleep habits and poor diet can lead to fertility issues. A visit to the physician can help identify these factors and offer strategies for quitting smoking or improving your diet. Many popular supplements used by fitness enthusiasts can have negative effects on fertility. Research says these supplements—particularly pre-workout and testosterone boosters, but even branched-chain amino acids and others that are used to increase strength — can be laced with chemicals related to anabolic steroids that can harm users.

“Many of the products that are advertised as making your muscles big can atrophy your testicles.” It is recommended avoiding workout supplements and discussing any other vitamin supplements you are taking with your Doctor.

Q. HOW IS MALE INFERTILITY DIAGNOSED?

An initial evaluation will be conducted and will include a detailed history of the male partner. During this overview, a proper history of current and childhood medical conditions and past infertility should be given. It's also very important for the fertility doctor to be aware of environmental factors that may contribute to male infertility such as exposure to heat or chemicals as well as the use of certain drugs. A semen evaluation will be performed to test the amount of semen created, the number of sperm per ml of volume, percentage of live sperm and the shape of the sperm.

Q. CAN MALE INFERTILITY BE TREATED?

Yes, in many cases of male infertility, treatment can help couples conceive. For example, during IVF, infertile males may choose Intracytoplasmic Sperm Injection (ICSI), a procedure performed when sperm can't penetrate the egg. This Fertility treatment offers great success for couples where the man is deemed infertile.

Q. WHAT IF THE MALE PARTNER HAS BEEN FERTILE IN THE PAST?

A history of male fertility is not a definitive indicator of current male fertility health. History of fertility should not exclude a male fertility evaluation when a couple is experiencing trouble conceiving.

Q. WHAT ARE THE PREVENTIVE MEASURES?

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.

Q. HOW DOES SPERM DONATION WORK?

More often than not, IVF treatment will help couples successfully create embryos with their eggs and sperm. However, for men who aren't producing any sperm, sperm donation is another alternative to consider. Donor sperm can be used for IUI or IVF. In IUI donor sperm is directly inseminated inside the women's uterus after processing the semen. By using In Vitro Fertilisation (IVF)techniques, eggs are obtained from the woman, fertilised by sperm from the donor, and the resulting embryos are placed int the woman's uterus.

Finding Sperm

Donor sperm can be arranged only from Govt. authorised sperm banks. Sperm donation by a known donor is not allowed in India according to ICMR guidelines.

Donor Sperm Health

Men who wish to donate their sperm are screened for common infectious diseases before donation. A quarantine period is used and donors provide blood for repeat testing for HIV (AIDS) and hepatitis before any sperm is released from quarantine

Legal Rights

As the law currently stands, sperm donors are unable to trace offspring and vice versa. the current position of children born through donor sperm is that they have the same legal rights as naturally conceived offspring and the sperm recipients' names can be put on the birth certificate.