MALE INFERTILITY

 

Infertility is a common problem affecting one couple in six. Infertility is a common problem worldwide which has both psychological and social impact.

Infertility can be defined as the incapacity to fulfill pregnancy after reasonable time of sexual intercourse with no contraceptive measures taken. It can also be defined as the inability to conceive naturally after one year of regular unprotected intercourse.

Childlessness could be male infertility, female infertility or combined Infertility.

For healthy young couples, the likelihood of getting pregnancy varies. In 2010, an estimate of 47.5 million couples worldwide, were infertile. This article provides a brief review on infertility causes, abnormal semen causes, Diagnosis and treatment modalities.

The cornerstone of male infertility evaluation is Seminal Fluid Analysis (SFA), it provides information about sperm production but not the actual fertilizing capacity of the sperm.

CAUSES OF MALE INFERTILITY

There are causes of male infertility which is stated below:

•Congenital Factor (Cryptorchidism and Testicular DYSGENESIS, congenital absence of the Vas Deferens).

•Acquired Urogenital Abnormalities (obstructions, testicular torsion, testicular tumor, orchitis).

•Systemic Diseases(diabetes, renal & liver insufficiency, cancer, hemochromatosis).

•Exogenous Factors (medications, toxins and irradiation)

•Lifestyle Factors (obesity, smoking, drugs and anabolic steroids)

•Urogenital Tract Infections 

•Increased Scrotal swelling (it could be caused due to Varicocele) 

•Endocrine Disturbance

•Genetic Abnormalities

POSSIBLE CAUSES FOR ABNORMAL SEMEN

•Low Volume: it's caused during retrograde ejaculation.

•High Volume: it is caused when there's a problem in the accessory gland.

•High Viscosity: when there's infection and also problem in the accessory gland.

•Low Sperm Count: Absence of vasa or seminal vesicles, abnormal sperm production.

•Low Motility: Dead sperm, agglutination, hormone imbalance and structural defects.

  DIAGNOSIS

•AZOOSPERMIA: This is when there's no sperm in an ejaculate, which can be caused by an obstruction in the genital tract. It is the most severe case in male infertility.

                              Normal

                          Azoospermia

Once diagnosis of AZOOSPERMIA has been made, obstruction can occur anywhere along the genital tract from the seminiferous tubules to the distal Vasa.

We should understand that, the most common site for obstruction is the Epididymis (two thirds of all blockages are found or occurs there).

Treatment

•If testicular and EPIDIDYMAL function can be verified, surgery to remove or correct maybe justified.

•Other Assisted Reproductive Treatment (ART), like Testicular Aspiration (TESA) or Percutaneous EPIDIDYMAL Sperm Aspiration (PESA), can be used to treat, it since they are not relatively invasive.

•OLIGOSPERMIA: This is when there's a low sperm count, which is caused by infections, toxins, Testicular failure, germ cell wastage, obstruction, varicocele (abnormally swollen veins around the areas of the scrorum).

                               Normal

                          Oligospermia

Treatment

•Quit smoking/drug/alcoholic use.

•Reduce stress.

•Treatment with anti-estrogen such as CLOMIPHENE Citrate or Tamoxifen, is sometimes useful since the don't interrupt the negative feedback effects of estrogen on the pituitary gland, thereby, stimulating gonadotropin output and testicular function.

•ASTHENOZOOSPERMIA: This is when there is low sperm motility of less than 50% or less than 25% with rapid forward progression.

Note:Sperm are very sensitive to temperature, rubber and spermicides.

There's a particular structural defect In Sperm that helps explain the motility anomaly.

Treatment

•Go for hormonal test when there's hormonal imbalance.

•Seminal fluid analysis (SFA) is use to analyze semen mortility.

•VARICOCELE: It is common in ≥40% of men. It is caused when there's a dilation in the PAMPINIFORM plexus of the SPERMATIC veins, which affects testicular function.

Varicocele affects scrotal temperature leading to decreased sperm production.

              

             

                          Varicocele

Treatment

Physical examination can be used in detecting varicocele unless they are very small and occur mostly on the left side.

The primary focus is the genitalia with the physician, who will palpate the presence of varicocele or torsion and measure the size of the testes with an ORCHIDOMETER to ascertain the presence of the Vasa and Epididymis.

TREATMENT OF INFERTILITY USING ADVANCED TECHNOLOGY

Use Of assisted reproductive technologies (ART)

After evaluating the patient and making a diagnosis, assisted reproduction may be indicated immediately depending on the patient's particular condition and after consideration of other factors. Men with obstructive azoospermia or low sperm counts will need Intra-cytoplasmic sperm injection (ICSI), to have a reasonable chance of initiating pregnancy.

Assisted Conception

It Include the following;

•Intra-uterine insemination (IUI): It's a main method of assisted Conception. IUI is often used in cases of unexplained infertility, where tubal patency, ovulation and normal sperm parameters have been demonstrated.

•In-vitro fertilization (IVF): One of the widely used methods of assisted Conception. IVF could be used as a treatment for many other conditions, including male factors, PCOS, endometriosis, unexplained and immunologic infertility.

•Gamete intra-fallopian transfer (GIFT): GIFT is a method also used in assisted Conception which is only appropriate for patients with patent and healthy fallopian tubes. 

Note:The investigation and treatment of the causes of Infertility are complex and vast, but fortunately this disease is resolved for many patients with the use of  advanced technology. Although extensive testing of male Infertility is available and the ultimate test is the ability of the sperm to fertilize oocytes.