Male infertility is quite common these days . One third of the cases are caused by male infertility. The sperm count may be low ,nil or the sperms may have decrease motility or they may be abnormal in shape. The main cause is low sperm count. We follow WHO 2010 criteria for semen analysis (mentioned below).
Semen analysis is the foremost simple and diagnostic investigation for male infertility.
Semen Collection is preferably to be done at IVF Centre only. It requires:
WHO criteria for normal semen values :-
The various semen abnormalities may be:
We perform a repeat semen analysis 2 months after the first report. If the previous report mentions azoospermia, we confirm Azoospermia by centrifugation of a semen specimen at 3,000 g *15 min and examine the pellet under high power. Many a times we have observed sperms in centrifuged samples, where the previous reports have mentioned azoospermia. We have an integrated team of Urologist and Psychologist and Endocrinologist and the male partner is evaluated by an urologist who takes a detailed history and examines the male partner. Confidentiality is maintained. A thorough history is taken, noting occupational history or any exposure to high temperature and environmental toxins, any prolonged illness or surgery done before, history suggestive of any sexually transmitted diseases, coital frequency or any ejaculatory dysfunction. His weight and height are taken and his genitalia are examined for Testis, Epididymis, Vas Defrens and Prostate.
In most of the cases, the history and examination is suggestive of diagnosis and tests are done according to the diagnosis. Only minimal and indicated tests are done and unindicated and unnecessary tests are not done at our centre.
To confirm the diagnosis, we usually do
The treatment is specific to the cause. In general, Patients are advised:
2. Medical Treatment
The drugs work in cases like
A. Hypogonadotrophic Hypogonadism (HH) – It’s a condition where 2° sexual characters are absent, testis are small and there is azoospermia. The levels of FSH, LH & Testosterone are very low. Treatment for these patients is simple. Injectios of hCG (1,000-2,000 IU) IM are given twice or thrice weekly along with FSH injections for 6-24 months. Testicular growth occurs in almost all and spermatogenesis occurs in 80—95% of patients without undescended testes.
B. Pyospermia – Antimicrobial therapy is given in cases of pyospermia; where there are ≥ 10 M/ml of peroxidase positive white blood cells (WBCs ). However it only eradicates microorganisms. It has no positive effect on inflammatory alterations and/or cannot reverse functional deficits or anatomic and secretory dysfunctions.
C. Coital infertility – like Anejaculation or Retrograde Ejaculation
D. Idiopathic Male Infertility – It occurs in ~30-45% of infertile men. There is no demonstrable cause for abnormal semen parameters. Subnormal sperm parameters include:
There is low scientific evidence for the use of bromocriptine / hCG / HMG / α blockers / Systemic corticosteroids. Androgens are contraindicated. Recombinant FSH, folic acid with zinc, or antioestrogens are beneficial in some patients. Antioxidants can be given empirically for 2 months. They may work in few idiopathic cases.
IUI is a suitable alternative in:
The pregnancy rates with IUI in male infertility are 9-20%. Four cycles of controlled ovarian hyperstimulation (COH) combined with IUI are superior to IVF and less expensive than single IVF cycle.
Assisted Reproductive Techniques (ART)
A. In Vitro Fertilization (IVF ) – works well in cases of Severe Oligospermia (When number of motile sperms is < 10 M/ml and also where no Pregnancy has occurred after 3-6 cycles of IUI in Mild-Moderate Oligospermia.
B. Intracytoplasmic Sperm Injection (ICSI)- ICSI is suitable for
A. Microsurgical vasectomy reversal: Vasectomy reversal may be offered to the desired patients. Low cost , good success rate makes it more effective than IVF. Overall patency in 86 %of cases and live birth rates up to 58% is reported with vasectomy.
B. Varicocelectomy: It is of benefit only if there are semen abnormalities and the varicocele is clinically palpable in the absence of female factor infertility. The average spontaneous pregnancy rate after varicocelectomy is 39%
C. Surgical sperm retrieval and assisted reproduction:
WHO Criteria for Normal Semen Values
|Parameter||Lower Reference Limits (WHO)2010|
|Total Sperm Number(106 per ejacuate)||39|
|Sperm Concentration(106 per ml)||15|
|Vitality(live spermatozoa, %)||58|
|Sperm Morphology(normal forms, %)||4|
|Peroxidase-positive leukocytes(106 per ml)||< 1.10|
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