Becoming a father has never been considered a challenge. In today’s world, it is still difficult to accept that infertility affects both men and women equally. The incidences of male infertility are on the rise, and it is rampant in cities where people are prone to stressful lifestyle.
Many male fertility problems often go undiagnosed and untreated because of various reasons such as misconception that infertility is a female problem, fewer number of male infertility specialists (andrologist), etc. The incidence of male factor is 40-45% of infertile couples in Bangalore. A majority (46%) of the male infertility patients in the city fall under young age group between 29 and 35.
Often there may not be a particular symptom of male infertility, apart from the obvious inability to get pregnant when a couple is trying. A thorough medical and urologic history including duration of infertility, timing of puberty, childhood urologic disorders or surgical procedures, acute or chronic medical illnesses, sexual history, testicular cancer and treatment, medications, spinal cord injury, etc. is needed for the diagnosis of male infertility.
Around 15-20% of male infertility is because of Azoospermia, i.e. absence of viable sperms in the semen. Sometimes men are able to produce sperms in sufficient quantity but the quality is poor. This causes difficulty in conception. For fertilization to take place, sperm must be able to reach the egg and then penetrate its outer layer. Sperms that don’t move well or are abnormally shaped may be unable to do this.
Some of the frequently seen problems that cause male infertility are acute infections such as smallpox, mumps and chronic infections like TB, leprosy, prostatitis, etc. Another common and reversible problem is varicocele, an enlargement of the veins that wraps around the testicles and affects sperm development. It occurs in about 15 to 20 percent of infertile men. Congenital obstructions, vasectomy and sexual dysfunctions are also common.
Lifestyle factors such as age, delayed marriages, nutrition, lack of regular exercise, work stress, exposure to environmental pollutants, etc. also play a role in the development of infertility in men. Habits like cigarette smoking, illicit drug and alcohol abuse negatively influence fertility in men. Both obesity and poorly controlled diabetes can also affect fertility.
During any fertility check-up, it is mandatory to investigate both partners. A male fertility assessment usually starts with a thorough medical history. A semen analysis that examines the count, motility and morphology of sperm in the ejaculate should be done in an IVF lab as per WHO criteria after an abstinence of 2-5 days. If the results are abnormal, it is repeated after a gap of 2 to 3 weeks. Hormone profile, DNA fragmentation and scrotal scan with Doppler are done if abnormalities are found. Semen analysis is repeated after three months if the patient has been put on treatment.
Couples struggling with infertility should make every effort to find the right help for both partners. While ob-gyns deal with women’s reproductive problems, treatment for male infertility is advised based on the test reports in consultation with the andrologists. There are many treatment options starting from simple tablets to IUI (injecting sperms directly into the uterus) to IVF-ICSI (test tube baby) depending on the cause and severity of the condition. Advanced ART techniques like MACS help select better quality sperms for ICSI.