In vitro fertilization


Male infertility

Men can also be the reason of infertility in a couple. Male infertility is a problem with a male’s reproductive system because of which he is unable to have children. It can be caused by low sperm count (not having plenty of sperm in your sperm), poor sperm motility (when sperm don’t move well enough to reach the egg), incorrect formation of sperm, presence of no sperm in the semen and many other reasons that we’ll explore later.

What are the symptoms of male infertility?

The main symptom of male infertility is not being able to have a child. Usually, there are no other signs or symptoms. However, sometimes, an underlying disease or condition may cause signs and symptoms.

The signs and symptoms that usually appear are as follows:

  • Issues with the sexual function
  • Pain, swelling or presence of a lump in the testicular region
  • Unusual growth of breast
  • Recurrent respiratory infections
  • Reduced hair on face or other things that may be a sign of a chromosomal or hormonal abnormality
  • Abnormal sperm count (<15 million/ml or total sperm count <39 million per ejaculate)

 

What are the causes of male infertility?

To have a child, the first condition is that male’s sperm must combine with a female’s egg. The sperm are stored in the testicles which is where they are produced as well. During sexual intercourse, the testicles release sperm so that they can be ejaculated by the penis to deliver sperm to the female reproductive tract.

More than 90% cases of male infertility are caused by low sperm count, poor sperm motility, or both. Other than that, male infertility is caused by imbalance in hormones, genetic defects, issues pertaining to the anatomy. Factors related to the lifestyle and age can also contribute to male infertility. Some of the sperm abnormalities are as follows:

  • Azoospermia: When there’s a complete absence of sperm cells in the ejaculate, it is called azoospermia. It can be caused by an imbalance in the levels of hormones or a blockage of sperm movement.
  • Oligospermia: When the sperm count is less than 20 million/ml, it is called oligospermia.
  • Asthenospermia: When around 60% of sperm population have unusual motility (they move slow and not in a straight line), it is called asthenospermia and may lead to infertility.
  • Teratospermia or Teratoozoospermia: It means that the morphology of the sperm is abnormal, especially the head, midpiece and/or tail.

There are some conditions that influence how a sperm is formed. They can lead to a sperm that’s not properly formed or malformed or to small levels of sperm. Some of the most common causes of that affect sperm formation are as follows:

  • Chromosomal defects
  • Injury to the testicle
  • Swollen testicles due to infections, such as gonorrhea, chlamydia, or mumps
  • Hyperprolactinemia which is producing excess amounts of a hormone in pituitary gland called prolactin
  • Cryptorchidism, which is a condition in which one or both testicles stay undescended
  • Klinefelter syndrome, which is a chromosomal disorder
  • Issues with thyroid
  • Varicocele in which the veins are enlarged in the scrotal area; the enlarged veins interfere with the blood flow in the testicle and lead to an increased temperature that harms the productive of sperm. It is present in 40% men who have fertility issues.
  • Being insensitive to androgens, including testosterone
  • Diabetes

10-20% of the cases of male infertility are caused by an inability to transport sperm. Conditions that affect sperm transport are as follows:

  • Natural blockage in the tubes that transport sperm from testicles to penis
  • Vasectomy, a surgy in which the tubes are cut and sealed
  • In many cases of cystic fibrosis, tubes that carry the s perm to penis are not present. However, such men aren’t sterile, as they produce sperm.
  • Erectile dysfunction in which the penis doesn’t get erect
  • Retrograde ejaculation which causes the sperm to go towards and move into the bladder instead of out of penis. Taking certain medications increases the chances of it developing.

 

What is the treatment for male infertility?

Intrauterine insemination (IUI)

It is a simple process of collection, concentration, and deposition of sperm into a women’s uterus. There are many causes as to why a couple is experiencing difficulty getting pregnant and IUI may be useful for some of these causes.

The collected sperm is washed properly to concentrate the sperm and get rid of the seminal fluid. It takes 2 hours. The procedure is done when the woman is ovulating. When the semen is ready, it takes a few minutes. In the procedure, the woman lies on an examination table and the clinician puts in a speculum to expose her cervix. Insertion of a catheter is done through the cervix into the uterus and the washed semen is injected at a slow pace. The procedure doesn’t cause pains in most cases. Sometimes, a woman may experience cramps. Spotting may occur for one or two days after the procedure of IUI.

IUI works the best in patients who have an unexplained case of infertility, who have a cervix that doesn’t let sperm through and who are not able to ejaculate properly. It is not the best choice of fertility treatment for men who produce less amounts of sperm, or who have unusual sperm and for women who have had disease of fallopian tube, moderate to severe endometriosis, or have had pelvic infections. Other forms of fertility treatment are much better for such people with infertility.

In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI)

IVF is a procedure in which the female egg is fertilized outside of the body. Around 100,000 sperm are added for every egg in a medium that’s specially made. A minimum of 50,000 to 500,000 motile sperms are the requirement for IVF, else ICSI will be performed. Commonly, retrieval of 12 eggs is done for each cycle. Out of these 2 to 4 are implanted into the female and rest are frozen.

ICSI involves using a microscope and a micropipette to inject one healthy sperm directly into an egg that’s been surgically taken out. Once the eggs have been fertilized, they’re implanted into the uterus of the female.

Generally, IVF is preferred with ICSI when there is presence of significant male factors that are difficult to overcome through other modes. Some viable sperm can still be obtained. It is used when other procedures have failed to cause pregnancy. There is just one male contradiction to this procedure which is the absence of viable sperm and necrospermia which, thankfully, is rare.

Other treatments

There are other forms of treatment for male infertility, such as vasovasostomy and vasoepididymostomy. Transurethral resection of ejaculatory ducts helps patients who have obstructions in their ejaculatory duct. Varicocelectomy is used to help the patients who have varicocele and involves removal of enlarged veins in the scrotal area to restore proper blood flow to reproductive organs. Midline prostatic and ejaculatory cyst that are >0.017mL in size, can be treated either with transurethral resection or by cyst puncture with puncture with transrectal ultrasound.

 

Which doctor should I consult for male infertility?

For male infertility, you should see a urologist who has a specialized training, sometimes, called an andrologist.

 

It is recommended that male infertility is identified early to better manage it. It is also recommended that genetic testing should be advised to couples who carry a potentially inheritable disease or to couples with an abnormality in the genetic or clinical investigation. Spermatogenesis failure can be the cause of male infertility in many cases. But most cases of male infertility are treatable. Male infertility has a notable effect on the psychological, social and emotional health aspects of a male. So, it should be effectively managed and treated on time to reduce its effects on the mentioned aspects.

 

FAQs

  1. Can male infertility be treated?
    Generally, it is possible to treat male infertility. In rare cases, it can’t be treated, and it becomes impossible for a man to have a biological child.

  2. What is the main cause of male infertility?
    The main cause of male infertility is problem with production of healthy sperm.

  3. How do you know if you’re an infertile male?
    You can find out if you’re infertile by taking a semen analysis test in which your sperm count, and quality will be determined. Other ways to check if a man is fertile are hormone blood test or a semen culture to figure out whether a sample is healthy by checking its color, smell, and texture. Other fertility tests for males include sperm DNA fragmentation test, semen culture, genetic test, hypo-osmotic swelling test (HOS), sperm FISH and testicular biopsy.

  4. Can a small testicle be a sign of infertility?
    Small or firm testes could be a sign of potential issues that should be explored by a doctor.

  5. How can male infertility be fixed?
    Male infertility can be fixed by using one or a combination of fertility procedures, such as IVF, ICSI, IUI, etc.

  6. What foods boost sperm count?
    The foods that boost sperm count are eggs, spinach, walnuts, dark chocolate, asparagus, maca roots, bananas, etc.

  7. What foods should be avoided in male infertility?
    Foods that should be avoided in male infertility are processed meats, trans fats, soy products, high fat dairy products, fish, etc.

  8. How is sperm blockage treated?
    Sperm blockage can be treated surgically. A cystoscope is inserted into the urethra and a small incision is created in the ejaculatory duct. This enables the sperm to get into the sperm.

  9. How can I get pregnant if my husband is infertile?
    You can get pregnant using fertility drugs, medical procedures, or through surrogacy. You can also adopt a child.

  10. What is a high sperm count for a man?
    A high sperm count for a man is >200 million/ml.