Dr. Virendra Dhankhar is a senior consultant urologist, andrologist, and transplant surgeon at Chandigarh healthcare, sector 16, Mohali and Apollo hospital sector 8C, Chandigarh. In this video, I will talk about male infertility.
If the male partner is the reason the couple cannot get pregnant, then it is called male infertility. This is a very common problem. Changing lifestyle, growing age, stress, and unhealthy eating habits can contribute to this problem. With the reference provided by the World Health Organisation WHO, one gets an idea of an average sperm count. But the number is reducing day by day. Before, the normal sperm count was 40 million. But currently, WHO states that the normal sperm count is 15 million per ml. WHO is reducing the numbers because of the fall in the production of sperms in an average male due to his changing lifestyle over the years. So this gives us an idea of how big this problem is. on an average from 100 infertile couple, 33% of it is because of the male, 33% female, and the other 33% is unknown. So in an infertile couple, the male and female are equally responsible.
When checking for infertility in men, the sperm count, sperm motility, and morphology. Of the male is checked. If the sperm count is above 15 per ml, then it is called normal sperm count. If the sperm count is zero, then it is called azoospermia. There can be various causes of azoospermia like genetic, any physiological reasons, or low sperm count.
The term “sperm motility” refers to the ability of the sperm to swim the right way. So why do we need sperm motility? So the process of fertilization goes like this: the female’s egg stays in its position, and the sperm swims to the egg and then transfers its genetic data. For this, the sperm has to be motile. The faster it swims, the better the sperm . If the sperm is less motile or has zero motility, then it is called Asthenozoospermia. So this was about the motility of the sperm.
Sperm morphology refers to the size, shape, and appearance of a man’s sperm as sperm has a head, neck, and tail. The head has the genetic material, the neck is the charging point, and the tail helps the sperm swim. If there is a problem in the sperm’s morphology, like the tail being weak or small, it is called Teratospermia.
These problems can be isolated as well as combined, which is called Oligoasthenoteratozoospermia. Oligo is a low sperm count, astheno is low motility, and terato is morphological. These can be together or in combinations like Oligoasthenozoospermia, Teratoasthenozoospermia, and Oligoteratozoospermia.
For evaluation, a clinic examination of the testes is done. The firmness, size, and nerves are all critically examined. If there are too many nerves, it is called varicocele. The vas presence and appearance of the vas are examined. The epidermal is inspected for swelling. All these things help in the diagnosis.
If one testicle is smaller in size than the other one, then a color doppler is suggested. This will help us know how much the nerves have swollen and the grade of glycosyl is. The size of the vas could affect the motility of the sperms as well. An ultrasound helps detect whether the semi vesical is swollen or grown in size. If the semi vesical is swollen, then it means that there is an obstruction in the ejaculatory duct.
The normal volume is 1-2ml. 0.5 comes from the testes1.5 -2 from the semi vesical and 0.5 from the urethra gland. So if the volume is low, it means that somewhere there is a blockage in the ejaculation passage.
So volume, count, motility, and morphology are to be diagnosed and then treated accordingly. We should not panic after seeing only the semen analysis board as the production of semen is a 64 days cycle. And if the person had a fever or was sick, then the first report of the person does come out to be abnormal.
So you should not panic after seeing the first result. Instead, you should find out what the reason was. Whether you have a fever or started a new medication, smoked or consumed excess alcohol, etc., all these reasons can cause the semen parameters to be abnormal. After three months, the second test is done. And if the results are the same as before, then the second is considered for further diagnosis and treatment. So the patient should always get two semen parameters tested, and if the results are the same, it should be treated accordingly.
If a couple below the age of 35 is trying to have a baby for a year without any success, they should get tested. A couple above the age of 35 should get tested after six months of unsuccessful trying.
The patient is asked not to have sexual intercourse for about four days. Then a semen analysis is done. First, the semen is examined for volume, count, morphology, and motility. After analyzing these four further diagnoses it is decided whether an ultrasound is required or a doppler test necessary, etc., and then treat it accordingly.
If the volume is low, that means the problem is ejaculator objection. That can be treated with a simple telescopic surgery.
If the sperm count is low, then we should check whether there is sperm production or not. And if both the testes look normal, then a hormone test is suggested, testosterone, FSH, LH, and prolactin. If the tests come out normal and the testes look normal, the testicles are picked with a needle. This test is called TESE., and this helps us find out if the sperms are being produced. And if the TESA test is normal and the production is good, then it means there are obstacles in the way. For example, the most familiar passage blockage is at the junction of the vas. This can be corrected by surgery which can get us 60 – 70% success in conceiving.
The other objection can be at the ejaculator, where both the semi vesicles meet and open at one point. That mouth is called an ejaculator. And due to the blockage of the ejaculator’s mouth being blocked, the semen volume of low and causes azoospermia. Again, an ultrasound can be done to detect this problem, and then it is surgically treated to bring the sperm volume back to normal.
Azoospermia can also be caused if the male has gotten a vasectomy done. And it can be cured by joining it.
When it comes it low motility, we first need to figure out whether the cause of this is reversible or irreversible. The reversible causes are a problem in the varicocele. When an ultrasound is done, or the size of both the testes is different, it can be surgically treated and corrected. And after the surgery, 70 – 80% of the semen parameters could be improved, and 15 – 20% chances of getting pregnant.
The patient must make healthier life choices to avoid infertility issues and avoid alcohol, smoking, drugs, and anti-depressants. If you are taking medication for cancer, I suggest you preserve your semen before starting your medications. The patient is also given multivitamins and multi nutrients like zinc, etc. These multivitamins, if given in proper proportion, can help improve semen health. The results can be variable, but they have proven to help the body and semen health. Some of the professions can pose a threat, like if you work near a radiation field. A radiotherapist or an X-ray technician who works at high temperatures like the furnace should shield themselves from the heat by moving to a lower temperature and working.
In a nutshell, male infertility is very common. With the changing lifestyle, the problem of infertility has become more prominent. ⅓ of the population is infertile. One way to prevent it is to change your lifestyle and opt for healthier lifestyle choices. For example, cultivate healthy eating habits and always consult a urologist regarding these problems. And infertility problems in females can be treated by a gynecologist.
The progress in technology has made it easy for infertile couples to have a baby using IVF and other techniques. Consult your doctor, and they will help you make the right decision.
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