Understanding infertility in men

Dr. Neelima Gupta, Consultant - Reproductive Medicine, Milann - New Delhi

Due to the stigma attached to infertility, many shy away from consulting doctors when they are unable to conceive. According to the Society for the Study of Male Reproduction, a male factor is present in about 40-50 per cent of infertile couples, or in nearly 30 per cent of all infertility cases, the cause is attributed to a problem in the male.

Infertility is defined as the inability to conceive after one year of unprotected intercourse (six months if the woman is over 35 years old) or the inability to carry a pregnancy to live birth. Heavy alcohol consumption, smoking of cigarette or marijuana, exposure to toxic substances like mercury, lead, radioactive rays, x-rays, ulcers or psoriasis drugs etc., are few environmental factors had may lead to male infertility.

Undescended testicles, hernia repair, history of genital infection or mumps after puberty are some of the other factors responsible for male infertility. Heat can also effect sperm production. A one degree elevation in testicular temperature leads to 14 per cent decline in spermatogenesis.

Azoospermia is another infertility diagnosis. In this condition, sperms are absent in the semen sample, as a result of improper sperm production in the testes or due blockage in tubes that transport sperms. Production of sperms can be affected due to hormonal imbalance, testicular damage, and genetic anomaly of male partner or varicocele (swelling of veins in the scrotum). On the other hand, sperm transportation could be affected due to obstruction of tubules around the testicles. The cause of the problem can be identified by an experienced doctor with a thorough medical examination and blood investigations.

There are various treatment options available for male infertility. Assisted reproductive technology (ART) is one of the options. A few of the other recent technological advancements include:

  • PESA (Percutaneous Epididymal Sperm Aspiration): In this procedure sperms are retrieved from the tubule around the testis (epididymis) with the help of fine needle aspiration.
  • TESE (Testicular / Epididymal Sperm Extraction) - It's advocated for patients with defective sperm production. In this procedure, sperms are directly extracted from the testes.

Latest addition to the technology is Micro-TESE; currently available only at few super-specialty clinics.