Causative and risk factors
Infertility may sometimes be due to a congenital cause and sometimes due to an acquired cause.
In males, a reduced sperm count is the biggest cause of infertility. Sometimes the number of sperms is normal, but they are qualitatively poor. Addictions to alcohol, drugs, smoking etc, can damage the sperms thus making a man infertile. In addition, exposure to high temperatures for long periods can also destroy sperms.
Some men may be born with defects involving the testes or penis. Primary testicular failure due to mumps or other childhood illnesses, non- descent of testes etc. can cause infertility. Varicocele is a common cause of male infertility. Systemic illnesses such as diabetes or hypertension can also contribute to infertility.
Advancing age, obesity exposure to chemotherapy or radiotherapy can also have a detrimental effect on sperm production.
Clinical presentation
Failure to get pregnant even after 1 year of regular unprotected sex is a signal to investigate the couple for infertility. Other symptoms may be present depending upon the cause of infertility.
The male partner may suffer from impotency (inability to produce or sustain an erection), premature ejaculation or erectile dysfunction. He may have a low libido. The facial or body hair may be sparse.
Diagnosis & Investigations
A man suspected with infertility is first and foremost required to undergo a sperm examination test. An ultrasound of the testes is recommended. Sometimes he may need to undergo a biopsy of the testes.
The semen analysis report is interpreted as follows:
Azoospermia – complete absence of sperms
Oligospermia – Only few sperms are seen
Apart from the number of sperms, abnormal morphology or motility of the sperms can also produce infertility.
A normal semen analysis report will show a sperm count of about 20 million per ml. At least 30% of the sperms must have normal morphology and at least 50% of the sperms must have normal motility.
Treatment
The cause of infertility must be corrected first. Any underlying defects or conditions must be corrected via medications or surgery.
Infections must be treated appropriately. Hormone replacement can be done in men with a hormonal deficiency, Conditions like varicocele or obstruction in the male reproductive organs can be treated with surgery.
The couple is advised to have unprotected sex at least 3 times a week to increase the chances of pregnancy. Lifestyle corrections are advocated such as losing excess weight, curtailing smoking and drinking and avoiding exposure to high temperatures.
Newer drugs for premature ejaculation and erectile dysfunction are prescribed if necessary.
If the couple still fails to achieve pregnancy, assistive reproductive techniques such as Intra-uterine insemination (IUI) and In vitro fertilization (IVF) are recommended to the couple. More than 50% of couples with infertility problem become pregnant after treatment.
