Male Infertility by Dr. Mamta Dighe, Director of Xenith advanced fertility centre

I’m this is dr. Mamta Dighe director at Xenith advanced Fertility Center in Pune Today we are going to address the topic of male factor infertility Male factor contributes to about 50% of the causes in infertility cases Basically about 30% of the times these causes are related only to the male With the female factor being completely normal about 20% of the times there is a problem in the female as well as the male and therefore both put together We have about a 50% contribution from the male for the infertility causes Unfortunately, the main factor is many times not evaluated as well as it should be as the female factor infertility is evaluated The basic investigation that we do to assess the male factor is a simple semen analysis Which forms the basis to understand whether the sperms are capable of a good fertilization rate and producing a viable embryo Now WHO has defined certain criteria and set limits as to what we can call is a normal semen analysis Unfortunately, the way a semen analysis is done is not completely standardized according across all the laboratories and therefore getting a semen analysis done in a good IVF IVF laboratory under a good embryologist becomes extremely important The factors that we evaluate when we look at the semen analysis is mainly I will not go into all the other factors we just talked about the main factors is mainly the count the number of sperms in the given semen the motility now the motility of a signal sample or a sperm is divided into a fast-moving, a sluggish moving which we call actually a rapid progressive, a slow progressive very sluggish motility which is only in the place and one the last one is immotile. Now, what is important? Is that the sperm sample or the semen sample should have a good number of a fast progressive and a slow progressive semen motility in the semen sample. In the absence of good motility in the semen sample it becomes difficult to have these sperms go ahead, completely travels the female tract of the reproductive tract from the vagina up to the tubes and fertilize the oocyte and therefore motility is an extremely important factor. The third important factor is the morphology or the number of normal sperms that are present in the semen sample Many a times, the morphology of a semen sample is not evaluated with great care and many times we see semen samples will show large amount of normal sperms whereas actually the number of abnormal sperms in such semen samples are very high and it’s important to make sure that we do not miss this finding in a semen analysis. Over it about a basic semen analysis the next evaluation that is sometimes important is to analyze whether there are any breaks in the DNA of the sperm. So basically the sperm has a head and a tail inside the head is the DNA of the sperm, which is very important for the fertilization and forming a normal embryo Under certain conditions like if the man smokes a lot, if there is any exposure to environmental pollutants like if they are working in paint factories or chemical factories, there’s a possibility that there are breaks in the DNA of the sperm Now these breaks cannot be assessed on a routine semen analysis and we have to do certain investigations called a sperm DNA fragmentation test for such semen samples. It is very important to understand which kind of semen analysis after looking at them, do you advise to go in for other treatments and investigations like the sperm DNA fragmentation. Now it is important to understand here if the male factor is evaluated correctly we understand and go down to the basic root cause of why we’re dealing with a low semen count or motility or an abnormal morphology then it is very possible to treat this at a basic level and help the couple achieve a pregnancy either naturally or even through IUI and many times we can avoid such couples from going on into an IVF treatment. It is also important to understand that there will be some males who have absolutely, no sperms in the semen sample, which we term as azoospermia Now azoospermia can happen because of two factors : One is that there are no sperms being produced in the testes at all and therefore there are no sperms in the semen sample The second cause could be that the sperms have been produced in the testis but there is a blockage in the transportation which helps the sperms come out into the semen samples and due to the blockage even those sperms are being produced in the testis, they are absent in the semen sample It is extremely important to understand what kind of an azoospermia are you dealing with. If it is an obstructive azoospermia which means there is a blockage many times you can either treat this blockage or it is very easily possible under such circumstances to retrieve sperms from the testis and utilize them for an IVF or an ICSI procedure However, if there are new sperms being produced in the testis in the first place, which we call as non-obstructive azoospermia then it becomes very difficult to find sperms even in the testis and therefore having a good reproductive medicine unit where you have an andrologist and a trained reproductive medicine specialist who can understand the type of extraction procedures, microsurgical extraction procedures, that you can use in such a male, in order to ensure that you retrieve sperms even from males where there are very limited amount of sperms being formed in the testis At Xenith we have an operating microscope and we’re the only standalone center where we do all our micro surgical sperm extractions with an operating microscope. So in such cases there will be only some places in the testes where a few sperms are being produced and in order to retrieve these sperms which are very difficult to find you have to use an operating microscope after you put a small very tiny incision on the testes and under microscope identified a tubule which is filled with these sperms and then extract that tubule and take the sperms from the testis. So even in cases of azoospermia where you do not have any sperms in the semen sample it is still possible to undergo an ICSI procedure with sperms which have been retrieved from the testis However, it is important to understand what kind of male infertility you are dealing with. Where you can treat this patient and help them conceive without any advanced forms of treatment and where you have to utilize the correct advanced forms of treatment in order to give the couple their own biological child Male infertility is an important factor and needs to be addressed completely There could be other factors such as genetic causes which could be passed on to the baby and therefore it is also important that if there is a severe male factor contributing to infertility you make sure that there are no other chromosomal or genetic causes causing such a problem which could thereby be passed on to the baby, and therefore a complete evaluation is important What I would like to say to all couples is that it is very possible to treat male infertility but it is important to try and diagnose and treat it in the early stages so that we do not need to go to any advanced forms of treatment and if you apply the right and the correct treatment, then there is great hope even today for all the couples wishing for their own now a baby It is also important to understand that male factor infertility is increasing worldwide and there are many factors contributing to this so all of us need to develop an awareness towards this and need to work towards the correct treatment of male infertility We would be happy to take and answer any questions if you have please do go ahead and leave any comments below if you have any and we welcome you to visit our website and let us know if you have any question and we’ll be very happy to address them. Thank you so much.

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