Male Factor

Male partner may have low sperm count or non-motile sperms or their motility may be poor or they may be abnormally shaped. The males may also have problem with delivering sperms in the female genital tract.

Semen Analysis: The semen sample is used to determine the fertility of male. This requires a masturbation specimen, collected in a sterile container provided by the laboratory.

Morphology: Sperm appearance, its structural examination is not done by most of the labs, but we are doing it in our Centre. It is the best predictor for sperm function. Even if a semen analysis has been done else where, we may request a repeat test in our lab.

Semen survival test: The ability of sperm to survive in female genital tract can be assessed by this test. Washed and prepared semen is kept under co2 with body temperature in incubator for 24 hours and check latter to assess the sperm survival in female genital tract.

CAUSES OF MALE INFERTILITY: Male infertility is caused by

  • Undescended testis: Occurs when the testis fails to descend from the abdomen into the scrotum during fetal life. This leads to total absence of sperm production.
  • Varicocele: This consists of dilated and tortuous testicular veins that contain stagnated blood. This leads to impaired sperm production in testes.
  • Hydrocele: This consists of collection of fluid in coverings around the testis. This may lead to impaired sperm production.
  • Infection of testis (Orchitis): This can be caused by sexually transmitted diseases, prostatitis, urethritis, etc.
  • Genetic diseases: Chromosomal disorder like Klinefelter’s syndrome having 47xxy karyotype can cause low sperm count or azoospermia.
  • Sperm antibodies: Sperm antibodies can form in individual’s blood that can lead to infertility.
  • Medical conditions can be associated with infertility such as: Diabetes / Thyroid disorders / Disorders of pituitary gland / Disorders of adrenal glands / Liver or kidney failure / Genetic diseases / HIV/AIDS

Common sexual problems in men:

  • Erectile dysfunction
  • Ejaculation disorders
  • Loss or less libido

Causes: Sexual problems can be a result of physical or psychological disorder.

Erectile dysfunction or Impotence:

Definition: Inability to attain and or maintain an erection suitable for intercourse.

Causes: Artherosclerosis [hardening of the arteries] affects blood flow. Nerve disorders / Psychological factors / Stress / Depression / Performance anxiety / Injury to the penis / Chronic illness / Peyronie’s disease[scar tissue in the penis]

Ejaculation disorders: There are 4 types of disorders:-

  • Premature ejaculation – It occurs before or soon after penetration
  • Inhibited or retarded ejaculation – Inhibited or retarded ejaculation is delayed &/or slow to occur
  • Retrograde ejaculation – At orgasm the ejaculate is forced back into the bladder rather than through the urethra and out the end of penis.
  • Anejaculation – absence of ejaculation

Loss of Libido: Decrease in sexual desire or interest in sexual activity.

Assessment of male infertility:1)Semen analysis: Semen analysis is the most important and easy investigation for male partner. You should have abstinence of at least three days before giving semen for examination.

Semen is usually given by masturbation in a sterile semen collection container in laboratory.

Analysis of semen usually includes the following components:

  • Semen volume – is the total amount of semen in a single ejaculation.
  • Sperm concentration – is the number of sperms present in one ml of semen.
  • Sperm motility – is the ability of sperm to move.
  • Morphology – indicates the structure of sperms.
  • Minimal requirements for male fertility:
  • Semen volume: more than 1.5 ml
  • Sperm concentration: more than 15 millions/ml
  • Total sperm count: more than 38 millions/ml per ejaculate
  • Motility : more than 40% sperms having grade 3 to 4 motility( forward progression)
  • Morphology : more than 30% normal sperms

Evaluation of male hormones:

  • Testosterone, Follicle stimulating hormone (FSH), Luteinising hormone (LH),
  • Prolactin (PRL), Dehydroepiandrosterone sulphate (DHEAS), Thyroid hormones (T3, T4, TSH)

Scrotal sonography & Color Doppler: this can diagnose hydrocele, hernia or varicocele.

Testicular biopsy: when semen analysis shows absence of sperms in repeated semen samples and testicular size is normal, then testicular biopsy is usually indicated to know the cause of azoospermia. In this small piece of one or both testis is taken for histopathological examination under local or general anesthesia.

Genetic karyotyping: This test is done when some genetic disorder is suspected in male partner or in patients with severe sperm defects. This is also required before proceeding for IVF or ICSI.

Surgical retrieval of sperms for ICSI: When semen analysis shows absent sperms but testicular biopsy shows production of sperms in the testes, we use various surgical sperm retrieval techniques to retrieve the sperms from testes or the collection system. ICSI treatment is done with these surgically retrieved sperms to achieve the pregnancy. These techniques are:

  • Testicular sperm aspiration (TESA)
  • Testicular sperm extraction (TESE)
  • Percutaneous epididymal sperm aspiration (PESA)
  • Microepididymal sperm aspiration (MESA)
  • Vas deferens aspiration (VDA)
  • Spermatocele aspiration

Mother Hood Fertility video
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