Male factors in infertility – incidence, causes and treatment

Male factor in sub-fertility is rising and responsible partly or wholly to more than 50% the cases of infertility. The factors responsible for this are many including increasing environmental toxins which act as endocrine disruptors, and high stress levels. Moreover, more males are also being diagnosed because they are more willing now to get themselves tested.

Varicocele as a cause of male infertility:

Though certain database proved that varicocele is not a significant cause for male infertility; but this factor if present, is the most correctable cause. Some patients certainly gain from varicocele surgery showing a remarkable enhancement in semen quality and producing a pregnancy, while others have no benefit at all. Hence, it is valid to recommend surgery for a clinical

varicocele. At the same time, there is no point in looking for sub-clinical varicoceles discovered on ultrasound. Microsurgical ligation of the varicocele should be preferred, where indicated. Laparoscopic ligation has a high recurrence rate.

Causes and incidence and treatment of low quality of semen in males?

Azoospermia:
Azoospermia means there is no spermatozoa in the semen. About 10% of male infertility is due to azoospermia.

90% of the time this azoospermia is because of testicular failure and the rest is due to obstruction. In testicular failure, unfortunately no treatment can help. The commonest cause of obstruction is a block in the epididymis or, congenital absence of the vas deferens. Vas blocks are usually iatrogenic (following vasectomy or hernia surgery). Obstruction at the level of the seminal vesicles or ejaculatory ducts is relatively uncommon and is characterized by low volume of ejaculate and absence of fructose in the semen. Some but not all of these blocks may be amenable to surgical correction.

Immunological causes are less frequent than thought earlier, and the diagnosis is not easy since most laboratories test for antibodies by means of ELISA method which is highly unpredictable.

Isolated sperm defects in the form of total asthenozoospermia, necrozoospermia, or extreme teratozoospermia are uncommon and usually can be treated only by Intra Cytoplasmic Sperm Injection or, ICSI.

For more information about Azoospermia read here

Role of Vitmains, antioxidants, CoQ 10 and antibiotics in improving male infertility.


There is no drug or, supplement which had been proven to be effective consistently and proved by well controlled studies. Few men with insufficient activity of gonadotrophins might respond to hormonal therapy. Other therapies are mostly empirical. Antioxidants may help in some men. Injectable testosterone cause suppression of spermatogenesis and it s use is not advisable.
Studies could not prove any role of empirical use of antibiotics to improve sperm quality, unless there is definite infection.

External factors and drugs affecting sperm quality:

Sulphasalazopyrine, nitrofurantoin, spironolactone, estrogens, and anti-androgens are medications that affect sperm count. Recreational drugs like marijuana and other opioid derivatives affect sperm quality. Habits that expose the man to excessive heat like frequent use of sauna or steam, very hot baths, or tight underwear can affect sperm quality and count. Excessive smoking can affect sperm chromatin Integrity, High levels of stress can also affect sperm quality,

Scrotal cooling has been reported to be useful in men who work in a hot environment or who have varicocele. For all oligospermic men scrotal cooling is not advisable.

Success rate of Intra Uterine Insemination (IUI) in oligospermia and with normal sperm:

IUI is not a treatment for male factor infertility. Pregnancy rate after IUI in oligospermia is no more than 8 – 10% per cycle. Four cycle pregnancy rate can be up to 20% provided one million healthy some is recovered from the semen.

The best results with IUI are in cases of normal semen with cervical hostility or antibodies, where a cumulative pregnancy rate of 40% can be expected. IUI for ejaculatory dysfunction, where the semen quality is usually normal, also has a very high success rate.

This article is also published in India study Channel