How the male partners can be responsible for inferilty

Male factors are responsible for infertility in 30 – 40% of couples. Male factor infertility includes problems with the man's sperm. The difficulty may be with the sperm themselves or the delivery system that takes them from the testicles, where they are formed, through the penis and into the woman's vagina.

Normally, there are at least 20 million healthy sperm in each milliliter of semen ejaculated. Some men produce no sperm at all or very few. Others may have sperm that are oddly shaped or unable to move properly. Any of these problems can cause infertility.

Even if a man produces healthy sperm, exposure to certain conditions or substances may kill them. For example, heat is harmful to sperm. Fevers, long soaks in hot tubs, and tight underwear that keeps the testicles close to the body all can result in temporary drops in sperm counts. It takes 90 days for sperm to mature, so any man who has had a high fever within 3 months may have a low sperm count also.

AGENTS HARMFUL TO SPERM

Chemotherapy, Radiation treatment Alcohol, Antibiotics (nitrofurantoin, sulfa drugs), Ulcer treatments (cimetidine), Marijuana, Nicotine, Diethylstilbestrol (DES), Anabolic steroids (used for body building), Some lubricants used during sex.

A man's reproductive system can be affected if his mother took DES while pregnant with him.


Some substances have a permanent effect, while others are only temporary. A man trying to father a child may want to consult with his doctor if he has been exposed to any of these agents.

Other men have difficulty in getting the sperm to the right place. Some are impotent or cannot maintain an erection sufficient to allow intercourse. Others have blockages in the tubes that carry the sperm from the testicles through the penis. These blockages may be caused by infections, some sexually transmitted. In other men, a condition called retrograde ejaculation results in sperm going the wrong way once they reach the penis. Instead of going out the penis, they move backward up into the bladder.

Causes of Infertility - An overview

The causes of infertility are multiple, and some are hotly debated in medical circles. In some cases, the reasons are found in the woman (female-factor infertility); in other cases, the cause lies in the man (male-factor infertility). In still other couples, the infertility may be due to a combination of medical problems in both partners. For some couples with infertility, a cause is never found. This can be very upsetting.

One important cause of infertility in both men and women is sexually transmitted diseases. Even STDs with no symptoms can cause scarring in a man or woman's reproductive system; such scars block passageways for sperm or eggs. Having several sexual partners increases the chance of getting an STD. An STD can lead to a pelvic inflammatory disease (PID), a severe infection of the uterus and tubes; it can scar and block the tubes, causing infertility later on. To avoid getting STDs, limit sexual partners and use a condom during sex.

What is Intra Uterine Insemination (IUI)? How IUI helps in infertility?

IUI (Intra Uterine Insemination) is a very simple, safe and relatively effective method of infertility treatment. Here spermatozoa are deposited artificially inside the uterine cavity and thus by passing some factors preventing fertilization normally. The overall success rate of IUI varies from 8 to 15% per cycle depending on the age of the patient and ovulation stimulation protocol (clomiphene vs. gonadotropins ). Most pregnancies following IUI occur within the first 3 or 4 treatment cycles. Best results are obtained in young patients below 30 years having only mild oligospermia (low count of spermatozoa) undergoing gonadotropin stimulation

What is actually done with the semen before insemination?
1. most functional sperms from Ejaculate are selected
2. cellular debris and Seminal Plasma is removed from the semen
3. to increase in sperm motility some substances are added.

In which conditions IUI is performed?

1. Unexplained infertility.
2.Cervical factor.
3. Malefactor
- Insufficient production and or, altered quality of semen Oligo/astheno/teratozoospermia.
- Ejaculatory failure.
4. Endometriosis (minimal, mild)
5. Immunological factors like Anovulatory Infertility

What are different techniques of IUI?

Different techniques of IUI is applied in different quality of sperms

Layering technique - for normal and good sperm count
Swim up technique - good sperm count with 1 or 2 factors abnormal
Gradient technique - low, abnormal and high viscous semen. This method is mostly used in “in vitro fertilization” or, IVF and ICSI (Intra cytoplasmic sperm injection).

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Azoospermia or no spermatozoa in semen – How can be managed?

Azoospermia or no spermatozoa in a man’s semen is a definite cause of infertility and this condition must be excluded before any invasive test performed in the woman partner.

This condition may be either due to
i) Testicular failure or,
ii) Obstruction in the passage particularly vas deferens

Normal sized testes with turgid epididymis and a normal serum FSH (Follicle stimulating hormone) suggest there is obstruction.

On the other hand small testes and flabby epididymis along with high FSH level usually suggest testicular failure.

Though, sometimes testicular failure may also have normal sized testes and normal FSH. Many a times these findings may be equivocal and a testicular biopsy is needed to get the final answer.


Currently, the needle method of testicular biopsy is preferred to an open biopsy. Often multiple biopsies are taken to map the testis properly. This helps identifying a sub-group of men with testicular failure who have focal spermatogenesis; in these men sperm can be retrieved from the testis and used for ICSI.
Men with obstructive azoospermia can be treated by microsurgical reconstruction to relieve the obstruction, or by sperm aspiration and Intra Cytoplasmic Sperm Injection ( ICSI).

The choice of procedure will depend on the wife's age and the expertise available.

This article is also published in India study Channel

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.

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Role of ultrasonography in male infertility

Ultrasound Assessment of the Mate Partner


Male factor infertility today comprises almost 40% of the causes in an infertile male. The modern life style and additives in food have became a major environ¬mental cause of oligoasthenospermia.

The function of male genital system encompasses the central nervous system (hypothalamus and pituitary), the adrenal glands, the testes, the epididymis, the seminal vesicles and the prostate gland. Any malfunctions of any of these may affect the male reproductive capacity.

Scrotal and transrectal (TRUS) are used in evaluation of the reproductive tract disorders. Color flow imaging is used for assessment of varicocele. 3-D is used for testicular volume and seminal vesicle and prostate evaluation. Computed tomography and endorectal Magnetic Resonance Imaging can also be used.

Scrotal sonography


Scrotal sonography is performed with patient in supine position using a special small probe. This can evaluate the testis for size, shape, hydrocele, benign tumours, atrophy, malignancy, orchitis, torsion, haemorrhage, focal lesions, etc. Ultrasound imaging is very sensitive in testicular evaluation.

Transrectal Ultrasonography (TRUS)


Transrectal Ultrasonography (TRUS) is an excellent approach for visualising the seminal vesicles, prostate and ejaculatory ducts. With TRUS we can assess obstructions, absence or hypoplasia of seminal vesicle and ejaculatory ducts. TRUS is an excellent screening test for ejaculatory duct pathologies and is indicated in all men with severe oligospermia and a low volume ejaculate.

This article is also published in India Study Channel