Infertility in Men

How Common Is Male Infertility/ Infertility in Men ? 

About 10% to 15% of couples will not be able to achieve pregnancy after one year of unprotected intercourse. Out of this group, the following statistics on the cause of infertility generally apply:
  • Thirty percent of couples will discover fertility problems in both partners.
  • About 30% of couples will discover fertility problems in only the man.
  • About 30% will discover fertility problems in only the woman.
  • About 10% of couples will not find a reason for their infertility (also known as "unexplained infertility").

What are the types of Infertility in Men?

Potential types of male infertility are:
  • Complete absence of sperm (azoospermia)
  • Low sperm count (oligospermia)
  • Abnormal sperm shape (teratozoospermia)
  • Problems with sperm movement (asthenozoospermia)
  • Sperm that is completely immobile (necrozoospermia); the sperm may be alive and not moving, or they may be dead
  • Problems with sperm delivery, due to sexual dysfunction, an obstruction, previous vasectomy, or retrograde ejaculation
  • Problems with erections or other sexual problems

What is a Varicocoele?

The most common cause of male infertility is varicoceles. A varicocele is a varicose vein found in the scrotum. The extra heat caused by the vein can lead to low sperm count and impaired sperm movement.

What are the other causes for Male Infertility?
  1. Infections like smallpox, mumps, TB, leprosy, prostatitis
  2. Sexually transmitted diseases
  3. Idiopathic - cause unknown
  4. Injurya. direct : testicular or pelvic trauma, heat, irradiationb. indirect : radiotherapy, chemotherapy, environmental toxins, drugs, marijuana, tobacco, alcohol
  5. Undescended testes (cryptorchidism)
  6. Previous surgery : inguinal, scrotal, retroperitoneal, bladder neck, vasectomy
  7. Obstructions : congenital (aplasia), vasectomy, post-infective
  8. Systemic illnesses esp. hepatic, renal
  9. Immunologic : infection, obstruction
  10. Ejaculatory disturbances
  11. Spinal cord lesions
  12. Genetic, endocrine & familial disorders : Klinefelter's syndrome, Young's syndrome, cystic fibrosis, adrenal hyperplasia

What increases a man's risk of infertility?

A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include—
  • Heavy alcohol use
  • Drugs
  • Smoking cigarettes
  • Age
  • Environmental toxins, including pesticides and lead
  • Health problems such as mumps, serious conditions like kidney disease, or hormone problems
  • Medicines
  • Radiation treatment and chemotherapy for cancer

What Are the Symptoms of Infertility in Men?

Unlike female infertility (where irregular periods may hint at a problem), obvious symptoms are not common with male infertility. In some cases, hormonal problems may be suspected if a man has abnormal hair growth, low libido, or other indications of sexual dysfunction.

How Is Infertility Diagnosed In A Man?

The tests for male infertility are fairly simple and easy. After a medical history and an examination, the man's sperm are tested. He is asked to ejaculate into a sterile plastic container in a private place in the laboratory, and this specimen is evaluated. The man should not ejaculate for 2 to 4 days before he takes the test, because each ejaculation may reduce the sperm count.

1. Semen Analysis: the sperm is evaluated for several factors:
  • sperm count (20 to 100 million sperm is the normal number)
  • movement of the sperm (motility)
  • maturity and shape of the sperm (which reveal its quality)
  • the amount of sperm produced (one teaspoon is sufficient)
  • acidity (the semen should be slightly acidic)
  • Presence of pus cells which are indicators of infection
The man may be asked to undergo this test twice, because some illnesses such as infections or viruses can affect the sperm. If a man has abnormal sperm, he is referred to a fertility specialist, where he might be asked to undergo more tests, such as:

2. Hormonal blood tests.

3. Imaging tests that check for swollen veins or reproductive system blockages.

4. A testicular biopsy. This is a procedure done in the office. The doctor takes bits of tissue from the testes, and this tissue is examined to see whether the cells that produce the sperm are working properly.

5. Anti-sperm antibody tests, which check whether the woman's mucous rejects the man's sperm. These tests also show whether the man produces antibodies to reject his own sperm.

What Are the Treatment Options for Infertility in Men?

Some causes of male infertility are treatable by medicines or correctable through surgery. Options for treatment may include:
  • Treatment with antibiotics, in cases of infection
  • Surgical correction, in order to remove a varicocele, reverse a vasectomy, or repair a duct obstruction
  • Medications or fertility drugs to improve sperm production
  • In cases where the above treatments are unsuccessful, or when the cause for male infertility is unknown or untreatable, IUI (intra uterine insseminaion) treatment or IVF(in vitro fertilization) treatment may be suggested.
  • IUI (intra uterine insseminaion) treatment, where the sperm are transferred into the uterus via the cervix, is commonly used in cases of low sperm count or quality. IVF(in vitro fertilization) treatment may be suggested if IUI is not successful or appropriate, or if female infertility is a contributing problem.
  • In some cases, you may be recommended a procedure known as intracytoplasmic sperm injection (ICSI). Done as part of an IVF(in vitro fertilization) treatment, ICSI involves injecting a single sperm into an egg.
  • If sperm does not appear in the ejaculate, but they are being produced, the doctor may be able to take sperm directly from the testicles, or from the bladder (in cases of retrograde ejaculation), and use that sperm to fertilize an egg in the lab. This would be done as part of an IVF treatment.
  • However, if none of these options are available, or if they are unsuccessful, your doctor may talk to you about using a sperm donor, or considering adoption, to help build your family.

Emails/ Letters to Dr. Richa Katiyar regarding Infertility in Men.

Hi Doctor,

Greetings for the day.

I am Rakesh from Kota. My cousin got married 3 years ago but he has no children yet. So he met an urologist and went to Semen, Testosterone and USG Scrotal test and the reports says that he has Azoospermia (Nil Sperm) in semen analysis and the reports are as follows...

Semen Analysys : Azoospermia (Nil sperm)
Testosterone : 2.6 ng/ml
USG Scrotal Test : both the testis are normal & No evidence of Hydrocorle or Varicocele, but a Small right Epididymal cyst (3-4 mm) seen.

Here I came to know that weather is there a treatment for AZOSPERMIA or else IVF is the only way to get kids. If IVF is the only way please give me the information about duration (i.e, how many days they should stay there).

Awaiting for your response.

Dear Dr. Richa

this is Mr. Pong writing you kindly from Bhutan, I hope I can have my good treatment by you my sperm has 15% active only the other is week some is diet and some is infection could you please help me how to treatment my self, also I am ready to visit in India, if you have any question please contact me

or please write your direct# and time I call you before my arrive in Delhi
I am looking further your kindly information please

thank you.

with best regards

Hello Mr. Pong,

Sorry to learn that you are having difficulty in having a baby. You have written about yourself but not your wife. How old is she and are all her reports normal? Have the following tests been done for her:

Ultrasound
Tube test (HSG)
AMH- anti muellerian homone

Feel free to contact me for further queries.

Best regards,
Dr Richa Katiyar


Hello,

My name is Louise.My age is 32 years. I am from Sri Lanka. with great respect and hope i would like to share my problem with you.after 8 years of my married life i could not have a child. i have 4 miscarriages due to blighted ovum and recently in January 2014 i did ivf treatment and failed. in year 2009 i visited Chennai Apollo and there dr attended me and prescribed me only metformin and folic acid and said everything will be ok. but nothing goes well.in year 2009, 2010 and 2011 i had three miscarriages then i went to chennai Apollo in 20. after doing chromosomal analysis of blood and other test of both husband and wife they suggested me tab ecosprine and when i would be pregnant they told me to take injection clexane, but coming from chennai i did those and got 4th miscarriage. i am bulky and my husband have oligo astheno teratozoospermia and i ve pregnancy diabetes. now i am on medication metformin 850 two times a day. ovacare two times. ecosprine and folic acid and my husband is taking spermotrend. i am becoming very helpless.and i am feeling due to having D n C 3 times my physical strength is decreasing day by day. i already visited two times india but did not get any positive solution. and now it is little bit difficult for me to come again. cause if i failed again situation wiil be worse here in my family. please doctor give me some way or solution. please. i will be always great-full to you.
waiting for your kind reply.


HI MADAM GRETING,

I SEE YOU WEBSITE YOU HAVE ABILABLE TRATMENT OF TEST TUBE BABAY
Artificial Insemination MY WIFE IS GOOD SHE HAVE NOT ANY PROBLAM BUT I HAVE NIL SPREM SO I WANT ADVISE FROM YOU WHAT I DO CANE YOU CONSALT ME PLEACE REPLAY MY MASAGE
Hello,

Sorry to learn that there is a problem in having a baby. If there is nil sperms, there are many treatments which can be done like donor Inrauterine insemination, IVF or donor embryo IVF. The costs of these treatments vary. I will need to examine your wife to decide whcih is teh best treatment for you.
Please make an appointment at 09810812189 to meet me. Please bring all old reports and papers.

Feel free to contact me for further queries.

Best regards,
Dr Richa Katiyar

Hi Dr,

I am from Zimbabwe. My aig 35 male.lab report azoospermia nd both testas r normal epididymides.prolactin 12.testeotern 16.6.suger 0.please doctor some advice nd help me.now what can i do.i am very upset.please what medicine i do please name.please help me.

Hello Dr.

I have one testies with problem of azoosprem
My wife is fit for pregnancy
What r the option to become pariet.
Kindly suggest ..
Ur

Sharma

Hello Mr. Choudhry,

Sorry to learn that you and your wife are having problems in having a baby.

The first thing we need to see is that are there any sperms in the testis. This is done by a test called PESA. If sperms are found, then they at the same time are frozen for future use for IVF - ICSI for your wife. Then you can have your own biological child.

If no sperms are found, then the option left is donor sperm IUI ((intrauterine insemination).

Feel free to contact me for further queries.

Best regards,