What is male Infertility?
As indicated by the International Committee Monitoring Assisted Reproductive Technologies (ICMART), inability to get pregnant is characterized as infertility if pregnancy isn’t built up following a year or a greater amount of standard unprotected sex. While it is possible that either of the accomplices may add to the conceptive difficulties of the couple, male infertility, similar to female infertility, is a clinical conclusion that must be resolved after proper evaluation and testing.
Male Infertility is the failure to deliver active sperm or to create motile sperm that can prepare the female egg. Approximate 40 percent of infertile couples, male infertility is a contributing variable.
How common is male infertility?
One out of eight couples experience difficulty getting pregnant or supporting a pregnancy. Roughly 33% of infertility is ascribed to the female accomplice, 33% credited to the male accomplice and 33% is brought about by a blend of issues in the two accomplices or, is unexplained.
Male infertility is progressively normal in conditions with elevated levels of natural contamination, including water contaminants, pesticides and herbicides. Some ongoing populace examines have recommended that sperm tallies have been declining all around despite the fact that barrenness has not been expanding significantly.
Male Infertility may be caused due to various causes and may require the suggested Treatment mentioned below.
Reason behind Male Infertility
Following are the essential drivers of male-related barrenness.
- Irregular swelling veins in the male testicles, known as varicoceles, are the most widely recognized reason for male infertility, and can bring about low sperm creation and poor sperm quality.
- The shape and size of sperm, known as sperm morphology, influence the sperm’s capacity to treat the egg.
- Chromosomal or hereditary issues that influence sperm creation may bring about low sperm include and focus in semen.
- Low sperm motility (development) additionally makes it hard for sperm to make a trip to and enter a lady’s egg.
- A lopsidedness in testosterone or different hormones.
- A characteristic physical blockage– in male tubes (vas deferens) that convey sperm from the testicles to blend in with semen before discharge.
- Retrograde discharge, a turmoil that precludes semen from appropriately discharging ostensibly, doesn’t permit sperm to leave the man’s body.
- Enthusiastic and mental conditions or spinal rope wounds may bring about feebleness and cause barrenness in men.
- Malignant growth treatment can cause male infertility (men planning to experience radiation or chemotherapy are firmly encouraged to counsel a conceptive endocrinologist or oncologist with respect to sperm freezing).
How Male Infertility Issue can be treated?
Male infertility can be treated successfully in more than half of all cases
- Treatments include assisted reproduction, drug therapy, and surgery
- In vitro fertilization (IVF) is a type of male infertility treatment
- Surgery to correct an abnormality in the reproductive tract may improve fertility
At least one-half of male fertility problems can be treated so that conception is possible. There are three categories of treatment for male infertility:
- Assisted reproduction
- Drug therapy
Assisted Reproduction therapy includes methods to improve erectile dysfunction, induce ejaculation, obtain sperm, and inseminate an egg:
- Electro ejaculation
- Sperm retrieval and washing (IUI)
- In vitro fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)
- Surgical Sperm Retrieval (TESA,MESA & PESA)
Treatments to Solve Male Infertility Issue
As mentioned above, there are some treatments and procedures used to resolve male infertility problems. Different treatment is used for different case of patient’s fertility hiccup. For instance if the male has very low sperm count, then ART technique (either ICS or IMSI) is used. If the sperm is unable to penetrate with the egg’s wall and the reason behind this is abnormality of sperm (morphological unfit), then IVF treatment with PICSI is performed.
What if the male is found with no sperm at all or barely very less sperm count? This is the time when the surgical way of ART is used – SSR or Surgical Sperm Retrieval. During the SSR process, the patient is kept under sedation, and the specialist retrieves the sperm directly from the male reproductive organ (epididymis, or testicles) and fertilized with the ICSI technique. Let’s read information in brief –
This procedure can be used to produce ejaculation when neurological dysfunction prevents it. An electrical rectal probe generates a current that stimulates nerves and induces ejaculation; semen dribbles out through the urethra and is collected. Retrograde ejaculation is associated with the procedure and sodium bicarbonate is usually taken the day before to make the urine alkaline (nonacidic) and nondetrimental to sperm. Candidates for electro ejaculation include men who have undergone testis removal (orchiectomy), retroperitoneal lymph node dissection (RPLND), and those with spinal cord injuries.
Surgical Sperm Retrieval
This technique is used to obtain sperm from the testes or epididymis when obstruction, congenital absence of the vas deferens, failed vasectomy reversal, or inadequate sperm production causes azoospermia. Using a technique called micro epididymal sperm aspiration (MESA), a surgeon makes an incision in the scrotum and gathers sperm from the epididymis, the elongated, coiled duct that provides for the maturation, storage, and passage of sperm from the testes. Percutaneous epididymal sperm aspiration (PESA, or fine needle aspiration) is similar to MESA but does not involve microsurgery. A physician uses a needle to penetrate the scrotum and epididymis and draws sperm into a syringe. Testicular sperm extraction (TESE), the removal of a small amount of testicular tissue, is used to retrieve sperm from men with impaired sperm production, or when MESA fails.
These procedures are done under local anesthesia, usually take about 30 minutes, and may cause pain and swelling.
Sperm retrieved by MESA, PESA, or TESE may be used in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). IVF involves combining eggs with sperm in a laboratory, providing proper fertilization conditions, and transferring the resulting embryos to the uterus. To retrieve an egg, a specialist uses ultrasound to guide a fine needle through the vaginal wall and into the ovary or makes an incision in the abdomen to get to the ovary (laparoscopy). Once the eggs are retrieved, they are combined with prepared sperm in a sterile dish for 2 to 4 days. After fertilization, the embryos are transferred to the uterus. IVF is used most commonly for infertility caused by female reproductive abnormalities.
While excess sperm from MESA or PESA can usually be frozen for future use, most TESE-derived sperm are not of sufficient quality or quantity for frozen storage (cryopreservation). Multiple MESA or PESA procedures are not recommended, since repetition can lead to scarring.
Sperm Washing –
This procedure isolates and prepares the healthiest sperm for insemination. Sperm and washing medium are combined and spun rigorously (centrifuged) and the process is repeated if necessary. The process separates sperm from white blood cells and fatty acids (prostaglandins) in the semen that may hinder sperm motility. It also concentrates sperm, which increases the chance for conception.
This process is also known as Artificial Insemination or IUI treatment, where the male provides his semen to the fertility lab for the further procedure. The fertility team washes the semen by a special technique in order to eliminate unwanted particles from the semen. Placing the fresh and washed sperm into the partner’s uterus (just prior to partner’s ovulation), so that the chances will be more for fertilization.
Intracytoplasmic Sperm Injection (ICSI)
ICSI may be used with immotile sperm during in vitro fertilization. Using a tiny glass needle, one sperm is injected directly into a retrieved mature egg. The egg is incubated and transferred to the uterus.
Fertilization occurs in 50% to 80% of cases and approximately 30% result in a live birth. The egg may fail to divide or the embryo may arrest at an early stage of development. Younger patients achieve more favorable results and poor egg quality and advanced maternal age result in lower success rates.
ICSI does not increase the incidence of multiple pregnancies. Long-term information about the health and fertility of children conceived through this procedure is not available because it was first performed in 1992.
Gamete intrafallopian transfer (GIFT) This procedure is recommended for couples with unexplained fertility problems and normal reproductive anatomy. Mature eggs and prepared sperm are combined in a syringe and injected into the fallopian tube using laparoscopy. Embryos that result from this procedure naturally descend into the uterus for implantation.
The Bottom Line
Success rate of all the male infertility treatment ranges from 45% to 65%.
Drug therapy for male infertility includes medications to improve sperm production, treat hormonal dysfunction, cure infections that compromise sperm, and fight sperm antibodies. The administration of testosterone is similar to that used to treat testosterone deficiency.
Surgery for male infertility is performed to treat reproductive tract obstruction and varicocele. Vasoepididymostomy is a microsurgical procedure that corrects obstruction in the coiled tube that connects the testes with the vas deferens (epididymis). Obstructions commonly result from STDs and also include cysts and tubal closure (atresia), which is usually genetic. Vericocelectomy, the removal of a varicocele from the testes, often results in increased sperm count.
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