CHENNAI: At the age of 35, when Sakshi, a software professional and her husband Amit, an architect decided that it was the right time to start a family, they were in for a shock. Sakshi’s reports were normal, but Amit had extremely low sperm parameters; a male infertility condition called Oligo Terato Astheno spermia (OTA). Amit had low sperm numbers, poor sperm motility and high abnormal forms, inspite of being completely healthy otherwise.
When couples face fertility issues, the first step is to visit an infertility specialist. Naming infertility as a female problem is a common misconception, even among healthcare providers.
Infertility is due to male factors in 40 per cent of cases and female factors in another 40 per cent of cases. The cause for infertility is unknown in the remaining 20 per cent of cases. At least 20 per cent of infertility cases are solely due to male factors which are significant and require advanced treatment. Many male fertility problems go undiagnosed and untreated, either because attention focuses on their partner or because men are reluctant to get help or unable to find it when they seek it. Moreover, men often resist being tested as unlike gynaecologists for females, male infertility specialists are very few in number. There are various factors that influence men’s fertility. Hormonal imbalance is a common yet reversible cause of male infertility, as testosterone is important for sperm development and maturity. Luteinizing hormone (LH) makes the cells in the testicle to produce testosterone, and follicle-stimulating hormone (FSH) is responsible for the testes to produce sperms to make new cells. If levels of these hormones are too high, sperm production can be disrupted, making it difficult for couples to conceive.
Lifestyle also plays a pivotal role in development of infertility in men. Factors such as age when planning a family, nutrition, weight, exercise, psychological stress, environmental and occupational exposures, and others have substantial effects on fertility. Factors such as cigarette smoking, illicit drug use, alcohol abuse and caffeine consumption negatively influence fertility in men. Both obesity and poorly controlled diabetes can also affect fertility. Additionally, male infertility can be genetic or caused by an infection, injury or medical condition. Another common and reversible problem is varicocele, an enlargement of the veins that wraps around the testicles and affects sperm development. It occurs in about 40 percent of infertile men.
For fertilization to take place, sperm must be able to reach the egg and then penetrate its outer layer. Sperms that don’t move well or are abnormally shaped may be unable to do this. As with a low sperm count, causes can be genetic or tied to lifestyle. A male fertility assessment typically starts with a thorough medical history, examination and a semen analysis that examines the volume, concentration of sperm in the ejaculate and what percentage of those sperms can swim.
Further testing is based on the results of the analysis. Men with low sperm counts, for example, might require hormonal or genetic testing. If no sperms are found in the ejaculate, a testicular biopsy — removal and examination of a small piece of tissue from the testicle may be necessary.
Couples struggling with infertility should make every effort to find help for both partners. While OB-GYNs typically deal with women’s reproductive problems, comprehensive infertility care units are the best options for men to seek help. There are many treatment options starting from simple tablets to IUI (injecting sperms directly into the uterus) to IVF-ICSI [test tube baby] depending on the cause and severity of the condition.
(The writer is the Executive Director, Nova IVI Fertility)