Male fertility:
About 40–50% of all infertility cases are due to “male factor” infertility. The inability to conceive a child can lead to a lot of stress and frustration.
- Detailed history: For all infertile males, before initiating male infertility treatment we gather detailed history like:
Sexual history: Frequency of intercourse, any problems during intercourse (erectile dysfunction/ premature ejaculation, etc.)
Any history of smoking/ drinking alcohol/ drug addictions
Any history of drug intake (as some drugs can decrease sperm counts)
Any surgical history (for hernia/ hydrocoele/ varicocele etc.)
Any history of diabetes/ hypertension (high BP)/ any other chronic illness
Occupational history (people who work in hot environments tend to have low sperm counts)
Any history of genetic diseases in the family
Any history of infections in the past (mumps etc.)
2. Physical examination: A detailed physical examination should be done as part of the male infertility treatment to rule out any abnormalities
- Semen analysis: For all infertile couples, males should be evaluated and a preliminary semen analysis should be done. Semen analysis should be done within 2 to 7 days to get the right report. We see the volume of the semen and sperm count, motility and sperm morphology, and many other biochemical parameters. If one report comes abnormal then we have to repeat semen analysis to confirm the findings.
- Hormone testing: Males with suboptimal sperm parameters should undergo a detailed hormonal evaluation which includes FSH, LH, E2, and testosterone. Along with these, it is better to evaluate thyroid and prolactin hormones as abnormalities in these hormones can also cause altered semen parameters.
- Scrotal ultrasound: In patients with suboptimal sperm parameters some doctors might suggest a scrotal ultrasound to see for testis and the presence of varicocele or any other problems.
- Transrectal ultrasound: This test is mainly indicated when we suspect some blockage in the tubes that carry semen. This is an ultrasound which is done through the rectum.
- Post-ejaculation urinalysis: This is mainly done when there is no sperm to ejaculate. Sometimes sperm can travel retrograde through the urethra into the urinary bladder instead of coming out through the penis.
- Genetic tests: When sperm parameters are extremely low we should rule out any genetic conditions. A karyotype and Y chromosome analysis is done to see for any abnormalities.
- Testicular biopsy: This test involves taking a small biopsy from the testis with a needle.
- Sperm function tests: these are specialized tests to know the functional ability of sperms.
Sperm retrieval techniques:
these are used in cases of azoospermia (no sperms in semen sample)These are used in cases of azoospermia (no sperms in semen sample)
- TESA: (Testicular Sperm Aspiration): In this procedure, sperms are extracted using a needle from the testis. It is a form of TESE (testicular sperm extraction). This sperm can be used for fresh ICSI or can be frozen for future use. This can be done under local anesthesia or short GA and the patient can go home on the same day.
- MESA: (Microsurgical Epididymal Sperm Aspiration): In patients where there is no sperm in the semen because of some obstruction ( vasectomy, congenital absence of vas deferens, etc.), this technique is used. We make a small incision and fluid is drawn out from the epididymis (the place where sperms are stored). This is done under general anesthesia and lots of sperm can be retrieved with this procedure. This procedure requires an operating surgical microscope.
- PESA (Percutaneous Epididymal Sperm Aspiration): In this procedure a needle is passed into the head of the epididymis (the place where sperms are stored) and fluid containing sperms is taken out and is used for IVF/ICSI. There is no incision/ cut in this procedure and is relatively less costly and does not require a microscope. This is mainly done in cases of obstructive azoospermia.
- The epididymis is a long coiled tube that stores and carries sperm from the testes to the ductus/vas deferens in the male reproductive system. As it passes through the epididymis, the sperm matures so that it is ready to fertilize the female cell by the time it enters the ductus/vas deferens.
- MicroTESE: This is mainly performed on people with no sperm. This procedure requires general anesthesia and is done with the help of an operating microscope and the urologist should be trained in performing a microsurgery. In this, the outer covering of the testis is cut open, and testicular tissue is examined for the presence of sperms with a microscope. This technique removes very little testicular tissue and is relatively safe.
