About 40–50% of all infertility cases is due to “male factor” infertility. Inability to conceive a child can lead to a lot of stress and frustration.
- Detailed history: for all infertile males we should take a detailed history:
Sexual history: frequency of intercourse, any problems during intercourse (erectile dysfunction/ premature ejaculation etc)
Any history of smoking/ drinking alchohol/ drug addictions
Any history of drug intake (as some drugs can decrease sperm counts )
Any surgical history (for hernia/ hydrocoele/ varicocole etc)
Any past 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 family
Any history of infections in the past (mumps etc)
- Physical examination: a detailed physical examination should be done to rule out any abnormalities
- Semen analysis: for all infertile couples, males should be evaluated and a prelimnery semen analysis should be done. Semen analysis should be done with an abstinence of 2 to 7 days to get the right report. We see for 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 underg detailed hormonal evaluation which includes FSH, LH, E2, testosterone. Along with these its 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 presence of varicocoele or any other problems.
- Transrectal ultrasound: this test is mainly indicated when we are suspecting 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 in ejaculate. Sometimes sperms can travel retrograde through the urethra into the urinary bladder instead of coming out through the penis.
- Genetic tests: wen 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 specialised tests to know the functional ability of sperms.
Sperm retrieval techniques: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 epidydymal sperm aspiration): in patients whom 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 epidydymis (place where sperms are stored). This is done under general anesthesia and lots of sperms 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 (place where sperms are stored) and fluid which contains 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 sperms. 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 , outer covering of testis is cut open and testicular tissue is examined for the presence of sperms with a microscope. This technique removes very less testicular tissue and is relatively safe.