FAQ’s – Male Infertility

FAQ’s – Infertility: There are many Frequently Asked Questions on Infertility that we provide answers to:

What are the treatment options for couples whose husbands have azoospermia i.e. they have no sperms in their semen?

Azoospermia – is the medical condition of a man not having any measurable level of sperm in his semen.

Males with testicular failure have two options-

  • Donor Sperms
  • Or adoption.

Males with a block in their reproductive system have the following options

  • block corrective surgery
  • use of aspirated sperms from the head of the epididymis( PESA_ ICSI) or from the testis (TESA_ ICSI) or by using a small testicular biopsy (TESE- ICSI) for Assisted Reproductive Techniques (ART).

The results of microsurgery are not very promising.

As a man I have normal sexual performance? How can I be responsible for infertility?

The sexual act and fertility are not directly related to each other. One could be impotent yet fertile. At the same time, a sexually potent man might not be fertile. Fact: In 50% of childless marriages, the male factor has been found to be the major cause of the couple’s inability to conceive due to infertility.

Does subclinical varicocele cause male infertility?

Yes. Subclinical Varicocele with abnormal semen analysis, usually contributes to male infertility. Varicocele causes progressive testicular damage over time. Surgical correction not only halts the damage, but can also reverse it.

Does varicocele always cause male infertility?

Usually Varicocele is asymptomatic. It is usually detected when the patient is evaluating for possibility of male factor in an infertile relationship. The presence of abnormal semen parameters (Oligo-astheno-terato-zoospermia) and / or diminished testicular size points to Varicocele as a cause of infertility.

What is Varicocele? How does it affect the fertility potential of a man?

Varicocele is a condition which is a common cause of low sperm count in males.  A varicocele is an abnormal tortuosity and dilatation of the veins within the spermatic cord. It is more commonly seen on the left side and the cord feels like a bag of worms. The correlation between varicocele and low sperm count is not consistent and is a highly controversial point.

What important steps must be followed before performing a semen analysis?

The following steps are crucial and must be strictly adhered to for semen analysis:

  • The semen sample should be a fresh sample. It should be preferably collected in a private room close to the laboratory. If it is collected at home it should be delivered to the laboratory within 30-60 minutes. It should not be kept in the refrigerator before transportation to the laboratory.
  • The semen sample should be a masturbation sample and not collected by withdrawing the penis at the time of sexual intercourse, as a good number of sperm may be lost by this technique.
  • It should not be collected in the condom sheath as this contains lubricant jellies which would kill the sperms in the semen.
  • An abstinence period of 2-3 days prior to collection is adequate although some specialists prefer 5 days of abstinence.

What is a normal Semen Analysis report?

The Word Health Organization (WHO) has laid down some guidelines for a normal semen analysis report and the important ones are,
Volume 2.00 ml – 4.00 ml
It is fructose positive This sugar provides energy for sperm motility and also its absence suggests a block in the male reproductive tract.
Sperm concentration 20 million / mL or more.
Motility 50% or more with forward progression or 25% or more with rapid progression within 60 minutes of ejaculation.
Morphology 30% or more normal forms.
White blood cell Fewer than 1 million / mL.

How viable an option is vasectomy reversal?

Often, a vasectomy reversal is the best option for a couple interested in conceiving after the man has undergone a vasectomy. By far, the most natural, least invasive and most economical method of producing a pregnancy.

Upon successful reversal, the sperm count may be sufficient to allow for natural conception. Otherwise, there may be adequate sperm for the ejaculate to be processed and placed inside the woman’s uterus through Intrauterine Insemination.

For how long after ejaculation in the vagina, can the sperm remain viable?

Sperm Viability

Following ejaculation, the semen forms a gel. This gets liquefied in 20–30 minutes due to the presence of prostatic enzymes in the semen. The ejaculated semen is alkaline in pH and this provides protection for about 2 hours for the sperm from the acidic environment of the vagina. Very active sperm have been found in the fallopian tubes even 5 minutes after semen deposition. Most of the sperms because of their own motility gain entrance into the cervical mucosal folds where they get their nourishment and could fertilize the female egg even 2–4 days after intercourse. This is one of the reasons why rhythm method as a mode of contraception has a high failure rate.

What lifestyle changes can be made to improve sperm count and quality?

The following factors affect sperm count and quality:

  • Quit smoking
  • Stop using recreational drugs
  • Reduce alcohol consumption
  • Avoid using lubricants while trying to conceive
  • Moderate aerobic and resistance exercise
  • Avoid high temperatures, i.e. saunas and hot tubs
  • Take supplemental vitamins (antioxidants)

Does the sperm count improve if the man does not have sex for many days?

Unfortunately no your sperm count will not improve. If ejaculation does not occur for many days, the sperm simply die in the reproductive duct. Hence, if the man gives his semen for analysis after abstinence for many days, the sample contains a high number of dead sperm.

Does having frequent intercourse or masturbation cause a decrease in the sperm count?

No Fortunately frequent intercourse and maturbation does not decrease your sperm count! One doesn’t run out of sperm as the male body keeps producing sperm as long as the testicle are functioning normally. The sperm are stored in the upper part of the epididymis. The ability to store functional sperms provides a capacity for repetitive fertile ejaculations.

How common is male infertility?

In three out of every five couples experiencing infertility, a male factor is involved. Male infertility is the primary factor in two out of five of these couples and furthermore, it is a combination of male and female infertility, in one out of every five couples struggling with fertility. It is prudent to examine both the male and female partner when dealing with this issue.

What are the most common reasons for a low sperm count?

Unfortunately the commonest reason for a low sperm count is not known and hence there is no definite form of treatment.

The other known causes of a decrease in the Sperm count are

  • Testicular injury
  • Surgery
  • Mumps
  • Tuberculosis infection in the childhood,
  • Exposure to excessive heat,
  • Excessive tight clothing
  • Severe Allergic reactions
  • Heavy physical labour and working in high temperature environment, exposure to industrial or environmental toxin.
  • Insecticides, petrochemicals, pesticides, benzene, xylene, anesthetic gases and X-Rays.
  • heavy marijuana and alcohol use
  • certain antiacidity drugs like Cimetidine
  • Antibiotic like Erythromycin Tetracycline
  • anticancer drugs
  • drugs used for high blood pressure like methyldopa, reserpine, guanithidine and propranolol
  • Corticosteroids and Anabolic steroids used for muscle building.
  • Radiation therapy for diseases like Hodgkin’s lymphoma, leukemia and testicular tumors damages the testes making these men absolutely sterile. Anatomical causes like congenital obstruction, bilateral non descent of testes can cause absence of sperms in the semen.
  • Sexually transmitted Disease like Gonorrhea, Chlamydia, and Syphilis cause irreparable damage to the internal lining of the Genital tract.

What are the reasons for male infertility?

In a couple with a fertility problem have the male partner evaluated in the initial stages to establish if male infertility is the cause. A semen analysis of the male is a simple test and it gives a good idea about his fertilizing potential. The reasons for a male to be infertile are

  • either the testis do not produce adequate number of good quality motile sperms or,
  • due to a block in the male reproductive system, the sperms are not present in the semen.

In a few cases the male partner is responsible and is unable to perform sexual intercourse.

How is the male partner evaluated for infertility?

The male partner can be easily evaluated by getting his semen analyzed by a reputable and reliable laboratory for infertility. For this, the man does not have to undergo any procedure or be subjected to any form of anesthesia. Hence it is a very simple exercise.

What is the treatment options are available for male infertility?

A wide range of supplements and medicines can aid with male infertility – vitamins, Antibiotics in cases of chronic infection, Clomiphene citrate tablets, Ayurvedic preparations, Vitamin E, Zinc, Co Q enzyme, may have some beneficial role in increasing the sperm count and also its motility. Assisted Reproductive techniques like Intrauterine Insemination, IVF-ET and ICSI have a great role in managing infertile couples with male factor as the cause of Infertility.

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