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Male factor is the cause for infertility in about 20% of infertile couples and it is contributory in up to 30 to 40% of the cases.
Causes
The causes for infertility may be coital dysfunction, hormonal disorders, genital infections, genetic factors, congenital conditions, vascular factors like torsion testis or varicocele, testicular damage due to previous infections or injury, immunological factors, or even exposure to heat, chemicals, radiation, and drugs. Diagnosis is made by careful history taking, physical | |
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examination of the male partner; a basic evaluation by semen analysis is
mandatory. |
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Male infertility can arise from a variety of abnormalities. Some of them include:
 Completely absent sperm in the ejaculate (Azoospermia)
Low concentrations of sperm in the ejaculate (Oligospermia)
Poor sperm motility (Asthenospermia)
Increased percentage of abnormal sperm shapes (Teratospermia)
Functional abnormalities preventing sperm from binding to and/or fertilizing the egg. |
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Evaluation |
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Semen analysis may be normal or abnormal. The semen analysis is said to be abnormal if there is abnormality in any of the sperm parameters like count, motility, and shape of the sperms. In cases where sperms are absent in the ejaculate, further investigations like hormonal assay to rule out primary testicular failure, scrotal doppler to detect varicocele, chromosomal analysis (karyotyping) to rule out genetic problem may be advised. Based on the severity of the male factor infertility and associated pathological conditions, a second opinion by a urologist may be preferred. Testicular biopsy is recommended for men with azoospermia (no sperms in the semen sample). Testicular biopsy helps to diagnose the cause for azoospermia. The cause can be obstructive (normal sperms are present but not ejaculated due to some obstruction in the genital tract) or non-obstructive (abnormal spermatogenesis like arrest in the process of formation of sperms, atrophy of testis, etc.). |
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Treatment |
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Treatment for male factor subfertility/infertility is based on the cause and severity of the infertility. The treatment of endocrinal conditions and infections tends to be efficacious. Intrauterine insemination can be opted for certain cases of male subfertility. In cases of severe male factor infertility, the best option is an Assisted Reproductive Technology (ART) technique called Intra Cytoplasmic Sperm Injection (ICSI), which is a micromanipulation technique to enhance fertilization chances. In azoospermic men with normal sperms on testicular biopsy, TESA-ICSI is the best option. In TESA-ICSI the normal sperms are aspirated from the testis and utilized to fertilize the woman’s eggs by ICSI. However, men with documented abnormal spermatogenesis/atrophy of testis by testicular biopsy or those who cannot afford advanced techniques like ICSI and TESA-ICSI, or those who have been diagnosed with genetic problems which can be transmitted to off springs are advised to opt for donor sperm. |
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1. Diagnostic Testing for Male Factor Infertility |
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2. Varicocele |
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Obstructive Azoospermia |
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