Male infertility is on the rise and now the male is equally responsible for infertility. Over the years has been seen that sperm count is falling along with the quality of the sperms deteriorating, with lower motility and morphology. While assessing the semen it is not just the number of sperms which is important but also whether they are motile and normal looking. All these factors determine if the sperm can fertilize an egg or whether a healthy pregnancy can ensue after fertilization. It is seen that poor semen parameters may be due to some illness or fever or due to local infections, stress, pollution and bad diet.
Counts of 15 million/ml are considered to be normal. Progressive motility of 32% and normal morphology of more than 4% is considered to be fine. If these parameters are compromised treatment depends on the grade of compromise. Mild compromise can be treated by intrauterine insemination (IUI). This process requires that the semen is prepared in the laboratory so as to concentrate the most motile sperms in a small volume of media. This is then inserted into the uterus thus bypassing the vagina. This brings the best sperms closer to the egg and improves the chances of pregnancy. The success rate of an IUI treatment for mild male factor infertility is 20%. The success depends on whether the semen was immediately prepared and instilled, the method of preparation, the presence of other infertility factors, monitoring of cycle and documentation of ovulation and the tubal status of the woman. If there is a mild tubal blockage then IUI is usually unsuccessful.
In case there is a severe compromise of the semen like a count of less than one million then an IVF is indicated along with an ICSI. In this process, the woman’s ovaries are stimulated to produce many eggs. The eggs are taken out and each egg is held under the microscope and with a needle one sperm is injected into it. This is done because the sperms are not good enough to fertilize the egg so the mechanical process of fertilization is done. This procedure is known as intra cytoplasmic sperm injection ( ICSI).
There are men who have no sperms in the ejaculate (azoospermia). For these men, an assessment is done to see if hormonal levels are normal. They are tested for FSH, LH Testosterone and prolactin. In case sperm production is there but there is an obstruction to the ducts, the sperms are aspirated from the testis directly by a needle or by a testicular biopsy a technique called TESE ( testicular sperm extraction). For better success rates and lesser tissue destruction of the testis this procedure can be done under the microscope and is known as micro TESE. This is a highly specialized technique where only the dilated tubules which are more likely to contain sperms are dissected out and not pieces of testis as happens in a regular testicular biopsy. This technique can only be done in specialized centres.
In certain men sperm counts may be affected because of poor hormone release from the brain. In these cases, injections of FSH and HCG may help. In case azoospermia is because of complete destruction of testicular tissue (endorgan damage) the only option left is to use a donor sperm.