DEALING WITH MALE INFERTILITY

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      Infertility is the inability of a couple to conceive after one year of unprotected, penetrative sexual intercourse. Infertility affects 10% of couples worldwide and is a major cause of marital disharmony, depression and even stigma in Sub- Saharan Africa.

      Factor of infertility can be present in both men and women, 30% of cases of infertility are due to male factor, 30% due to female factor, 30% due to combined male and female factors and about 5-10% of cases are unexplained. 

       Male factor infertility contributes to about 30- 50% of infertility cases. The spectrum of male infertility varies from:

1, low sperm count (oligospermia) 

2, low motility (asthenospermia) 

3, low normal forms (teratospermia) 

4, combined disorders to complete absence of sperm cells (azoospermia) These can only be discovered during routine seminal fluid analysis.

5, Erectile dysfunction that can present with either retrograde ejaculation (dry orgasm) in which sperm is seen in the urine rather than in the semen due to various conditions

 Possible Causes of Make Infertility 

1.Idiopathic: This means it is possible to have any of these conditions without any underlying identifiable cause. 

2.Genetic: There could also be genetic causes that could be inherited from the father. e.g., Chromosomal disorders like Klinefelter syndrome are the commonest genetic cause of absent sperms in the semen(azoospermia) and in this condition, men would present with:

- Tall stature

- Enlarged breasts(gynaecomastia)

- Very small testicles (testicular atrophy)

- Absent sperm cells.

- Genetic deletions of what we refer to as the ‘Y’ chromosome. 

- Congenital absence of male reproductive structures e.g., spermatic cords. The list is not exhaustive.

- Infections: Complications of infections such as Chlamydia and Gonorrhea can lead to obstruction in the pathway of sperm from the point of production to the point of ejaculation. This condition is referred to as obstructive azoospermia. Other infections like childhood mumps orchitis can predispose to male infertility.

- Undescended testicles is another condition that is noteworthy.

Lifestyle/environmental factors such as: smoking and alcohol have been shown to adversely affect sperm parameters and contribute significantly to male infertility. Quitting smoking and alcohol abuse are modifiable risk factors for infertility.

Medical conditions: like diabetes mellitus and cancers also contribute to male infertility

Medical therapy: The use of cytotoxic drugs for cancer treatments and radiation therapy can affect sperm production by causing damage to testicular cells. An innovation to help such men is to freeze their sperms before undergoing such treatments.

Acquired: Cases of trauma to the testicles from road traffic accidents or falls are factors.

    Evaluation of male infertility involves taking adequate history by the fertility specialist to ascertain possible causes and further evaluate by doing seminal fluid analysis, hormonal evaluation and sometimes genetic testing.

Diagnosis for infertility in men

       The concept of assisted reproductive technology through IVF (In vitro fertilization)/ ICSI (Intracytoplasmic sperm injection) has revolutionized fertility practice. Intracytoplasmic sperm injection means the injection of an individual sperm cell into an egg with the objective of generating embryos that would be transferred into a woman to achieve conception. With the advent of IVF/ICSI, it is now possible to help couples achieve conception with very poor semen parameters. 

        In cases of azoospermia (absent sperm cells), various surgical techniques to retrieve sperm cells directly from the testes are now available which are readily used such as PESA (Percutaneous Epididymal Sperm Aspiration), TESA (Testicular Sperm Aspiration) and TESE (Testicular Sperm Extraction). This is reliable option for men who might have gave up before.

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