Infertility and problems of impaired fecundity have been a concern through ages and is also a significant clinical problem today, which affects 8–12% of couples worldwide. Of all infertility cases, approximately 40–50% is due to “male factor” infertility and as many as 2% of all men will exhibit suboptimal sperm parameters.
It may be one or a combination of low sperm concentration, poor sperm motility, or abnormal morphology.
Causes of Male Infertility
More than 90% of male infertility cases are due to low sperm counts, poor sperm quality, or both. The remaining cases of male infertility can be caused by a range of conditions including anatomical problems, hormonal imbalances, and genetic defects.
Sperm abnormalities are a critical factor in male infertility. These abnormalities include:
- Low sperm count
- Poor sperm motility (movement)
- Abnormal sperm shape
- varicocele, an enlarged varicose vein in the spermatic cord that connects to the testicle
- Aging, which can reduce sperm counts and motility and decrease the genetic quality of sperm
- Sexually transmitted diseases, which can cause scarring in the male reproductive system or impair sperm function
- Lifestyle factors such as smoking and substance abuse
- Long-term or intensive exposure to certain types of chemicals, toxins, or medications
In addition to a medical history and physical exam, specific tests for male infertility include:
- Semen analysis to evaluate the quantity and quality of sperm
- Blood tests to evaluate hormone levels
- Imaging tests to look for structural problems
- Genetic testing to identify sperm DNA fragmentation, chromosomal defects, or genetic diseases
Treatment for male infertility should first address any underlying medical conditions that may be contributing to fertility problems. Drug therapy may be used to treat hormonal disorders. Surgery may be used to repair varicoceles and correct any obstructions in the reproductive tract.
If fertility issues remain unresolved, intracytoplasmic sperm injection (ICSI) is commonly used in combination with in vitro fertilization (IVF) to achieve pregnancy when male infertility is a factor. ICSI involves injecting a single sperm into an egg obtained through IVF. The fertilized egg is then implanted back into the woman. Pregnancy success rates depend on many different factors.
MD, DNB, FCPS, DFP ( Mumbai),
Fellowship in Reproductive Medicine (Singapore)
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