Male Sexual Dysfunction and Infertility
WHAT IS INFERTILITY?Infertility means inability to have a child even after one year of unprotected frequent sexual intercourse.
- In 50% of couples, the problem lies wholly or partly with the male partner.
- Urological investigation may reveal a reversible underlying cause for male-factor infertility and full assessment by a urologist is recommended in all cases.
- In many cases, the underlying cause cannot be reversed; in which case assisted conception may offer the best chance of pregnancy and this may involve surgical sperm retrieval in advanced cases.
- Infertile couples are often assessed in gynaecology departments so men with infertility may wish to seek a urology assessment.
CAUSES OF INFERTILITY
In 75% of infertile men, the cause of infertility remains unknown (Idiopthic Infertility). However it may still be possible for couples to conceive naturally, provided few sperms are present.
CAUSES OF INFERTILITY: REMEMBER MNEMONIC: “SPERM COUNT Going Very LOW”
S: Smoking, Steroids, Stress
P: Psychiatric illness
E: Exposure to industrial chemicals like paints, solvents.
R: Radiation and X-Rays
M: Mumps Orchitis
C: Coital factors, Chemotherapy
U: Unexplained (Idiopathic)
N: Non descended testis
T: Testis-Trauma, infection, tumors
Going: Genetic disorders, Gym supplements
Very: Varicocele, Vasectomy
L: Low hormones because of defects in hypothalamus and pituitary
O: Old age
W: Warm sauna baths and steam ( frequent use)
DIAGNOSIS OF INFERTILITYStarting with a detailed history and physical examination, one or more of the following tests may be required:
- Semen Analysis
- Ultrasound of scrotum or transrectal ultrasound in some situations
- Hormone analysis
- Genetic tests
- Testis FNAC
INTERPRETATION OF SEMEN ANALYSIS RESULTSSpermatogenesis means sperm production, which is hormonally driven and produced in testis.
- OLIGOSPERMIA means low sperm count. WHO definition of oligospermia is
sperm counts less than 19 million/ml.
- Except when the counts are zero, sperm count is not a good measure of fertility potential. Many men with low sperm counts can father children.
- Vaicocele is one of the most common causes of oligospermia which can be corrected surgically
- 2% cases can be due to hormone problems like high prolactin
- 2% men will have genetic problems
- Any recent fever episode or illness can reduce counts temporarily and reverse on recovery. So a repeat semen test is generally advised after a month.
- Smoking,substance abuse, hot tub baths, stress,chronic illness, obesity,alcohol,some medicines(antiandrogens,alpha blockers,calcium channl blockers,sulpha drugs),industrial toxins,metabolic problems,cancers, mumps orchitis can lower sperm counts.
- AZOOSPERMIA means total lack of sperms(zero sperm count)
- Occurs in 5% of infertile men
- Causes are either lack of production or blockage or absence of channels carrying sperms from the testis
- Diagnosis: Needs Physical examination, two semen tests one month apart and blood tests like FSH and Testosterone levels. FNAC or biopsy of testis to see if production present in testis or not.
- TESTIS BIOPSY
A small tissue is taken from testis using a needle and seen under microscope. If sperms are present then it means that there is a blockage in the tube carrying sperms to the urinary passage, which can be surgically corrected. However it does not tell where the blockage is present. Rarely these tubes may be absent since birth (Bilateral Absence of Vas) or have been removed surgically in the past (Vasectomy).
Biopsy is done under local anesthesia in OPD.
- Avoid smoking, tobacco, substance abuse, excessive alcohol and Gym supplements
- Avoid Obesity
- Avoid stress
- Avoid exposure to harmful chemicals
- Avoid frequent sauna and hot tub baths
- Avoid keeping laptops in the lap for prolonged periods
- Correct timings of sex: Only about 25% of men actually know the exact time to
have sex during the female cycle to achieve a pregnancy. The females are
fertile only during a certain days of monthly cycle when eggs are produced. It
generally extends from 6 days before ovulation (discharge of egg or ovum from
the ovaries) till 24 hours after ovulation from. How to calculate this fertile
1. Using online ovulation calculator, which calculates fertile period by using date of the menses.
2. Home kits that detect the LH surge in the urine immediately (24 hours) prior to ovulation.
3. Change in the texture of vaginal discharge which becomes clear, slippery and egg white like before ovulation.
- Treatment of erectile dysfunction or premature ejaculation: Many men, even with normal semen parameters are unable to father a child because of erection problems or premature ejaculation. This can be effectively managed using medicines in most of the patients.
PREVENTION AND GENERAL MEASURES FOR REDUCING INFERTILITY
NON SURGICAL MANAGEMENT OF MALE INFERTILITY
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