Male Fertility Treatments

It is usually claimed that 40% of all infertile couples have malefactors involved. In a few cases, both the partners suffer from medical conditions limiting them to get pregnant.

Understanding Sperm Production

Before we come to male infertility treatment, it’s important we understand the sperm production cycle. Testes constantly produce new sperms. During spermatogenesis, say 1500 sperms are produced every second. By the end of say 64-day full sperm production cycle, any man produces about 8-10 billion sperms. Every act releases 20-300 million. There is always a fresh supply available for conception.

When to see a Male Fertility Doctor

You should see a Male Fertility Specialist if you are unable to conceive a child. Following conditions need to be evaluated

Ejaculation problems
Pain or discomfort in the testes
Over the age of 35

Common Conditions suggesting ICSI/IUI Treatments

Male Infertility comprises of following findings in male partners

Poor sperm quality
Low sperm count
Azoospermia

Azoospermia

Azoospermia is the absence of sperms in a man’s ejaculate and we find this usually in 15 – 20% of male infertility issues.

There are two types of Azoospermia:

Obstructive causes commonly occur in the vas deferens due to Trauma, Infections, Inflammation, Previous surgeries, cyst, vasectomy, cystic fibrosis
Non-obstructive causes of azoospermia include Genetic conditions like Klinefelter’s syndrome and Y chromosome deletion

Other Causes of Azoospermia

Varicocele: A condition in which the veins inside the scrotum are enlarged and engorged, causing the whole testes to look much bigger.
Drugs: Certain antibiotics and prescription medicines, steroids, marijuana directly affects the sperm production
Stress: Stress affects every organ of the body including the testes and sperm formation causing male infertility
Excess heat: Eg truck drivers, welders, or firefighters, or tight clothing or excessive use of the hot tub or keeping laptop for too long on laps, causes habits, affects sperm production
Toxicants: People working in areas where they are exposed to pesticides, heavy metals, lead, mercury, or paint can over a period of time affects the hormones and sperm production
Excessive Exercise: Heavy lifting, tight clothing or acts like bicycling can cause injuries in the groin.
Chronic Diseases: Many conditions like anemia, malnutrition, cancer, or diabetes affect sperm health
Dietary Deficiencies: It has been noted usually men with infertility issues are suffering from zinc, vitamin C, folic acid deficiency
Obesity: Obesity directly affects and changes the hormones, causing secondary medical diseases and affects sperm production
Surgery: Childhood surgeries if not performed correctly on the male genital tract conditions like undescended testicleImproving Sperm Health
Diseases: Infections, cancer, trauma, or retrograde ejaculation directly affects the fertility potential

How to Diagnose Poor Sperm Motility

Initial Diagnosis for male infertility involves:

Medical History: History related to any genetic conditions, or chronic health issues, or injuries, or surgeries that may have decreased the fertility quotient.
Semen Test: A semen sample is taken from the husband /partner and the semen is sent for analysis. This is usually the most commonly done and provides a lot of information on the quality of the semen/sperms. Semen tests determine the shape (morphology), (motility), and count of the sperms.

Advanced Diagnostic Tests for Low Sperm Count

In case the semen test is abnormal, we recommend a few more tests to identify the cause.

* Testes Sonography: Sonography on the scrotum/testes to rule out varicocele or blockages of the tube.

* DNA Fragmentation Test: Sperm DNA fragmentation has become one of the routine tests to rule out male infertility, which helps to identify abnormal genetic composition within the sperm. Poor or bad DNA fragmentation directly leads to multiple IVF / ICSI treatment failures and multiple miscarriages. Embryos which are formed from sperms with high DNA fragmentation level usually have shown blastocyst arrest, increased chance of miscarriage and abnormalities in the children born.

* Hormonal Evaluation: Hormones play an important role in sexual development and sperm production. Any condition affecting the pituitary glands, or other organ systems, will influence infertility. Usually, Testosterone, FSH, LH are done.

* Urine Analysis: Sperm in urine means sperms are going back (retrograde) into the bladder instead of coming out through the penis during ejaculation.

* Genetic Evaluation: At times men may have inherited or genetic causes affecting their poor sperm sample. A simple karyotype will present the picture of the chromosomes.

* Biopsy of Testes: In this procedure, usually a sample wedge is taken from the testicle with a needle. If the results are normal, it means the sperms are getting blocked through the passage tubes.

Costs associated with Egg Freezing

The costs involved are towards the following parameters

* The basic fertility testing to see the ovarian status and hormonal values
* The medications used for the ovarian stimulation to make eggs
* The surgical ovum pick up procedure, including pre and post-operative medications
* Vitrification of the eggs

These costs usually vary between PKR 290,000 to PKR 350,000 depending on the age, hormonal values, number of eggs retrieved to be frozen. At Zoi, the costs reduce if you do multiple Egg Pick Up attempts to freeze your eggs.

Risks associated with Ovum Freezing

Fertility Drugs: Fertility Drugs are similar to hormones in our body but given at a higher dosage. These can cause temporary water retention, the increased size of ovaries can cause discomfort and abdominal pain. Other minor symptoms can be nausea, vomiting, bloating, etc.
Hyperstimulation: With present drug combinations and stimulation plans, it is very difficult to have ovarian hyperstimulation syndrome.
Surgical Complications: Very rarely, a surgical egg pick-up procedure can cause the needle to hurt any organ causing bleeding or infection internally.
Pregnancy Chances: The chances of retrieving healthy eggs after thawing, chances of creating good embryos after IVF fertilization, chances of pregnancy, and chances of miscarriage, all will primarily depend on the quality of eggs when they were frozen, and the age of the woman. If the embryologist or Lab is not trained or equipped with egg freezing, the success can be affected. At Zoi, we freeze the eggs of patients and donors. We have been doing it since 2014 and have frozen more than 1000 oocytes and recovered successfully 90%+ eggs after thawing. Arguably we have the highest success rate and experience in Mumbai, and India.

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