by Dr. Keshav Malhotra


There is a common misconception that infertility affects women predominantly but in reality men contribute to around 40 %-50 % cases of infertility. In our society where there is a lot of taboo associated with inability to bear children many of these couples don’t approach the clinician . Usually this leads to several precious years being wasted before the couple accept the problem and approach the infertility specialist when the chances to conceive have further declined.

Today, male sperm counts around the world are dropping fast at a rate of two per cent every year and have more than halved in the past 50 years. Although some males will have genetic causes , majority are due to potentially reversible factors. Reasons can range from stress, poor diet, excessive laptop and mobile use and vices like cigarette smoking. Exposure to everyday chemicals (phthalates) present in plastics and even cosmetics and household detergents can rewire 2the male reproductive system and cause sperm damage.

Simple precautions can help you to avoid these harmful chemicals .One is to read the labels on cosmetics and other personal care products and to choose those without phthalates. Another is to be cautious with plastic food containers, and to avoid using them to heat food and drink, as the phthalates in them may get transferred to what you consume.”

Simple measures employed timely can help you to protect your sperms from potential damage and improve your reproductive capability.

Plenty of fresh and vegetables in your diet

Avoid smoking and passive smoke , drugs and alchohol binges

Maintain a healthy weight

When planning a baby , let ur physician know before any drug is prescribed

Even for ur children, u can feel the scrotum that testes are properly placed. If undescended, show a urologist early and plan for surgery before 18 months age

Vaccinations will help protect from infections like mumps, measles , chicken pox which in future can damage the tubes

It is important to consult your doctor early, if you are having difficulty in conceiving and u r obese or have history of any genital or scrotal surgery , undescended testicles or endocrine disorders such as low testosterone and STDs," says Bar-Chama. "Another risk factor is toxin exposures, whether as the result of behavioral choices or chemotherapy received for cancer."

For men, the initial fertility evaluation is simple and noninvasive and is comprised of a physical exam, semen analysis and blood work.

If the sperm count is low, it is important to figure out why so that reversible conditions can be identified and treated and potentially life-threatening conditions such as testicular cancer can be diagnosed and treated early.

The past decade has seen remarkable advances in infertility treatments, which can range from medication to new microsurgery techniques and advanced assisted reproductive technologies.

the first step is making lifestyle changes like quitting smoking or losing weight.

When sperm are produced by ejaculation but in very low numbers, In-vitro Fertilization (IVF) along with an assisted reproductive technique called "ICSI" (Intracytoplasmic Sperm Injection) can help couples achieve a pregnancy. ICSI is performed by directly injecting a single sperm into one egg using microscopic instruments. ICSI, developed by Gianpiero Palermo, has dramatically changed the treatment available for even the most severe forms of male infertility.

Azoospermia, defined as complete absence of sperm from the ejaculate, is present in about 1% of all men and in approximately 15% of infertile men. "Azoospermia" that is Men with zero sperm count in ejaculate can be divided into two broad groups:

A. Men who have an obstruction problem or blockage, meaning they are producing sperm, but the sperm can't get out (Obstructive azoospermia)

B. Men who have a production problem, meaning they are not making sperm, a condition called "non-obstructive " azoospermia."

Until the mid 1990s, donor sperm was the only treatment for azoospermia. A minor outpatient procedure called "TESA" (TEsticular Sperm Aspiration) may be offered to obtain sperm directly from the testes where it is produced. If successful, the sperm can then be used with IVF/ICSI. The most exciting new development in the field of male infertility is the ability to treat men with severe sperm production problems called non-obstructive azoospermia. Surgical retrieval of spermatozoa from testes combined with ART has given new hope to those patients previously considered infertile.

Even though these men may have no sperm in their semen, we can now find sperm between the cells of the testicles in almost half of these cases. By using an operating microscope and doing micro dissection TESE, many researchers have been able to achieve pregnancies in half of those men in whom sperm can be found within the testicle. Cryopreservation of TESA specimens can avoid repeated testicular biopsies in azoospermic patients in whom the only source of spermatozoa is the biopsy. TESA with ICSI has successfully treated azoospermia and offers approximately a 40% live birth rate from OA and NOA patients. Because of this technique, 90% of all infertile men, including half of all men with non-obstructive azoospermia, have the potential to conceive their own genetic child.

Some of the most promising research is focused on isolating, growing and differentiating those stem cells located in the testicle that develop into mature sperm. "These cells have remarkable potential for differentiating into neural, cardiac and muscle cells as well as the future promise of repopulating a sterile testis, for instance after chemotherapy."

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