Male Infertility

Hello,

I am doctor Priya Dahiya, IVF speicalist. We have three-four centres, our main centre is at Maharaja Agrasen Hospital, Punjabi Bagh and our satellite centers are at Dwarka, Rohtak and Sonipat. So today we are going to discuss about the male infertility part, the cases where the male factor is involved in case of infertility. So how do we check about the male factor as we have discussed in our previous videos we do check for the semen analysis routine microscopy in a male partner. So if the semen parameter is below normal according to our standard WHO criteria we call it oligospermia or sperm count is less. Number one count can be less. Number two motility, the power of this sperm to move can also be less we call it low motility.

Third the sperm can be damaged in itself they have abnormal appearance. Fourth there are more dead sperms, the 90-100% of the sperms are appearing to be dead so these are called abnormal reports for male partner. So how do we go ahead with the abnormal report? So number one abnormal report is azoospermia there is no sperm count, there is no sperm in the entire sample yes when we diagnose azoospermia it is a mentally traumatic for the patient because it is very hard for him to believe that there is no sperm in his seminal sample to procreate. Now is azoospermia the end? no it's not end, azoospermic male are again tested for the hormonal profile just to check whether there body is able to produce the sperm or not, so azoospermia the cause can be we call it obstructive and non-obstructive, obstructive means the body is producing the sperm but the pathway is somewhere block so the sperm is not able to come out in the semen. Non-obstructive is like there some problem in the body that is why he is not able to produce the sperm. In non-obstructive cases the common cause is testicular failure, the testes now they are in the stage that they are not able to produce sperm so in these cases we see a very high level of the hormones in these males.

So most of the time testicular failure patient cannot be created. The hormone levels are low, yes we can increase hormone level and make the testes produce sperm again. How do we go ahead when there is azoospermia and the male is producing the sperm and it is obstructed, so in these cases we go for aspiration of sperm from the testes itself directly. Aspiration again can be done with the help of a needle, we call it TESA, then we can do it with the help of a biopsy called as testicular biopsy or we can do a little more specialised procedure like micro-TESA, when we are not able to find out even in the testicular biopsy.

So depending upon what problem the person is going through we can retrieve the sperm in cases of azoospermia. So that is not the end of the road if the sperm count is showing is nill in the report. Second cases where there is sperm count but there is very low count or there is very low motility, in these cases, these males can reproduce with the help of a specialised technique in IVF called ICSI (intracytoplasmic sperm injection). We are injecting the egg with the sperm with the help of a needle, so the sperm which is normally not able to fertilize egg will now be assisted with the help of a needle so it is able to fertilize egg. Then the cases where we find the morphology is not normal or if the count is normal, everything is normal still couple is having repeated IVF failures we do advice patient to go for a DNA fragmentation analysis to check for the DNA fragmentation level of the sperm, sometime these sperms may absolutely appear normal but when we check for the DNA fragmentation index it is found to be very high, again it is the cause of IVF failure as well as if that lady gets pregnant then these patients do have a high number of abortion. They have a very high chance of that pregnancy being getting spontaneously aborted.

So if the DNA fragmentation level is high then again we have the option of going for the sperm directly from the testis rather than taking it from the semen sample. Then there are multiple other tests available just to check for the fragmentation level in the sperm, so these all highly specialised tests are not required in each and every couple, they required in cases where we feel that this patient should go for this and then this gives us a better information. For dead sperms we do need to check whether they are alive and just immotile or whether they are actually dead. So we go for viability testing in these sperm, if they are viable they again can be used with the help of ICSI. So you know having no sperm count, very low sperm count please do not get depressed or hopeless because into today's technology, in today's time we have adequate facilities to treat all of these factors and you have every right to have your own biological child.

Thank you