What Is Male Infertility?

Hello,

I am Dr. Rutvij Dalal. IVF ki field mein mera takreeban 17-18 saal ka anubhav hai. Sir, aap humein bataiye purush banjhpan kya hai? Banjhpan ya infertility jisko kahte hai vo ek aisi condition hai jisme koi bhi couple agar 12 mahine se jyada try kar rahe hai conceive hone ke liye aur conceive nahi ho pa rahe hai uss condition ko hum infertility ya banjhpan ya nisantanta kahte hai. Nisantanta ki jo defination hai vo actually it varies depending on the female partner’s age. Toh halanki 12 mahine ke pahle hum koi jaanch wagaira nahi karwate hai ya koi treatment bhi nahi karwate lekin ye jo rule hai vo tabhi lagu hota hai agar couple young hai ya female partner ki jo age hai, wife ki jo age hai vo 35 se kam hai. Agar wife ki age 35 saal cross kar gayi hai jo aajkal ke jamane mein dekhne ko milta hai ki kaafi couples late marriage karte hai. Toh iss case mein unko 6 mahine se jyada rukna nahi chaiye. Toh aise mareejo mein jisme wife ki age 35 se jyada hai agar vo kewal 6 mahine ke liye try kare aur baahcha nahi ho raha hai toh unko kisi IVF specialist ya infertility clinic pe visit karna chaiye. Abhi sawal ye tha ki purush banjhpan kya hai toh banjhpan jo condition hai vo almost paya gaya hai ki almost one third cases mein stree jimmedar hoti hai, one third cases mein purush jimmedar hote hai aur baki one third mein dono mein thodi thodi pareshani hoti hai. Toh almost 50% matlab aadhe kisso mein purush ya males are responsible hai. Aur ye aajkal ke jamane mein bahut commonly milne lagta hai. Toh pahle ke jamane men hum dekhte the toh sperm count 100 million,150 million hua karta tha, aajkal ke jamane mein kewal 20 million is considered normal but vo bhi dekhne ko nahi milta. Toh uske peeche kaafi karan hai jiski wajah se ye jyada common hone laga hai toh purush banjhpan ek aisi condition hai isme hum semen analysis karte hai aur vo semen analysis mein WHO 5th manual ke hisab se jo criteria diya gaya hai vo match nahi hota agar count man lo 15 million se kam hota hai mortility 32% se kam ya fir morphology 4% se kam hoti hai, to unn cases hum bolenge ki purush banjhpan ki bemari hai unki.

Sir, aap hume bataiye purush banjhpan ke kya karan ho sakte hai? Most common reason ye ho sakta hai koi genetic fault hai purush mein jinke baare mein unko pata nahi ho, toh kai baar dekha gaya hai ki jo chromosomes hote hai 46 XY ek normal purush mein hota hai, agar yahi chromosomes ka number ek kam ya ek jyada ho gaya ho ya fir chromosome mein koi structural fault ho, maan lo koi chromosome mein breakage hai ya fir ek chromosome ki jagah pe dedh chromosome, ya fir kahi se extra chromosome ka piece aa gaya ho toh kya hota hai ki uss case mein genetic fault hone ki wajah se sperm ka production ruk jaata hai ya kaafi hadd tak kam ho jaata hai. Toh vo ek pramukh karan hai. Uske alawa tarah tarah ke kai karan hai,kai baar purusho ke sexually transmitted infection hua hota hai pahle jsiki wajah se unki jo naliya hoti hai jo sperms ka transport karti hai vo block ho jati hai toh uske wajah se obstructive absormia hota hai, balki aaj kal ke jamane mein late marriage hona ya pradushan you know pollution ka hona, food stuff mein adulteration hona, tarah tarah ke pollutants se aajkal hum long exposed hai, even lifestyle reason ek ho sakta hai buri aadte hai jaise smoking, tobbaco chewing hai, alchohal sharab ka sewan ye saari cheeje jimmedar hai purush banjhpan ke . increased number of cases ke hote huve.

Sir, purush banjhpan kitna commom hai aur ye kitne pratishat pursho mein paya jata hai? Almost 50% cases mein hum dekhte hai ki purush either alone ya fir in combination jimmedar hai kisi bhi couple mein bachche hone ke liye. Pahle ke jamane mein aisa mana jata tha ki kewal striya ya aurte jimmedar hoti thi balki infertility ko kai baar aurto ki hi beemari maani jati thi lekin aajkal ke jamane mein dekha jata ki kam se kam adhe cases mein purush directly ya indirectly jimmedar hai.

Sir, aap bataiye ki purush banjhpan ke kon kon se upchar hai? Purush banjhpan ke treatment ke liye sabse pahle hume uchit diagnosis karna jaruri hai. Toh sabse pahle complete thorough evaluation male partner ka ho vo jaruri hai, uske liye hum puri tarah ek toh clinical examination karenge, unka jo semen analysis hai vo detail mein dekhenge ki sperm count mein problem hai, mortility mein ya morphology mein ya teeno parameters kharab hai. Agar maan lo ki severe oligospermia hai jisme sperm count 5 million se bhi kam hai ya fir zero hai, jisko hum azoospermia bolte hai toh usi purush ke tarah tarah ke test hote hai jisme se kuch genetic tests ho sakate hai kuch hormones ke tests hote hai jaise ki testosaround hai, apheses wagaira, aur even ultrasound bhi karana jaruri padh sakta hai. So depending on the cause ye treatment vary karta hai alag alag cases mein alag alad treatment ki jarurat hoti hai depend karta hai ki kya wajah hai, agar koi wajah milti nahi hai jisko hum idiopathic male infertility bolte hai, toh hum kuch antioxidants ya vitamins, multi vitamins ki tablets 2-3 mahine try kar sakte hai. Balki agar maan lo sperm count zero hai jiska koi karan nahi hai toh hum directly testies mein se tukda nikal ke uska XE prakriya ke jariye unko ek bachcha de sakte hai vo aaj kal technology itni advanced hai ki zero sperm mein bhi treatment karna bahut asan hai. Agar maan lo varicoseal ek condition hai jiski wajah se sperm count kharab hai, varicoseal ek aisi condition hai jaha testies ke irdgird jo veins hoti vo engorsed ho jaati hai, vo bahut bhar jaati hai khoon se aur vo stagnation wajah se sperm count drop jata hai toh varicoseal ke liye surgery karwa sakte hai, usko ligate kar sakte hai hum. Agar maan lo blockage hai, kisi wajah se obstruction hua hai, kuch infection hua hai pahle uski wajah se obstruction hua hai toh vo obstruction ko reconstructive surgery ke jariye thik kar sakte hai toh uss marij mein dekha jayega ki sperm count normal ho jaata hai. Aur agar maan lo kisi kharab aadto ki wajah se sperm count drop hua hai toh unko vo aadate band karwa sakte hai agar hormonal imbalance hai toh latrozol clomifin citrate wagaira kafi dawaiya aati hai jis ki wajah se hormone thik ho sakte hai. Toh treatment basically iske upar nirdharit hota hai ki diagnosis kya hai, kis wajah se ye ho raha hai, agar koi diagnosis nahi mil raha hai toh uss cases mein bhi jaise meine bataya hum IVF ya XE kargar hai aur kaafi achche results mil sakte hai. Sperm function test kya hai? Sperm function test kuch aise tests hai jisme ye pata lagane ki koshi karte hai ki sperm ka jo function hai, eggs ko fertilise karna, vo kar pata hai ki nahi. Toh uske liye kaafi tests ka avishkar hua tha, kuch kuch fir accept huve the, kuch kuch tests accepted nahi huve the.

Toh uske baare mein vistar swaroop mein batane ke liye humare chief embryologist Dr. Akanksha Mishra humare sath shamil hai, vo apko jyada jankari denge ki sperm function tests kya hote hai. Sperm function tests, jaise humne baat ki, kai tarah ke hote hai jaise sperms hona, penetration hone se hota hai, sperm survival test hota hai aur DNA flagmentation bhi hota hai. Toh isme penetration se utna jyada aaj ke jamane mein jyada relevant nahi hai. Isme jyada jo kaam ka hai vo sperm survival test hai jisme hum ye check karte hai ki sperm kitne time ke liye survive karta hai. Lekin iski relevance bhi ek hadd ke baad khatam ho jaat hai, iss se jyada important hai DNA flagmentation test. Isme hum kya check karte hai ki jo sperm ka DNA hai,vo intact hai ya vo kisi tarike se tuta-futa hai. Toh agar sperm ka DNA tuta-futa hai toh iss se kya hota hai ki like previous miscarriages kisi ki hui ho, ya concieve karne mein dikkat ho rahi ho, toh jab aisi history hume milti hai toh hum DNA flagmentation test karwate hai ya toh kisi ka kuch previous medical record ho jaise ki diabetes ho ya kisi ko varicoseal ho ya kisi ki sperm reports, jisko hum sperm analysis karte hai, vo achchi na aayi ho, ya oligospermia ho ya sperm ki morphology humein achchi na dikhayi padh rahi ho, umar agar 40 saal se jyada hoti hai males ki, toh aise time mein hum DNA flagmentation test karke sekhte hai. Even agar kisi ke baar baar IVF fail hua toh usme bhi DNA fragmentation test hota hai. Previous IVF failure hota hai kisika ya uss se bhi jyada important, jaise ki logo ko repeated miscarriage hota hai, toh repeated miscarriage ka karan ho sakta hai ki embryo mein kuch chromosomal fault hona, aur iska contribution apke sperm ke taraf se bhi aa sakta hai. Toh aise patients ke liye bahut relevant hai ki hume DNA fragmentation test karke dekhe aur vo hum karte hai janini pe.

Sir, aage mein puchna chahungi ki azoospermia kya hai aur iske konse upchar hai? Azoospermia ek aisi medical condition hai jisme sperm count zero hota hai. Azoospermia ko sabse pahle ek diagnosis karna jaruri hai. Aisa ho sakta hai ki sperm count mil nahi ho lekin aapka diagnosis galat hua ho, kyuki kai baar aisa hota hai ki ek condition hai, criptozoospermia jisme sperms toh hote hai lekin agar usko sahi tarah se cntrifute karke semen analysis nahi kiya gaya toh ek galat diagnosis azoospemia ka ban sakta hai toh azoospermia ke diagnosis pe ek toh repeate semen analysis hona chaiye ye confirm karna chaiye ki wakai mein azoospermia condition hai aur agar azoospermia condition hai toh uske liye darne ki jarurat nahi hai. Azoospermia ke tarah tarah ke karan ho sakte hai, azoospermia ko teen hisso mein divide kare diagnosis ke hisab se toh iske teen pramukh karan hai ek hai pre testicular jisme brain se jo hormone nikalta hai uski kami ho ya fir thik se brain function nahi kar raha ho toh vo ek karan hai. Dusra karan hai intra testicular fault ya fir testies fail ho gaye ho, production mein hi kami ho. Aur teesra karan hai ki, agar testies bhi thik se function kar raha hai, brain bhi thik se hormones bana raha hai, par sperms banke bahar nahi nikal pa rahe hai usko hum obstructive azoospermia ya post testicular azzospermia bolte hai. Toh depending on the diagnosis agar sahi karan hume mile ki azoospermia kis wajah se hai toh uss hisab se hum treatment aage badate hai. Agar maan lo sperm production thik hai jo ki obstructive azoospermia mein paya jata hai uska upchar bahut aasan hai, simple hai. Ya toh hum reconstructive surgery karke obstruction ko hata sakte hai aur couple can go for a natural conception ya fir, agar maan lo blockage hai kahi pe toh epiderma se chhoti si sui daal ke hum sperm nikal sakte hai jiska upyog issi prakriya ke jariye hum bhroon bana sakte hai. Usko hum misa ya pisa per cutipiderma spermation bolte hai, bahut hi simple technique hai aur bina kisi aneasthesia ke ho jati hai. Lekin agar maan lo production mein hi kami hai, agar maan lo testies mein hi fault hai, toh jisko hum non obstructive azoospermia bolte hai usme sabse pahle ye dekhna jaruri hai ki sperm production wakai mein andar ho raha hai ki nahi, halaki iske liye koi proactive tests nahi hai lekin kuch tests jaise ki hormonal tetsts hai ya fir genetic tests hai, jisme hum microchromosome, micro deletion test kar sakte hai, vo dekhke hum pata laga sakte hai ki andar wakai mein sperm production ho sakte hai ki nahi. The best thing to do in case of non obstructive azoospermia is doing a micro tese.

Micro tse ek aise technique hai jisme testies ko poora open karke testis ko hi hum 40 -50 times magnification mein microscope ke neeche dekhke usme se tubles nikal ke embryologist ko de. Micro tse almost ek blessings ka roop hai jo kaafi azoospermia ke patients ko kaam mein aaye hai balki humare paas aise patients bhi aate hai jo dusri jagah pe testicular biopsy ya simple tesa karwake aaye hai aur jinko bola gaya hai ki aap ki testies mein koi sperm nahi hai, aise purusho mein nhi jo dusri jagah pe sperms nahi hai aise batake aaye hai, unke bhi sath humne micre tesa karke unhi ke sperms find karke unhi ke sperms use karke, bhroon banake humne bachche diye huve hai. Toh micro tese ek aisi taknik hai jisme kaafi skill ki jarurat hoti hai, kaafi mahanga equipment lagta hai toh poore delhi mein shayad 2 ya 3 jagaho pe hi hai aur poore bharat mein 10 se kam jagah pe micro tese uplabdha hai. Toh micro tese has been literally a blessing for such patients jo khud ki hi sperms ke sath jo apna khud ka bachcha banana chahte hai.

Mein Dr. Akanksha se poochna chahungi ki vo micro tse ke bare mein hme kuch vistar mein bataye. Jo micro tse ke prakriya hai uske liye ek bahut hi efficient team ki jarurat hai. Isme na sirf aisa clinician chaiye jo bahut achche se testies ko kholke usme se jo achche tubules hai unko identify karke uni tubules ko nikal ke lab mein de, jo humare clinician hai unhone brazil jaake khaas iss cheej ki training li hai par iske sah hi embryologist ka bhi lab mein bahut important role hota hai. Kyuki ye jo tubule hai vo clinicial nikal ke hume de dete hai lab ke andar lekin jaise ki isme tubule bahut hi kam hote hai, isme poori testies mein apko aisi bahut kam jagah milegi jaha pe sperme hai, aur jab ye tubule humare paas lab mein aate hai toh hume usme se hi sperm ko nikalna hai dhoodh ke aur ye jo sperms hote hai bahut hi microscopic hote hai ye bina microscope ke dikhai nahi padte. Toh micro tesa mein se humko sperm dhoondh ke unko xe karne ke liye choose karne ke liye kam se kam 3-4 ghante ka time lagta hai humein microscope mein iss sample ko microscope mein 3 se 4 ghante dekhna padta hai,taki hum usme se vo sperm choose kar payein jinse ek achcha embryo banega. Aur ek baar humare paas ye sperm aa jaate hai toh uske baad ye bahut hi jyada keemati hote hai toh inn sperms ko hum aise hi nahi jaane dete, hum inko kaafi technology ki sahayata se freez karke rakh lete hai, taki agar maan lijiye ek bar mein ye prakriya safal nahi hui ya IVF ka result nahi aaya toh agli baar jo ye purursh hai ye micro tesa ka poora procedure nahi karwana padega humare paas frozen sperm bhi rakhe hote hai jinka istemal hum baar baar XE karne ke liye kar sakte hai.

Thank You!