Male Infertility
MALE INFERTILITY
Male factor infertility may result from low
sperm count or low sperm motility, or decreased ability of the sperm to
fertilize the egg or abnormal shape of sperms or lack of semen or absence of
sperm or inability of man to deposit the sperm into female privates due to
erectile dysfunction.
Male infertility: -
(1) Oligospermia | Low Sperm Count
(2) Azospermia | Nil Sperms | Low Sperm Motility.
Improper diet may cause male infertility:
- Drinking over 1 litre of cola a
day might decrease sperm quality by up to 30% (study claims there is
correlation, but not causation)
- Bevarages rich in caffine or
more number of coffees may cause infertility.
- Soy products decrease sperm
quality due to the high content of a type of phytoestrogen calledisoflavones.
- A review in 2010 concluded that
there is little evidence for a relationship with semen parameters and
increased BMI.
- Nutritional deficiencies
especially calcium, zinc, iron, magnesium and phosphate also can cause
male infertility.
- Gossypol has been associated with
reduced sperm production. It is present in crude cottonseed oil, and
potentially the organ meats from animals poisoned with cottonseed.
A photograph of human sperm. Sperm are not really red and green
in colour; the
colours were added to the photograph to make the sperm stand out
more clearly.
- LOW
SPERM COUNT (Oligospermia).
Oligospermia (low
sperm count) is the condition in which the male individual has low level of
sperm count, unable to make to conceive a girl in normal ways, In general low
number of sperm count is usually mentioned as oligospermia.
Common Reasons for the Cause of Oligospermia
(low sperm count).
* Stress :- reduces sperm
count
* Tobacco:- Nicotine damages sperms motility and its
survival rate.
* Lead :- Workers in printing press have low sperm count
* Hot climates.
* Varicocele
* Avoidance of saunas, hot baths, the wearing of tight
underwear, and other situations in which scrotal temperature may be raised
* Alcohol:- Alcohol damages sperms.
Other Reasons for the Cause of low sperm count.
* Pus in Semen.
* Anti-Sperm Antibody.
* Less Semen Formation.
* Absent Ejaculation.
* Dead Sperms.
* Abnormal Sperms.
* Immotile Sperms.
Azoospermia is called when there is no sperm in semen. This type of semen
disorder is found in approximately 3% of infertile men i.e. absent sperm. You
should know that testis has two separate functions.
* Production of normal sperms in semen which needed for
pregnancy & normal fertility.
* The other function of testis is production of male
hormones i.e. testosterone & others.
So in most patients with nil sperms though semen has absent sperms still
production of male hormones remains normal.
Causes of Azoospermia or
Nil Sperms.
Hormone disorder : The
various endocrine (Hormone) disorder leading to azoospermia are as follows
(1) Hormone deficiency of pituitary gland as L.H., F.S.H., Prolactin, thyroids
hormone, hypothalmic deficiency of GnRH, Pituitary gland failure,
Hypopituitarism, Idiopathic hypopituitarism, Kallman syndrome, Isolated
hypogonadotropic hypogonadism, Drugs, toxins, Idiopathic hypogonadotropic
hypogonadism & due to many more causes.
(2) Obstruction in the outflow of semen (Sperms) from testis to outside through
urethral opening.
(3) Absence of germ cells in testis also called sertoli cell only syndrome.
(4) Maturation Arrest
(. Spermatid arrest): of primary spermatocytes to secondary spermatocyte,
spermatids or to mature spermatozoa. Due to devoid of hormones.
(5) Testicular disorders (primary leydig cell dysfunction), Chromosomal
(Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in
androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia
dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals,
cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine,
spironolactone)
(6) Varicocele (Grade 3 or more severe): A varicocele is a varicose vein in the
cord that connects to the testicle. (A varicose vein is one that is abnormally
enlarged and twisted.)
(7) Varicocele decreases sperm productions by elevating temperature of the
testis, may produce higher levels of nitric oxide chemical in the testis which
blocks sperm production, varicocele damages sperms directly & lastly
varicocele decrease the oxygen supply to testis.
(8) Presence of Antisperm antibody. These Antisperm antibodies bind with sperms
& either make them less motile, totally immotile or even dead which is
called necrospermia
(9) Trauma.
(10) Environmental toxins.
(11) Viral orchits.
(12) Granulomatous disease as tuberculosis, sarcoidosis of the testis.
(13) Defects associated with systemic diseases, Liver diseases, Renal failure,
Sickle cell disease, Celiac disease.
(14) Neurological disease as myotonic dystrophy.
(15) Development and structural defects, Germinal cell aplasia, sertoli cell
only syndrome, Cypt-orchidism.
(16) Androgen resistance.
(17) Mycoplasma infection.
(18) Cystic fibrosis patients often have missing or obstructed vas deferens
(the tubes that carry sperm) and hence a low sperm count.
(19) Klinefelter syndrome patients carry two X and one Y chromosomes (the norm
is one X and one Y), which leads to the destruction of the lining of the sperm
forming germ cell in the testis.
(20) Environmental Assaults: Over exposure to environmental assaults (toxins,
chemicals, infections) can cause nil sperm either by direct suppression of
sperm production or on the hormone. Some chemicals that affect sperm production
men are: Oxygen-Free Radicals, Estrogen emulation pesticidal chemicals (DDT,
aldrin, dieldrin, PCPs, dioxins, and furans), plastic softening chemicals like
Phthalates, hydrocarbons (ethylbenzene, benzene, toluene, and xylene)
(21) Exposure to Heavy Metals: Chronic exposure to heavy metals such as lead,
cadmium, or arsenic may affect sperm production and may cause nil sperms in
otherwise healthy men. Trace amounts of these metals in semen seem to inhibit
the function of enzymes contained in the sperms, the membrane that covers the
head of the sperm.
(22) Radiation Treatment: Over-exposure to radiation & xrays affect any
rapidly dividing cell, so cells that produce sperm are quite sensitive to
radiation damage. Cells exposed to significant levels of radiation may take up
to two years to resume normal sperm production, and, in severe circumstances, may
never recover.
(23) Misuse of substances: There are a number of banned substances that can
have potentially lethal effects on sperm production. Taking anabolic steroids,
for example, to increase performance in sports such as weight lifting, can
dramatically alter both the motility and the health of the spermatozoa. Other
banned substances, such as cocaine, marijuana and heroin can reduce sperm
production & may make a man infertile.
(24) HGH Deficiency.
(24) Medication
- Many antibiotics, e.g. penicillin
and tetracycline, suppress sperm production. It may indirectly reach
humans through eating livestock given antibiotics as a growth promoter.
In
addition, in vitro studies have observed
altered sperm function by the following medications:
Diagnosis of Cause of Nil Sperm Count
Investigation & Diagnosis:
* Complete male hormone profile: This profile includes all
the male hormone tests which affect testicular development, growth & other
genital organ development as well as genital functions. L.H., F.S.H.,
Testosterone, prolactins, thyroids test.
* Antisperm antibody
* USG or
Sometimes complete semen analysis and culture
tests are also essential.
Other tests used for Infertility:
Doppler
Study of scrotum &
testis
* Semen culture sensitivity
* Semen fructose
* Fine Needle Testicular Biopsy of the testis to look for
evidence of spermatogenesis & testicular structure.
* Human Sperm-Zona Pellucida Binding Ratio
* Human Sperm-Zona Pellucida Pentration test
* Genetic Studies
* FNAC Testis
* Egg penetration test
* Molecular genetic studies done in some special cases
* Chromosome analysis i.e. Karyotype (chromosome analysis)
* Assessment of androgen receptor
* Combined Pituitary hormone tests is performed when needed
* Immunobead test
* MRI head, Hemogram, test for systemic diseases.
* Factory test is done to find out kallman's syndrome.
Semen Analysis:- Normal
parameters :-
Volume : normally
2-3.5ml for some males up to 5ml.
Colour : white to
light pale yellowish
Density : highly
viscous to semi solid, solid.
pH : 7.2 to 8.0
(alkaline)
Total count: 80 to 150
million will be considered to be good.
Motility: Actively
motile 90% and above,
Normal morphology: 90%
Bacteria and other
microorganisms: Nil
Pus cells: 1-2 cells
or zero.
TREATMENT OF NIL SPERMS
After the finding out
cause of azoospermia treatment is started depending on the cause found.
The various treatments are as follows:
(1) Correction of the Cause: First of all we try to find out the primary cause of
nil sperms by above mentioned investigations. Then we correct the basic defect
i.e. correction of hormone disorder & other defects. We also give following
treatment for permanent cure of low sperm count & motility disorder.
(2) Correction of Hormone deficiencies: Once the hormone disorder is found then
it is corrected by any of the below medicines. Usually sperm count normalizes
in three month time with proper hormone treatment.
(3) Varicocele: A varicocele is an abnormal tortuosity and dilation of veins of
within the scrotum, for which specific herbal medicines gives cure permanently.
Our Treatment:
Before following our treatment system, semen
count test is very essential and stop treatment using synthetic medicine,
hormonal treatment if any……
Our treatment involves in two main steps (i)
first strengthening of entire organ system
(ii) Secondly herbal medicines given for
enhanced production of sperm.
Advantage of treatment :
- The
treatment is completely free of any side effects.
- Medicine
increases Sperm Count, Sperm Motility, and Semen Quantity and corrects
Sperm Abnormalities.
- Medicine
is effective in 95% in sperm abnormalities i.e. Low Sperm count, Low
Motility, Low Semen Quantity and Abnormal Sperm Cell Morphology.
- It
is the fastest among all treatment. It raises sperm count fourfold with
every month’s treatment till optimum count. So with low sperm count like 3
million per ml. to normal count of 40 million per ml. can be achieved
within two to Three months of treatment.
- The
maximum level of improvement can up to 60 to 110 million at an average
level.
- This
treatment can support azoospermia or zero count to the maximum
extent, If there is infection, low in hormone production, nutrition
deficiency etc… in case of any block it is impossible in normal
treatment.
* It improves not only sperm count but also it’s
quality. It raises low sperm motility to high sperm motility. It also
improves grades of sperm motility simultaneously.
* The success rate of system is very high.
- The
greatest advantage is that even after stopping the treatment the higher
count remains longer.
- It
is quite comfortable to take it, as it has sweet pills and drops only, to
take with 2 doses per day. So, this treatment being simpler avoids
complicated procedures in case of male infertility.
OTHER RELATED TOPICS:
What it is semen
made up of ?
|
Glands
|
Rough amount
|
Substances
|
|
|
5%
|
- Sperm – in each ejaculation, there are between 40
million and 600million sperm.
|
|
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40–60%
|
|
|
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13–33%
|
- Zinc – this stops the parts of the sperm
containing DNA from breaking up. If a man does not have enough
zinc in his food, he will have lower fertility and be less able to make a woman pregnant as his body will not be able to make sperm
well, and the sperm will be weaker.
- Prostate-specific antigen
(PSA) – this is an enzyme (a chemical that speeds up chemical reactions) which causes the semen to become watery so sperm
can move easily inside a woman's body.
- Other substances such as acid
phosphatase, citric acid, fibrinolysin, and proteolytic enzymes.
|
|
|
5%
|
- Mucus – this is a slippery fluid
that gives semen its jelly-like texture. It helps sperm to move through
the man's urethra and inside the woman's vagina and cervix, and also stops them from spreading out too much
from the semen when it is inside the woman's body.
- Other substances such as
galactose (another kind of sugar), pre-ejaculate and sialic acid.
|
Seminal plasma protects and provides food for
sperm as they travel inside a woman's body. The inside of a woman'a vagina does
not suit sperm cells as it is acidic. To protect the sperm
from the acid, seminal plasma is alkaline. A woman's immune system also tries to kill organisms (living things) that are not part of her body. Seminal
plasma has chemicals called prostaglandins in it to stop the woman's body from
killing the sperm.
Some common terms used in sperm counting test
Sperm
Morphology (Shape and Appearance)
The
evaluation of sperm size, shape and appearance characteristics should be
assesed by carefully observing a stained sperm sample under the microscope. The
addition of colored "dyes" (stains) to the sperm allow the observer
to distinguish important normal landmarks (characteristics) as well as abnormal
findings. Several methods of staining sperm are used, and the method employed
should be one with which the examiner is comfortable and experienced.
Several
different shapes or forms of human sperm have been identified and
characterized. These forms fall into one of four main categories: normal forms,
abnormal head, abnormal tail and immature germ cells (IGC), as follows:
Normal forms
Normal sperm have oval
head shapes, an intact central or "mid" section, and an uncoiled,
single tail.
Abnormal heads
Many different sperm
head abnormalities may be seen. Large heads (macrocephalic), small heads
(microcephalic) and an absence of identifiable head are all seen in
evaluations. Tapering sperm heads, pyriform heads (teardrop shape) and
duplicate or double heads have been seen. Overall (gross) abnormalities in
appearance may be termed "amorphous" changes.
Abnormal tails
Coiling and bending of
the tail are sometimes seen. Broken tails of less than half normal length
should be categorized abnormal. Double, triple and quadruple tails are seen and
are abnormal. Cytoplasmic droplets along the tail may indicate an immature
sperm.
Immature germ cells (IGC's)
White blood cells
(WBC's, germ fighters) in the semen should rarely be seen. It is very difficult
to distinguish between an immature germ cell and a WBC. Because the presence of
WBC's in the semen (pyospermia) can be a serious concern, if a report of
"many IGC's" is delivered, it becomes very important to assure that
these cells are not, instead, WBC's.
Sperm "Motility" (Movement)
Sperm
motility studies identify the number of motile (moving) sperm seen in an
ejaculate specimen. Here again, as in many other sperm studies, many
laboratories use "normal" values that are out of date and inaccurate.
Many labs will assess sperm motility upon receipt of the specimen, and again at
hourly time intervals for four to twenty four hours. It is well known that
sperm motility is a temperature dependent sperm function, so the handling and
processing of specimens is critical. It is for this reason that we, except in
very rare instances, require that specimens be evaluated only in a laboratory
such as our own, where we are able to tightly control laboratory conditions. We
have found the repeated testing of sperm over time for motility adds little to
the evaluation of motility over the initial sperm motility assessment. Sperm
are known not to survive well for extended periods of time in semen, and in
nature, sperm very rapidly leave the semen to enter the cervical mucus. Many
laboratories consider "normal" sperm motility to be 60% or greater.
Our own studies, in agreement with many others have found men with 40% or
greater sperm motility to be "normal". Motility characteristics:
Asthenozoospermia
Decreased sperm
motility. If found to be present, exam should be repeated to assure that
laboratory conditions did not cause the problem. Frequent causes: abnormal
spermatogenesis (sperm manufacture), epididymal sperm maturation problems,
transport abnormalities, varicocele. These conditions should all be looked for
if sperm motility is repeatedly "low".
Necrozoospermia
A total absence of
moving sperm. It is vital, if sperm are seen, but are not moving, to carry out
studies (vital stains) to see if the sperm seen are alive. It is possible to
have sperm with normal reproductive genetics that are deficient in one or
several of the factors necessary to produce motility. We have achieved several
successful pregnancies emploting microinjection of healthy, non motile sperm
directly into the egg (ICSI).
Chemical
and Biochemical Semen Characteristics
Semen acid-base balance (pH)
The pH of semen is
measured using a specially treated paper blot that changes color according to
the pH of the specimen that it is exposed to. The pH of normal semen is
slightly alkaline ranging from 7.2 to 7.8. Prostatic secretions are acidic
while the secretions of the seminal vesicles are alkaline. Therefore,
alterations in pH may reflect a dysfunction of one or both of these accessory
glands. The pH of semen has not been generally found to have a major influence
on a man's fertility potential.
Color and Turbidity
Semen is normally
translucent or whitish-gray opalescent in color. Blood found in semen
(hematospermia) can color the semen pink to bright red to brownish red. The
presence of blood in semen is abnormal and should be reported. The presence of
particles, nonliquified streaks of mucus or debris requires further evaluation.
Liquefaction
Semen is normally
produced as a coagulum. The specimen will ususally liquify within 30 minutes.
The failure to liquify within one hour is abnormal. Excellent methods for correcting
this problem in the laboratory are available.
Viscosity
Nonliquefaction and
excessive viscosity are two separate conditions. Viscosity is measured after
complete liquefaction has occured. Viscosity is considered "normal"
if the liquefied specimen can be poured from a graduated beaker drop by drop
with no attaching agglutinum between drops. The role of hyper (excessive)
viscosity is being studied, but it seems possible that htis condition may
interfere with the ability of sperm to travel from the site of deposition into
the cervix or uterus.
