Male Fertility 

Q. What is male infertility ?

A.

Male infertility is the inability to cause a pregnancy due to an insufficient quality or quantity of sperm.Male infertility is not the same as impotence, which is the inability to have an erection.

Causes of Male infertility ?                    

• Alcohol
• Drugs
• Physical injury to the testicles
• Vericocele
• Certain chronic medical conditions
• Blockage of the ducts that carry sperm
• Sexually transmitted diseases
• Hormone deficiency
• Adverse effects of medical or surgical treatments
• Specific abnormalities in the Y chromosome
• Genetic or inherited diseases

(Assessment, Diagnosis & Treatment)

Important issues related to the evaluation of the male factor include the most appropriate time for the male evaluation, the most efficient format for a comprehensive male exam, and definition of rationale and effective medical and surgical regimens in the treatment of these disorders. It is extremely important in the evaluation of infertility to consider the couple as a unit in evaluation and treatment and to proceed in a parallel investigative manner until a problem is uncovered. It has been shown that the longer a couple remains subfertile, the worse their chance for an effective cure. Many couples experience significant apprehension and anxiety after only a few months of failure to conceive.

Unduly prolonged, unprotected intercourse should not be advocated before a workup of the man is instituted. Initial screening of the man should be considered whenever the patient presents with the chief complaint of infertility. This initial evaluation should be rapid, non-invasive and cost effective. Of interest is the fact that pregnancy rates of up to 50% have been reported when only the woman has been investigated and treated even when the man was found to have moderately severe abnormalities of semen quality.

Approximately 15% of couples attempting their first pregnancy meet with failure. Most authorities define these patients as primarily infertile if they have been unable to achieve a pregnancy after one year of unprotected intercourse. Conception normally is achieved within twelve months in 80-85% of couples who use no contraceptive measures, and persons presenting after this time should therefore be regarded as possibly infertile and should be evaluated. Data available over the past twenty years reveal that in approximately 30% of cases pathology is found in the man alone, and in another 20% both the man and woman are abnormal. Therefore, the male factor is at least partly responsible in about 50% of infertile couples.

Just as women need the right balance of hormones to ovulate regularly, men need certain hormonesto produce healthy sperm. Surprisingly, the same substances (follicle-stimulating hormone and luteinizing hormone) control these reproductive functions in both men and women. That's why doctors can use the same fertility drugs to stimulate ovulation and sperm production. The catch is that fertility drugs don't perform nearly as well for men (success rates are about a third of those for women), and the FDA hasn't yet approved them for use in men, though a specialist can prescribe them. Very few studies have been done on the effects of fertility drugs on men, and those few agree on just one thing: The drugs can help only men with specific hormonal imbalances that originate in the pituitary gland.

The Drugs and how they Work

The two most popular fertility drugs for women are clomiphene citrate and human menopausal gonadotropin or hMG, and used with human chorionic gonadotropin or hCG. They are also used to treat men with primary hypogonadotropic hypogonadism a hormone deficiency in the pituitary gland that prevents a man's testicles from receiving the signal to make sperm. Both clomiphene (taken daily as a pill ) and hMG injected two to three times a week, prompt the pituitary gland or hypothalamus (the part of the brain that regulates basic functions such as temperature) to make more luteinizing hormone and follicle-stimulating hormone. These hormones tell the testicles to produce testosterone and, possibly, more sperm. ,

Good Candidates

Fertility drugs can help treat hormonal imbalances in men that are linked to low sperm counts and, sometimes, to poor sperm quality and motility. For drugs to have any effect at all, the problem must originate in the pituitary gland.

Length of Treatment

Drug therapy typically lasts about three or four months.Taking the medication longer doesn't improve the success rates , so if you try it for three or more months and your partner doesn't get pregnant, your doctor may increase the dosage, switch you to another medication, or, most likely, suggest another kind of treatment. However, as long as a man's hormone levels remain normal, he can take clomiphene in low doses for six months to a year.

Success Rate

Although success is far from guaranteed, fertility drugs can sometimes help men jump-start their sperm production, upping their counts to 20 million or more (anything under 20 million is considered low). If the medications work, a man won't have to think about undergoing a testicle biopsy to see what else might be wrong with his sperm. Some studies cite an estimated 20 to 25 percent pregnancy rate for couples when the man has used fertility drugs — low compared to the rates for women on fertility drugs (20 to 60 percent). But even that number loses some of its punch when you consider that it's about the same rate infertile couples battling a low sperm count or poor sperm quality can expect for a spontaneous pregnancy with no treatment at all.

Side Effects

In men, both clomiphene and hMG can cause temporary blurred vision, weight gain, and temporary breast enlargement and tenderness. In rare cases, clomiphene can cause liver damage.