What is Male Infertility?
- Infertility:A couple is usually considered to be infertile when pregnancy has not occurred after one year of unprotected intercourse.
- Primary infertility: Inability to conceive within one year of marriage by regular unprotected intercourse.
- Secondary infertility:Inability to conceive within one year of regular unprotected intercourse, after having first pregnancy.
Female Infertility
What are the causes of male infertility?
Causes of male infertility: Male infertility is caused by
1. Abnormal sperm production and function
- Oligozoospermia:count less than normal is called oligozoospermia.
- Asthenozoospermia:decreased motility of sperms is called asthenozoospermia.
- Teratozoospermia: abnormal structure of sperms is called teratozoospermia
- Azoospermia: absence of sperms in semen is called azoospermia.Usually the above abnormalities are present in various combinations. These abnormalities are caused by following defects in male reproductive system.
Undescended testis: occurs when the testis fails to descend from the abdomen into the scrotum during fetal life. This leads to total absence of sperm production.
Varicocele:This consists of dilated and tortuous testicular veins that contain stagnated blood. This leads to impaired sperm production in testes.
Hydrocele: This consists of collection of fluid in coverings around the testis. This may lead to impaired sperm production.
Infection of testis (orchitis): This can be caused by sexually transmitted diseases, prostatitis, urethritis, etc.
Genetic diseases:Chromosomal disorder like Klinefelter’s syndrome having 47xxy karyotype can cause low sperm count or azoospermia.
Sperm antibodies: Sperm antibodies can form in individual’s blood that can lead to infertility.
What investigations are performed for male infertility?
What are the treatment options available for male infertility?
What constitutes female infertility?
Females are termed infertile when they are unable to ovulate or when they have obstructed or damaged fallopian tube or uterus. Pelvic inflammatory diseases like tuberculosis or sexually transmitted diseases (STD), endometriosis, fibroids or tumors, surgeries like appendiectomy, birth defects or abnormally shaped uterus like bicornuate or septate uterus can cause infertility in females.
What is unexplained infertility?
When there are no obvious causes of infertility in the couple even after complete investigation, it is termed as unexplained infertility.
What is the success rate of pregnancy after IVF?
The success of conception depends on causes of infertility in a couple, age of female partner, number and grade of embryos transferred, experience of treating doctors, IVF lab standard and many other factors. In our center, the success rate is 50 to 60% pregnancy having attained with ICSI, practically over-ridding male factor. This success rate is comparable with worldwide success rate of IVF– ICSI.
What are causes of IVF-ICSI failure?
Success rate of IVF-ICSI depends upon the age, general condition of female partner, cause of infertility in couple, response to fertility drugs, number of eggs retrieved and fertilized, number of embryos transferred, condition of uterus, laboratory standard and experience of center.
a) Maternal age: Success rate of IVF-ICSI decreases with increasing maternal age as number of eggs produced and their fertilization rate decreases with increasing age. Success rate of IVF-ICSI is 60% for women in age group of 25 to 35 years, where as it is 18% for woman in the age group of 40 to 45 years.
b) Cause of infertility: This is another important factor deciding the outcome of IVF-
ICSI cycle. Highest success rates are found in patients having tubal damage with good uterine cavity and lowest among those with male factor infertility. Infection of uterus causes adhesions or scarring in uterine cavity or decreased endometrial thickness that can cause implantation failure. Also general ill health, debility and systemic diseases decrease the chance of conception.
c) Failure of response to drugs: In spite of giving daily injections of fertility drugs some patients respond poorly to produce sufficient number of eggs. This can be due to increasing age of patient or resistance to the drugs.
d) Failure of fertilization: Failure of fertilization may be due to poor quality oocytes, sperms, genetic diseases or improper culture conditions in the laboratory.
e) Number and grade of embryos transferred: Pregnancy rate increases with increasing number of grade 1 embryos transferred. But this also increases the risk of multiple pregnancies. Good quality grade 1 embryos have good potential for implantation and further development than grade 2, 3, 4 embryos.
f) Embryo cryopreservation: Cryopreservation of excess embryos increases the cumulative pregnancy rate in a given IVF-ICSI cycle. It also decreases the cost of treatment and risk of multiple pregnancies. Now day’s embryo freezing is an integral part of IVF-ICSI cycle.
g) Genetic disease: : Genetic diseases in a couple can cause fertilization failure, cessation of growth of embryo or abortion. Karyotyping of couple, at least in high risk cases, is necessary before IVF- ICSI treatment to rule out genetic diseases.
h) Male factor infertility: Extremely low sperm count, impaired motility or poor sperm morphology represent main causes of failed fertilization in conventional IVF. Now days these factors are tackled by ICSI to some extent.
Who can be semen donors?
Men with sound medical health and known fertility can donate their semen for IUI, IVF or ICSI procedures after submitting his written consent for the same. They should be between 25 to 45 years of age and should not have had any past history of infectious diseases. They are required to submit their infectious diseases evaluation report, semen analysis and general health analysis report, which should include a complete physical examination done and certified by a registered medical practitioner. For infectious disease evaluation, the donor is required to be tested negative for Hepatitis B, C antibodies, HIV 1 and 2 antibodies, Trichomonas, Candida, Cytomegalovirus and HTLV-I. Three semen samples of the donor is taken at regular intervals of 3-4 weeks and is tested for volume, pH, count, motility, abnormality, pus cells, agglutination and particulate matter. His semen analysis is required to match with the normal semen parameters of WHO. The donor semen tested should maintain the quality standards in his three trial attempts and only then he is recruited on our lists of semen donors. The donor should be willing to undergo the infectious diseases evaluation tests as well as semen analysis tests every three months. If he fails to do so or if the results tend to become substandard, he is eliminated from our list of regular donors. When and for whom is cryopreservation necessary? Firstly, cryopreservation is of utmost advantage to couples whose male partner is not always available during his spouse’s ovulation period i.e., when the husbands work away from their homeland or when the husbands are unable to produce semen sample when it is required. It is also beneficial to those husbands who have to undergo chemotherapy. In such situations freezing of husband’s semen is beneficial so that during his wife’s ovulation time his frozen semen after thawing can be used for IUI, IVF, or ICSI as the case may be. Secondly, after the process of super ovulation, women tend to develop oocytes that are more than sufficient for one cycle. Usually one to three embryos are replaced per IVF cycle. In centers which do not have cryopreservation facilities, the remaining would remain non-utilized and hence wasted. With cryopreservation, excess embryos can be preserved so as to transfer them for future embryo transfer cycles. In this way the female can avoid undergoing frequent ovarian stimulation, avoid the risk of multiple gestation and it would also prove cost beneficial. Frozen specimen is also easy to transfer to other locations if the patients prefer to get embryo transfer done at their new location. What is the survival rate of the specimen after the freezing procedure? Freezing and thawing does reduce the number of viable cells and so, the total count of the spermatozoa tends to become less after thawing. At our center, 70-80% of fertilization has been attained using cryopreserved spermatozoa. Cryopreserved embryos also have the tendency to get degraded; however, we regularly cryo-preserve the embryos and we are getting good pregnancy and take home baby rate. Pregnancy rates of 50% per IVF cycle can be achieved with use of frozen thawed embryos which is comparable with pregnancy rate of fresh embryo transfer cycle.