Even until recently, the term ‘infertility’ was “assumed to be a female problem by definition.” Women were held responsible for being infertile by society at large, and were discriminated for being ‘barren’ i.e. unable to conceive, of which they had no control over! But the sorry part is, in most cases even when the husband was infertile or had some infertility related problems, it was the wife who had to take the blame of being infertile and barren. It is time to put an end to such brutal discrimination against women which arise out of total medical ignorance. Male infertility is as much a serious problem as its female counterpart. Let’s look at some stats from the World Health Organization (WHO). In a multicentre WHO study, male infertility accounted for 20% of all infertility cases among test subjects, while in 27% of cases both male and female factors were present (38% of cases were due to female factors alone and 15% could not be satisfactorily attributed to either partner). This study unmistakably proved that Male Infertility Is Real!
Although the myth surrounding ‘male infertility’ has ebbed a few miles in recent years, a new score of issues have surfaced. Poaching of wild beasts like Tigers and Rhinos has been widespread for over centuries. In the past most of these gorgeous creatures were killed as trophies. Only among wild tribes hunting was a means to survival – be it for the skin/fur, meat and horns, tusks and teeth of the majestic beasts. However, with the gradual acceptance of the truth concerning male infertility and its widespread nature, a global black-market for male potency boosting drugs has proliferated. Claimed to possess miraculous power, these ‘male power booster’ drugs utilize such exotic ingredients like grounded (powdered) horns of Rhinos, genital tissues of Tigers, bile of Bears and gall bladder of Snakes. Most of these ingredients are illegally sought from people running or involved with poaching of wild animals. As these ingredients are highly sought after in the black market underbelly of China, South Africa and South American nations, poachers have become desperate more than ever before.
Very recently, poachers shot dead a male rhino in Kaziranga National Park in Assam using high-powered assault rifles. The incident caught international coverage as it happened just hours after the Royal Couple – Prince William and Kate Middleton of England visited the same park during their tour of the subcontinent. Ignorance about male infertility is the chief cause of such widespread misconception that male infertility can be cured with black magic, consuming and application of crude concoctions made out of animal horns, bones, genitals and what not!
What Causes Male Infertility?
In many cases of male infertility, a specific cause has yet to be identified. Yet advances are being made, and the successful treatment of most cases of male infertility makes studying this subject a particularly rewarding exercise. Reports of declining sperm counts and increasing incidence of urogenital abnormalities and testicular cancer from many different countries have stimulated public interest and concern about male infertility. While modern lifestyles and environmental pollution have been incriminated in infertility, whether there is a true deterioration of human semen quality is still a matter of some controversy. To put it briefly, “a quagmire of epidemiology, lifestyle, environmental pollution, systemic illnesses, medications, gene polymorphism and partner’s fertility can all affect male fecundity.”
Key Male Infertility Treatments
- Intracytoplasmic Sperm Injection (ICSI) is the main Assisted Reproductive Technique (ART) used in the treatment of infertility in men with low sperm count, low sperm motility, low strict sperm morphology and sperm agglutination. In this procedure, a “normal-looking spermatozoa is immobilized by teasing the tail and injected in the cytoplasm of the oocyte.” ICSI has “revolutionized the treatment of men with very severe oligozoospermia, asthenozoospermia and teratozoospermia.” At GENOME, successful pregnancy has been reported with injection of immature sperm cells, such as elongated spermatids. Strict morphology of the spermatozoa (to be injected) is very helpful in counseling patients for ICSI as it helps to avoid the frustrations of failed or poor fertilization with IVF.
- Intrauterine Insemination (IUI) can be performed in either of these two methods –
- The centrifugation and the swim-up technique whereby “motile sperms are concentrated in a small volume of culture medium. The motile sperms are then injected into the uterine cavity with a soft catheter”
- The density gradient technique “which separates motile spermatozoa from leucocytes and bacteria, thus reducing the reactive oxygen species damage to the sperm DNA.”
The insemination is timed just prior to ovulation, using home urine LH kits and is frequently combined with ovulation induction. “In couples diagnosed with male infertility, intrauterine insemination more than doubles the pregnancy rate compared with Intracervical Insemination or timed natural cycles.”
A Recent Case In Point
A lady of 32 years came to GENOME with her husband, a police officer by profession. Married for 6 years and after having tried to conceive for 5 years they were unsuccessful and needed urgent consultation. Her menstruation was regular and all hormonal profile and tube test was found to be okay. However, the husband was diagnosed with oligospermia. As the husband’s total motile count was less than 10 million the reproductive consultant of GENOME counseled him for IUI or IVF. Both partner received detailed counseling regarding prognosis in IUI and IVF cycle & finally they opted for IUI. At GENOME the couple underwent two successive cycles of IUI in the following two months but sperm parameter was not satisfactory to give her result. Then GENOME’s seasoned reproductive specialists decided for IVF-ICSI. Her ovaries were stimulated and 9 eggs were collected and then ICSI was done. All embryos were frozen through vitrification as her uterus was not ready to accept embryos. On her next natural cycle after formation of proper uterine lining, embryos were transferred to her uterus. Her Joy was double as she got twin pregnancy and is now waiting for delivery in next month!
Infertility is a diagnosis that can have a considerable psychological impact to the man concerned, his partner and their relationship. With Assisted Reproductive Technique (ART) like ICSI & IUI a number of male infertility issues have been successfully dealt with. It is time that men should stop ‘denial’ and rather come out in the open, discuss with a reproductive specialist of a leading infertility treatment institution and get their confidence back.