Dealing with male fertility through ART

In recent years it has been found that over 15% of the male population are not able to have children. Male infertility is on the rise, not just in India but globally as well. This not just due to medical reasons but has a lot to do with lifestyle choices. To some extent, the work environment also plays some role in the fertility health of a man. Working in hot environments like factories can be as bad for your fertility as jobs that require you to remain seated in one place for an extended number of hours.

What is the role of a male in reproduction? A man is the father and generally considered the caretaker and provider of the family. He plays a small role in childbearing, which is limited to contributing a healthy sperm. The male sperm helps to fertilise the female egg, which becomes an embryo upon successful fertilisation. The woman does the rest of the work of growing the baby in her uterus, nourishing it, delivering it and raising it.

With the increase in male fertility problems, there is an increasing number of medical treatments that have been devised to deal with the different problems that the men may be facing with their sperm production and ejaculation.

CONDITIONS OF MALE INFERTILITY

There are multiple reasons that could be behind the female partner not being able to get pregnant. To a large extent, men suffering from fertility problems are mainly related to sperm count and the ability to ejaculate sperm. There are several medical conditions that men suffer from as well, but they constitute a very small percentage of male infertility and have to be dealt with through medical procedures. The most common male infertility issues are:

Low Sperm count: Today, a large percentage of the male population suffers from low sperm count or poor sperm quality. A male is supposed to produce 12 billion sperm every month, and of that, a male should ideally ejaculate 100 million sperm per ml of semen. However, lifestyle changes and poor dietary habits have severely hampered male fertility leading to an average sperm count of 20 to 40 million sperm per ml of semen. This is still okay, but some men fall short of this mark and find themselves way below. A sperm count of 15 million and less per ml of semen is considered a low sperm count.

Some people may wonder why 15 million is a low sperm count. This is no small quantity. Only one good sperm is required to fertilise the egg. This is true, but a large percentage of the sperm are redundant and do not serve any purpose. Many of them perish upon entering the acidic environment in the cervix. Among those that survive, many are very sluggish and prefer to stay where they are. Very few sperm are active and adventurous to go and look for the egg. Even a lesser few sperm among the millions actually find the female egg in the fallopian tube. There are even instances when during some cycles none of the sperm reaches the egg in time before it disintegrates. Female eggs which are not fertilised during the fertility period move towards the uterus and disintegrate.

Sperm retrieval: Some males have no sperm in their semen. There could be a number of reasons for this, such as:

  • Vasectomy
  • Sperm retrograde
  • Blocked tubes
  • Varicocele
  • Other conditions

These males are still producing sperm but are not able to ejaculate them in their semen. In this kind of situation, the sperm are surgically retrieved from the testes. This is a simple procedure where the mature sperm are drained out from the epididymis.

A male continues to produce new sperm, and it takes about three months for the sperm to mature and be ready to impregnate a female egg.

There are a number of different methods used to deal with male infertility. The type of procedure is determined based on the type of fertility problem. Fertility clinics usually recommend Intra Uterine Insemination (IUI) or intracytoplasmic sperm injection (ICSI). Both these methods are a part of the Assisted Reproductive Technology and are successfully being used by fertility clinics around the world.

INTRAUTERINE INSEMINATION (IUI) TREATMENT

IUI treatment is the most popular treatment used for male fertility problems. Doctors recommend Intrauterine insemination for couples where the male partner has a low sperm count. This procedure involves injecting the male partner’s sperm directly into the uterus. The procedure is simple and painless. It is also a quick and easy procedure. The semen sample given by the male partners is first washed. Then the active and good looking sperm are selected for the IUI procedure. The semen is washed out as the sticky substance could inhibit the movement of the sperm.

Once the sperm are ready, the medical assistant inserts a thin tube-like a catheter into the uterus through the vaginal canal. This may take a minute or two. Then the sperm are injected into the uterus. The whole IUI procedure hardly takes a few minutes. The procedure is simple and does not require any kind of special medical setup or infrastructure. Many gynaecologists recommend IUI treatment as they can conduct this procedure in their consultation room itself.

IUI SUCCESS RATE:

Since the sperm are left to find the egg on their own and fertilise it, in most cases, the sperm are either not able to find the egg or fail to fertilise it. The IUI treatment has a first-time success rate of about 20%. Usually, by the third try, about 70% of the women are pregnant. Irrespective of the success rate the IUI procedure is still very popular because it has several advantages.

IUI is preferred by most women because of it a simple procedure and non-intrusive. There is no surgical procedure involved and no medication routine or injections. The IUI treatment is also a very cheap and cost-effective treatment for those who do not have huge sums to spare for fertility treatment. Some couples are willing to try the IUI procedure even up to 8 or 9 times in the hope of getting pregnant.

The IUI procedure is very similar to a normal conception, and the likelihood of success improves with each try. This is the reason that doctors continue to recommend that patients try again when their IUI cycle does not succeed. Few couples lose hope when they do not see immediate results, but many couples are willing to try multiple times until they succeed. If there are no other complications or problems involved, the couple does successful conceive through IUI eventually. What everyone needs to remember is that even in a normal pregnancy, it takes a while before the female partner gets pregnant.

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

Even though IUI is highly recommended by doctors for male infertility problems caused due to low sperm count, IUI has its limitations. The intracytoplasmic sperm injection is now gaining popularity and is commonly being used along with the IVF treatment for the egg fertilisation process.

The ICSI procedure is carried out in the laboratory. Once the eggs have been retrieved from the female partner and sent to the lab, the male partner also gives a semen sample, which is then processed in the lab. An active, well-shaped and healthy-looking sperm is selected for the ICSI procedure. This sperm is then injected directly into the female egg. The egg is then monitored for a period up to 48 hours to check for fertilisation.

The success rate of treatment is given very high precedence. ICSI has proved well in this department and has a success rate of over 80%. Most of the eggs fertilise successfully. The few that do not fertilise are attributed to chromosomal abnormalities. Occasionally sperm or eggs have some chromosomal abnormalities, and these eggs and sperm very rarely fertilise as they are not able to function normally. Poor quality sperm or eggs also do not fertilise sometimes.

The ICSI technique is very suitable for situations where a male suffers from zero sperm motility. This is a condition where the sperm have no movement ability. For sperm to fertilise an egg in the female body, it needs to be able to swim a long distance through the cervix and the uterus to the fallopian tubes. Sperm with no motility do not move and hence are not able to reach the female egg to fertilise it.

Case Study 

Anup suffered from zero sperm motility. The couple had gone to a number of fertility clinics and fertility doctors who had all suggested Intra Uterine Insemination (IUI) treatment. The IUI procedure was not successful, but in desperation, they kept trying as they were told the IUI is the only male fertility treatment for poor sperm quality. After 8 attempts of failed IUI treatment, the couple came to Medicover Fertility Clinic. They heard that Medicover was an international brand and used advanced fertility techniques.

The Fertility Consultant at Medicover Fertility Clinic said that Intracytoplasmic Sperm Injection (ICSI) was the best treatment option for their case. The couple underwent the IVF procedure with ICSI, and on the second cycle, they were pregnant.

In the general lab fertilisation technique, the egg is placed in a perti dish with about 10000 good sperm. Here the sperm has to move a little to get near the egg and penetrate it to get in. The ICSI procedure is the best treatment for men who have no sperm motility at all. Like in the above case study, we find that the male partner’s sperm had no motility, and hence, IUI treatment would be futile as the sperm do not move.

The ICSI procedure is also the best technique for couples who are using donor sperm. Even though this procedure is more expensive than the IUI treatment, it has a high success rate, which makes it preferable.

DONOR SPERM

Donor sperm is when the male partner's sperm are not of the required quality, or the male partner is not able to produce and sperm due to a medical condition. In these cases, when a couple wants to have a child, the doctor may suggest that the couple use donor sperm.

Healthy young males with a good sperm count donate their sperm to a donor bank. When a couple has a requirement for sperm, they can get these sperm from the sperm bank. Sperm are given to couples after a profile match to ensure that there are some similarities between the male partners and the donor, especially in physical appearance and background.

Situations where the use of donor sperm is highly recommended:

  • Weak sperm: There are some instances where a male may have a very weak sperm. A weak sperm causes a weakness in the embryo. Usually, weak embryos do not survive for long. Even if a weak embryo does implant in a female uterus, and she becomes pregnant, there is a very high probability that she might have a miscarriage within the first few months.
  • Poor quality sperm: Some men have a very poor quality, which is not able to fertilise the female partner’s egg. This could be conditions such as a large percentage of abnormally shaped or unusually small sperm. The head of sperm has been designed in a way such that it can penetrate the outer cover of the female egg. Sperm with an abnormally shaped head is not able to penetrate the egg.
  • No sperm: Some men have hormone problems or have encountered damage to their reproductive organs. These men are not able to produce sperm.
  • Genetic abnormalities: Some families suffer from genetic deformities and would like this hereditary gene to stop with them. There is a high probability of the genetic defects showing up in the next generation. In this case, the couple may opt to use donor sperm to avoid the genetic abnormalities from being carried any further in their lineage.
  • Defective sperms: Due to strong medication like cancer treatment, some men suffer permanent damage to their reproductive organs. With this kind of damage, sometimes the reproductive organs are so badly affected that they are not able to produce sperm. In other instances, the damage is severe enough to affect the quality of the sperm that is being produced. The men continue to produce poor quality sperm, which are not suitable for a healthy pregnancy.

In all of the above conditions, there is no better option but to use donor sperm. The donor banks provide high-quality donor sperm. This is one of the treatments for male infertility, where there is no alternative option.

PATIENT TESTIMONIAL

“We were very apprehensive about the baby we would have with donor sperm. My whole pregnancy, we were plagued with all kinds of doubts and fears. But when our son was born, all our concerns were over. He is a lovely child, and he is our child. We are so happy that Medicover helped us find a good donor sperm and I had a comfortable pregnancy with no complications.”

BEST FERTILITY TREATMENT FOR MEN

Male infertility requires very specific treatment. A proper diagnosis is the first step to ensure that the required treatment is given. There are some treatment options which can help to improve the quality of the sperm. Habit changes like quitting alcohol, smoking and drugs, along with a strict healthy diet, are helpful. Some foods are particularly recommended to improve sperm quality.

Medicover has a panel of internationally certified full-time fertility consultants. They can help couples with their fertility issues and guide them as to the most recommended treatment options. These are determined after conducting some tests to ascertain their fertility condition.

Medicover is a leading fertility chain in North India with 13 centres in Delhi, NCR and Rohtak, Punjab, Haryana, Srinagar etc. It is a highly reputed European brand that maintains international standards and uses latest technology treatments to improve the chances of fertility success. Medicover Fertility Clinic deals with male and female fertility issues, and the doctors are highly experienced in the field of Assisted Reproductive Technology.

SOME FAQ’S

Q: I had a non-reversible vasectomy and now want to have another child. What are my options?
A: Even though you are not ejaculating sperm, your body is still producing sperm. Your sperm can be retrieved from the epididymis through a sperm retrieval procedure. This can then be used in an Assisted Reproductive Technology procedure to impregnate your female partner.

Q: We have tried 7 IUI procedures with no success. What should we do now?
A: The first and best next course of action is to do a thorough medical check-up of your female partner to ensure that her reproductive organs are functioning correctly and there are no problems and then try IVF treatment for a better chance at getting pregnant.

Q: I was detected with low sperm count and have been on a strict healthy diet to improve my sperm quality and quantity. After one year there has not been much improvement in my sperm quality. What treatment should we try to have a baby?
A: If your female partner has a healthy reproductive system, you could try Intra Uterine Insemination (IUI).