Male Infertility and IVF

IVF, as an effective treatment of male infertility, was developed as a result of a discovery that relatively few sperms are required to achieve fertilization that takes place outside the body. With improved methods in IVF, it became apparent that as long as lower concentrations of motile spermatozoa were obtained, IVF could be used for the treatment of male infertility. Moreover, the current clinical practice involves the extensive use of Assisted Reproductive Technology (ART), which has become a popular treatment for alleviating male factor infertility.

What is Male Infertility?

Infertility is defined as the failure of couples to achieve pregnancy after twelve months or more of regular unprotected intercourse.

Male Infertility is the inability of a man to father a child.

What are the symptoms of male infertility?

The most basic symptom of infertility is the person’s inability to help his wife conceive pregnancy. There may not be any other obvious signs. However, some of associated male infertility symptoms include:

  • Issues with sexual function like reduced sex drive, difficulty ejaculating or very less ejaculation, difficulty maintaining the erection.
  • Low sperm count.
  • Pain or swelling in the testicle area.

How is male infertility diagnosed?

In order to diagnose any factor relating to male infertility, investigations should include medical history and physical examinations according to the published guidelines of WHO. It also helps in the implementation of appropriate treatment. Some such male infertility diagnosis processes are:

Hormonal Investigations: Hormones produced by the pituitary gland, hypothalamus and testicles play a great role in the sexual development and sperm production. Abnormalities in any such hormones or organ systems might contribute to infertility. A blood test measures the level of testosterone and other hormones.

Microbiological Assessment: The impact of any inflammation or infection of the male accessory gland is very important to diagnose infertility. The indicators of microbiological assessment include sexually transmitted diseases, UTI, abnormal urine sample, prostatitis, silent ejaculate infections (MAGI) etc.

Ultrasonography: For the investigation of scrotum and diagnose abnormalities within it, an ultrasonography is necessary. It helps detect any discrepancy in the testis relating to varicocele, epididymal abnormalities, as well as any changes caused by the obstruction of the genital duct. 

Testicular Biopsy: A testicular biopsy takes a tissue from your testis to investigate any abnormalities in it. It is usually performed in men with azoospermia. It is done to diagnose the location and condition of infertility.

Transrectal Ultrasound (TRUS): The transrectal ultrasound is one of the common investigation procedures to diagnose Obstructive Azoospermia. It helps enable high-resolution imaging of the prostate, seminal vesicles, and vas deferens. It diagnoses acquired and congenital abnormalities that leads to obstructive azoospermia.

Magnetic Resonance Imaging (MRI): This imaging plays a great role in the identification of the potentially correctible causes of infertility in men. It helps identify the congenital anomalies as well as the disorders that obstruct sperm transport.

What are the male infertility causes?

For a couple to become pregnant, all the steps must be undergone perfectly from the time of ovulation to fertilization and successful implantation of the embryo to the uterine walls. Any single abnormality or disorder might not allow the couples to conceive.

Although there are a number of factors responsible for Male Infertility, some of the major causes are:

  1. Congenital Abnormalities: These are the abnormalities, that are present in men from the time of their birth. One of the few examples, is congenital absence of vas-deferens, which is the absence of a tube that leads out from the testicles. Such a condition does not allow semen to ejaculate out, making it impossible to conceive.
  2. Male Accessory Gland Infections (MAGI): It is a condition with inflammation or infection in male genital tract, that does not allow semen to ejaculate out. It represents one of the possible causes of male infertility.
  3. Endocrine Disturbances: Our Endocrine System consists of several glands and controls the production of major hormones in our body. These hormones are responsible for our overall growth and development of a human body. Malfunctioning of major such hormones like pituitary, thyroid, or adrenals might lead to Infertility.
  4. Genetic Abnormalities: Some of the changes in gene can cause abnormal sperm production or blockage of sperm flow and cause Male Infertility. The most common genetic abnormalities are chromosomal conditions that affect sperm production and other condition such as Down Syndrome.
  5. Immunological Factors: Sometimes an injury or infection might lead to a condition in which the immune system attacks the sperm. It leads to an impairment in the sperm’s ability to travel to the uterus and penetrate through the eggs. Such an immunological factor hinders the persons fertility.
  6. Sperm Morphology: It refers to the size and shape of the sperm in a given semen. At least 4% of the sperm in semen should be of normal shape and size, below which the sperm is said to be abnormal and lead to infertility.
  7. Sperm Motility: It describes the sperm’s ability to move. At least 32% of the sperm should be able to move efficiently. Poor Sperm Motility or Low Sperm Motility affects the sperm’s ability move towards the egg and can lead to fertility problems.
  8. Primary Testicular Disease: It refers to a condition where the testes fail to produce sperm or produces sperm in very less quantity. Primary Testicular Disease is the major cause of oligozoospermia, where there is very less sperm in the semen and azoospermia where there is no sperm at all in the semen. Such conditions lead to Infertility in Men.
  9. Varicocele: It is the enlargement of the veins within the scrotum. Varicocele is one of the most common cause of decreased sperm production or low sperm quality. It is one of the leading causes of male infertility and is present in almost 40% of infertile men.
  10. Increased Scrotal Temperature: Production of sperm in the semen is dependent on the temperature of testicles. Since the sperm is produced in the testicles, the temperature of the testes should be 2-4 degree Celsius below the body temperature. The increased temperature of testicles affects both the quality and quantity of sperm production, leading to infertility.

The leading cause of infertility in men often remain unidentified. However, male infertility is basically due to low sperm production, abnormal sperm function, or blockage that prevents the delivery of sperm.

How to treat Male Infertility?

There are a number of treatment options depending upon the diagnosed reasons behind male infertility. The issues might require surgical treatment or medical assistance, depending upon the severity of the condition.

Some of the effective Male Infertility Treatment options are:

  • IUI also known as Intrauterine Insemination: It is a process in which sperm is injected inside the woman’s uterus using a catheter. It reduces the travel time of sperm, making it easier for the sperms to fertilize the eggs.
  • IVF or In-Vitro Fertilization: Male infertility IVF treatment is a process in which the fertilization takes place outside the body. Both Sperm and Ovum is separately collected and fused in a test tube, and once the embryo formation takes place, it is transferred in the women’s uterus to implant and help couples in easy conception.
  • Intracytoplasmic Sperm Injection (ICSI): It is a type of IVF treatment in which, the best sperm is selected and injected inside the cytoplasm of the ovum for embryo formation, to increase the IVF success rates in case of male infertility.
  • IVF with Donor Sperm: For couples with untreatable and severe male factor infertility, or in cases of hereditary disease, IVF is done with donor sperm, in consultation with the couples.
  • Surgical Sperm Retrieval: In cases of obstruction preventing sperm release, congenital absence of vas deferens, vasectomy, or non-obstructive azoospermia, surgical sperm retrieval processes like M-TESE, TESA, PESA, etc. helps in the retrieval of sperm or it’s quality for the success of male infertility treatment.

Above all, it should be noted that the most common, appropriate and effective treatment for infertility in men is IVF treatment with ICSI procedure. Today, with the advancement of technology and modern equipments for infertility treatment, the success rate of male infertility treatment has significantly increased.

Common Reasons for Infertility in Men:

Sometimes, certain irregular lifestyle factors do not allow you to conceive. Some of the common reasons behind a man’s inability to impregnate his wife are:

  • Irregular sexual life.
  • Smoke and drug abuse.
  • Surgical treatment in childhood.
  • Prolonged stress, depression, or anxiety.
  • Use of condoms, local anaesthesia, lubricants.
  • If the man does not know the time of ovulation of his wife.
  • Working in hot weather for long time or working in chemical factory ie. X-ray exposure.
  • Exposure to pesticides, heavy metals, radiation and cadmium may also interfere with reproductive function.
  • Mumps (a viral disease) may sometimes cause infertility in men because of the infection in the parotid salivary gland.
  • A recent study found that use of cell phones adversely affects the quality of semen by decreasing the sperm counts, motility, viability and morphology.
  • Although further research is needed about external heat affects in the testis, it is often advised that men should not sit in jacuzzi hotter than 96 degrees on a regular basis.

 

Conclusion

Infertility has significantly increased today due to general health issues like Obesity, rise in sexually transmitted disease, delay in having a first child etc. 

Out of all infertility cases, male infertility accounts for approximately 40-50% of the cases. The reduced male factor fertility can be the result of acquired congenital abnormalities or the abnormalities relating to urinary or genital factors, genetic, and other factors etc. 

When talking about the perfect treatment of male infertility, amongst all ART techniques, IVF treatment for male infertility is considered to be the most appropriate one. Moreover, the IVF success rates with male factor infertility depend upon a number of responsible factors like low sperm count, etc. and the level of infertility.

 

FAQ

Q – What is IVF treatment?

A – In-vitro fertilisation is the most common and effective male infertility treatment that has helped couples conceive pregnancy. It is the procedure in which fertilisation of the eggs and sperm takes place outside the body and the embryo is then transferred back to the uterus. Moreover, the IVF success for male infertility depends on a number of factors.

Q – Is IVF more successful with male factor infertility?

A – In maximum cases, the obstacles in male factor infertility can be easily eliminated by IVF with ICSI treatment. However, the IVF success rates for male factor infertility varies from person-to-person, depending upon their level of infertility, their selection of right fertility center etc.

Q – How does IVF help male infertility?

A – In case of male infertility and IVF treatment, sperms are first collected and washed. The best sperm is then chosen to fertilize the egg to increase the chances of conception. Moreover, in severe male infertility cases, IVF with ICSI is considered to be the better option.  

Q – Can a man with low sperm count do IVF?

A – In cases of severe male factor infertility, IVF with ICSI treatment is a better option, where sperm is injected in the cytoplasm of the egg to enhance the chances of pregnancy conception.

Q – How common is male factor infertility?

A – Of all infertility issues, approximately 40-50% of the cases account for male infertility. It may be due to a combination of several infertility issues in men like reduced sperm concentration, poor sperm motility, or abnormal morphology.  

Q – How to increase sperm count?

A – Natural ways to increase your sperm count can be by leading a healthy life, quitting to smoke, exercising regularly, avoiding stress etc. However, if you have reduced sperm count and planning to have a baby, right fertility treatment ie. IVF with ICSI is recommended to increase your chances of fathering a baby.

 

References:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236338/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746399/

https://www.sciencedirect.com/science/article/pii/S1555415506002479

https://www.sciencedirect.com/science/article/abs/pii/S1472648310603380