WHO defines Infertility as the “Inability of a sexually active, non-contracepting couple to achieve pregnancy in one year.” Infertility is not always due to female factors but can also be due to problems associated with the male partner. About one-third of cases of infertility can be due to malefactors. Dalmia IVF Centre offers services related to male infertility through its consultant andrologists and a well-equipped andrology laboratory.

Causes of Male Infertility

The various factors that can cause infertility in males are the problems related to

  1. Sperm production.
  2. Sperm motility or movement.
  3. Number of sperms or sperm count.
  4. Shape of sperms.
  5. Trauma to the male reproductive parts.
  6. Infections - that are untreated like gonorrhoea, Chlamydia.
  7. Hormone disorders – like low testosterone production.
  8. Medical conditions- like undescended testis, varicocele, retrograde -ejaculation.
  9. Various drugs can cause infertility like those used for cancer treatment, treatment of rheumatoid arthritis, calcium channel blockers (used for treating hypertension), patient with a history of drug abuse (marijuana, cocaine etc.).

A detailed history and evaluation can help in identifying the issues causing male infertility. Our andrologists at Dalmia IVF Centre can provide you with valuable advice and appropriate treatment.

Features of Male Infertility (Signs & Symptoms)-

The main sign of infertility in a male is the inability to conceive a child. There may be other features that a man may not notice or may not complain of. Absence of sperms in the semen, a condition known as azoospermia is a major cause of infertility in males. Sometimes other signs and symptoms may be seen like –

  • Low sperm count in semen - Semen is the fluid released (ejaculated) at the time of male orgasm. The normal sperm count in the semen is about 39 million per ejaculate. The condition wherein the sperm count in the semen is less than 15 million per ml is known as Oligospermia. A healthy sperm count in the semen is essential to impregnate a woman. Low sperm count or oligospermia is one of the common causes of male infertility. To diagnose oligospermia, a semen analysis is done. For analyzing the sperm count, your semen sample will be collected. This semen sample will be then examined in the Dalmia IVF Centre’s Laboratory.

  • Problems associated with sexual intercourse - Disorders in sexual function may be seen like sometimes the amount of semen released during ejaculation may be less, difficulty in maintaining an erection during intercourse (erectile dysfunction), retrograde ejaculation (the semen released goes back into the urinary bladder instead of appearing at the tip of the penis), diminished sexual desire etc.

  • Dilated veins around the testicles (varicocele).

  • Abnormal swelling or pain in the testicular area.

  • Abnormal enlargement of breasts known as gynecomastia may be seen.

  • Signs of chromosomal abnormalities or hormonal disorders- characteristic features known as secondary sexual characteristics may not be seen like facial hair (beard, moustache), pubic hair may be sparse, indicating chromosomal or hormonal disorders.

Diagnosis of Male Infertility

Generally, a female is thought to be solely responsible for failure to conceive. In most cases of couples seeking an infertility specialist consultation, it has been found that both the partners could be having issues causing infertility, whereas in another half there could be either issue in the male or female partner.

The causes of male infertility need to be thoroughly investigated. At Dalmia Andrology Unit we do a series of tests to evaluate the male partner. Tests like semen analysis, hormonal profile, radiological investigations like an ultrasound of scrotum, genetic testing and post-ejaculation urinalysis are available.

  • General examination and detailed history - The first step in evaluating the patient for male infertility is a detailed physical examination to look for any abnormality in external genitalia (penis, scrotum). History taking involves enquiring about any illnesses, chronic health problems, history of any injury or surgery that might damage the genitals, any inherited conditions or diseases that run in your family.

  • Semen Analysis - The semen analysis is a test of the semen done to evaluate certain characteristics of the spermatozoa or the sperm-like number, motility, size and shape (morphology) etc.

  • Collection of the semen sample - For semen analysis the sperm sample needed should ideally be collected at our Dalmia IVF Centre laboratory or if the patient is uncomfortable the sample can be collected at home and should reach the Dalmia IVF Centre at room temperature within one hour.

  • The semen is then evaluated at the Dalmia IVF Centre lab to look for the sperm count, to check for the motility of the sperms, to see the size and shape (morphology) of the sperms. Also, the volume of the semen is noted. The semen is also evaluated to look for any infections that may cause infertility. The diagnosis is made by testing repeated semen samples and not based on a single report.

  • Normal Semen Analysis Report - The normal volume of semen is about 2-5 ml per ejaculate. If a man produces semen less than 1.5 ml per ejaculate the amount is severely low. The normal concentration of sperms should be about 15 million/ ml and the total sperm count should be about 39 million/ejaculate.

  • Oligospermia - If the sperm count is less than 15 million/ml it is known as Oligospermia.

  • When there are no sperms in the semen it is known as Azoospermia

  • Sperm Motility- The sperms normally move forward and this is known as Progressive motility. When the sperms move in any direction it is called Total motility. To reach the eggs in the female reproductive tract the sperms need to have forward motility. The fast, forward-moving sperm meets the egg and fertilizes it. Also, about 50% of sperms should have forward motility to increase the chances of fertilization. When sperms have reduced motility it is called Asthenozoospermia or Asthenospermia.

  • More than 58% sperms in the semen should be alive; this is known as the Vitality of the semen.

  • Morphology of the sperm - Morphology refers to the size and shape of the sperm or how your sperm looks like under the microscope. The sperms are examined under the microscope and the percentage of abnormally shaped sperms is noted.

    Sperms develop in the testes. They have a head, a midpiece and a tail. The heat penetrates the egg during fertilization. About more than 15% of normal forms should be present to increase the likelihood of fertilization. The higher percentage of sperms abnormal in morphology is termed Teratospermia.

    Several factors can affect sperm morphology like exposure to toxins, chemicals, radiation, smoking etc.
    If your semen analysis report shows any abnormality, a repeat test can be done after 4-6 weeks. Many other tests may be done along with the semen analysis to find out the cause of the abnormal report and to arrive at a diagnosis.

  • Ultrasound of the scrotum - Scrotum is a pouch of skin that houses the testes. Testes or testicles are two oval-shaped male reproductive organs that produce the sperms and hormones called androgens like testosterone. Testosterone is responsible for male sexual development, development of secondary sexual characteristics like facial and pubic hair, for supporting spermatogenesis and erectile function. Certain conditions affecting the testes like a varicocele (enlargement of veins around the testes), hydrocele can be diagnosed by ultrasonography. Varicocele affects sperm development and may be the cause of infertility in a male.

  • Hormonal profile - Some hormones control the production and release of Testosterone. Disorders in the production of these hormones like luteinizing hormone (LH), follicle-stimulating hormone (FSH) can affect the development and function of testes. Blood tests are done to evaluate the levels of these hormones.

  • Post-ejaculation urinalysis - The urine sample of the male is analyzed after the ejaculation to look for the presence of sperms. The sperms after ejaculation should be moving out through the penis. Their presence in the urine indicates that they are travelling backwards into the bladder, known as Retrograde Ejaculation. This occurs when the muscle (sphincter) that closes the urinary bladder during ejaculation is not functioning properly. This may be seen after prostate surgery, surgery for testicular cancer, in diabetics, as a side effect of certain drugs like antipsychotics and antidepressants.

  • Genetic Testing - Certain cases of male infertility are due to changes in the DNA of the sperm. Healthy sperm DNA is essential for the sperm to penetrate the egg or the oocyte. Damage in the sperm DNA can be attributed to many causes such as advanced age, infections, exposure to toxins, chemicals etc.
    One such test is the DFI- DNA fragmentation index helps to identify the defects in the DNA of the sperm.

  • Sperm Visibility Tests (MACS)- Magnetic Activated Cell Sorting- is a method to identify the functional sperms i.e. sperms that do not show cell damage and selecting them. Selecting the functional sperms through MACS increases the probability of achieving success in ART (Assisted Reproductive Techniques) like IVF.

  • Transrectal Ultrasound - The prostate is a gland present in front of the rectum, between the urinary bladder and the penis. The prostate secretes fluid that provides nourishment and protection to the sperms. Any obstruction at the level of the prostate can hamper the flow of the semen to the penis. Transrectal USG helps in evaluating the prostate. Also, the ejaculatory ducts and the seminal vesicles that carry the semen can be examined by Transrectal ultrasound.

  • Testicular Biopsy - Testicular biopsy is a surgical procedure in which a small amount of testicular tissue is taken for examination. This tissue is examined under the microscope. Nowadays, testicular biopsy is mainly done to obtain the sperms for ARTs (IVF, ICSI). It also plays an important role in the diagnosis of obstructive azoospermia (absence of sperms in semen due to some obstruction in the flow of sperms to semen). Surgical removal of the obstruction in the male genital tract can help in restoring the sperms in semen and can result in natural conception.

  • Surgical sperm extraction procedures - These are done in cases of male infertility to look for the presence of sperms in the epididymis (it is a tube that stores sperms) and testes. These procedures are PESA (Percutaneous Epididymal Sperm Aspiration), TESE (Testicular Sperm Extraction)and TESA(Testicular Sperm Aspiration).

  • Hormonal profile - If the sperm count is less than 15 million/ml it is known as Oligospermia.

In cases of male infertility with azoospermia or very low sperm count, these surgical sperm retrieval techniques are used to obtain the sperm for assisted reproduction (IVF, IUI). Most commonly the cause of low sperm count in the semen is obstruction at some level in the tubes carrying and transporting sperms. These surgical procedures help in obtaining the sperms needed for fertilization of the egg.