Infertility, a term which has been long associated with woman only, has now under better scope of evaluation, investigations and under wider perspective has brouqht males also in the picture. Male infertility which has always been under diagnosed in previous years, is now showing an increasing trend and has reached upto 4006 of the infertility cases. This increase is partly apparent- due to better scope of evaluation. and partly real- due to many factors such as-
1 - Change in lifestyle and dietary habits
2 - Stress of modern society
3 - Frequent exposure to electromagnetic field by increasing use of mobile. laptop etc/exposure to pollution because of various conditions
4 - Use of pesticides, synthetic dyes, xenoestrogens in food items
Evaluation of a male in an infertile couple includes:-
1 - History
2 - Physical examination
3 - Specific focused investigations
A detailed history either from the male partner or from his parents may directly or indirectly indicate most of the causes of his subfertility. A variety of information may be elicited only through history. like information about childhood illness. abnormalities and treatment performed.illstory of current or past illness like cancer, tuberculosis, mumps. STDs. recent acute viral fever, diabetes. drug abuse etc.
History about modern life style like sauna bath. Hot bath. long distance cycling as they can cause scrotal hyperthermia or trauma resulting in spermatozoa abnormalities.
Management of an azoospermic male is planned depending on the FSH level and testicular size
1. Testis small or nearly normal, high FSH- (Testicularfailure)
Usually a case of non obstructive azoospermia. May be due to genetic. immunologic. or some other cause. TESA/PESA/lCSl not possible. ART with donor semen may be suggested. in rare cases, immature sperms may be found in one of the four quadrants of testicular biopsy with which ICSl may be attempted.
2. Testis size small or nearly normal, low FSH- (hypogonadotrophic /hypergonadotrophic)
Gonadotropin replacement is possible after counseling the patient followed by TESA/PESA with immature to mature sperms. Chances of failure to retrieve healthy sperms are high and the couple needs to be counseled regarding this.
3. Testis size normal, FSl-l normal-(Absence of vas deferens)
Most likely to be obstructive azoospermia. Sperms can be retrieved with TESA/PESA and can be frozen if obtained in good concentration. Sperms thus retrieved can be used with the Help of A-R-T.
4. Retrograde ejaculation:
a urine sample immediately following an ejaculation may be centrifuged while maintaining an optimum ph for sperms and the isolated sperm can be used by lUi. in more severe cases, in-vitro fertilization with ICSl may be used.
Always a stigma on a woman has dominated the perception of general person and our society. It should be clearly counseled that 40% of infertility cases are due to male factors.
Various factors should be diagnosed and overruled before we take them for any A-R-T procedure.