Disease / Male Infertility

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Infertility in general is the inability of a sexually active, non-contracepting couple to achieve spontaneous pregnancy in one year, according the World Health Organisation.

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How common is infertility?

About 15% of couples do not achieve pregnancy within one year and seek medical treatment for infertility. Eventually 5% will remain childless. Infertility affects both men and women. In 50% of the childless couples there is some underlying cause on the male.

What will my doctor do if I approach him/her about concerns with childlessness?

Your doctor will first do a detailed examination and take a detailed history from you. Then the next step would be to do a semen analysis to look for different parameters of the semen analysis. Semen analysis is the checking of your semen for volume, total number of sperms, the ability of the sperms to move (motility) and also to estimate the proportion of live sperms and to look for the proportion of any abnormal sperms. The sample collection is very important. You need to provide the sample as soon as possible after ejaculation into the laboratory.

What other tests may I have to undergo?

If the semen analysis shows any reduction in the number of sperms, your doctor may refer you to an urologist. You will have a detailed clinical examination including an assessment of your testicles and possibly you may have an ultrasound scan of your testicles. Your doctor or your urologist may do certain blood tests to assess your male hormone (testosterone) levels as well as other hormones (FSH and LH) with are secreted from the pituitary gland.

What are the causes of infertility?

Male infertility can be cause by problems at different levels of production of sperm. It could be caused by hormone imbalance from the pituitary gland or direct damage to the testicles by different disease conditions. The most common cause is a previous history of undescended testes (cryptorchidism), Previous history of twisting of the testicle (torsion), previous infections in the testicles or the tubes coming from the testicles (Epididymo-orchitis), previous history of testicular trauma, an exposure to environmental toxins, previous intake of toxic medications which have damaged the gonads (chemotherapy), testicular cancer and absence of testis. The presence of a condition called varicocele which is the presence of dilated veins around the testicles can also damage the sperm producing ability of the testicles. Previous surgery in the groin may cause blockage of the tube (vas deferens) which conducts the sperms from the testicle to the urethra from where it will be ejaculated.

How will my infertility be treated?

The infertility treatment will depend on the underlying cause of the infertility. Any hormone imbalances may be corrected and you may be referred to an endocrinologist. Any local damage to the testicle as from conditions mentioned above may be reversible. One reversible causes of infertility is the varicocele and if this is corrected by surgery it may improve the sperm results and the count. Other conditions which cause a blockage of the vas may also be treated surgically. In the presence of other conditions that caused the irreversible damage to testicles, the sperm may be harvested by doing a testicular biopsy or aspiration of sperms from the testis and these sperms can be used for in-vitro fertilisation (IVF).

Who will manage this condition?

Your doctor may refer to a urologist or a urologist that may sub-specialise in infertility. You may be also acquainted with the infertility treatment from your female partner or wife who would also be involved in the in-vitro fertilisation (IVF), if this is the way forward.

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