Andrology

Picture1Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most people and six months in certain circumstances.
Most couples achieve pregnancy within the first six months of trying. Overall, after 12 months of frequent unprotected intercourse, about 90 percent of couples will become pregnant.
The reasons for infertility can involve one or both partners.

 


Causes of male infertility

Causes of male infertility may include:
Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, health problems such as diabetes, or infections such as mumps. Enlarged veins in the testes (varicocele) can increase blood flow and heat, affecting the number and shape of sperm.
Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; semen entering the bladder instead of emerging through the penis during orgasm (retrograde ejaculation); certain genetic diseases, such as cystic fibrosis; structural problems, such as blockage of the part of the testicle that contains sperm (epididymis); or damage or injury to the reproductive organs.
Overexposure to certain environmental factors, such as pesticides and other chemicals, radiation, or to certain medications, such as anabolic steroids, or marijuana. In addition, frequent exposure to heat, such as in saunas or hot tubs, can elevate core body temperature, impairing sperm production.
Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely. Removal of one testicle due to cancer also may affect male fertility.

Preparing for your appointment

To get ready for your first appointment:

Provide details about your attempts to get pregnant.

Your doctor will need information such as when you started trying to conceive and how often you’ve had intercourse, especially around the midpoint of your cycle — the time of ovulation.

Bring your key medical information.

Include any other medical conditions you or your partner has, as well as information about any previous evaluations or treatments for infertility.

Make a list of any medications, vitamins, herbs or other supplements you take.

Include the doses and how often you take them.

Make a list of questions to ask your doctor.

 For infertility, some basic questions to ask your doctor include:

  • What are the possible resons we haven’t yet conceived?
  • What kinds of tests do we need?
  • What treatment do you recommend trying first?
  • What side effects are associated with the treatment you’re recommending?
  • What is the likelihood of conceiving multiple babies with the treatment you’re recommending?
  • For how many cycles will we try this treatment?
  • If the first treatment doesn’t work, what will you recommend trying next?
  • Are there any long-term complications associated with this or other infertility treatments?
  • Don’t hesitate to ask your doctor to repeat information or to ask follow-up questions.

What to expect from your doctor ?

Be ready to answer questions to help your doctor quickly determine next steps in making a diagnosis and starting care.

Possible questions for the couple
  • How long have you been having sex without birth control?
  • How long have you been actively trying to get pregnant?
  • How frequently do you have intercourse?
  • Do you use any lubricants during sex?
  • Do either of you smoke?
  • Do either of you use alcohol or recreational drugs? How often?
  • Are either of you currently taking any medications, dietary supplements or anabolic steroids?
  • Have either of you been treated for any other medical conditions, including sexually transmitted infections?
  • Are you exposed through your work or lifestyle habits to chemicals, pesticides, radiation or lead?
  • How much does stress play a role in your lives?
  • How satisfied are you with your relationship?
Questions for the man

If you’re a man, you might be asked:

  • At what age did you start puberty?
  • Have you had any sexual problems in this relationship, such as difficulty maintaining an erection, ejaculating too soon or not being able to ejaculate?
  • Have you conceived a child with any previous partners?
  • Do you regularly take hot baths or steam baths?

Test And Diagnosis

Before having infertility testing, be aware of the commitment that’s required. Your doctor or clinic will need to determine what your sexual habits are and may make recommendations about changing them. Tests and treatment trial periods may extend over several months. In some infertile couples, no specific cause is found (unexplained infertility).
Evaluation can be expensive and in some cases involves uncomfortable procedures. Finally, there’s no guarantee — even after all the testing and counseling — that conception will occur.

Tests for men

For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman’s vagina and be able to travel to the egg. Tests for male infertility attempt to determine whether any of these processes are impaired.
You may have a general physical exam. This includes an examination of your genitals.

Specific fertility tests may include:

Semen analysis.

Your doctor may ask for one or more semen specimens. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A laboratory analyzes your semen specimen for the health of sperm and the semen fluid.

Hormone testing.

A blood test to determine the level of testosterone and other male hormones is common.

Transrectal and scrotal ultrasound.

Ultrasound can help your doctor look for evidence of conditions such as retrograde ejaculation and ejaculatory duct obstruction.

Genetic testing

Genetic testing may be done to determine whether there’s a genetic defect causing infertility.

Treatment

Treatment of infertility depends on the cause, how long you’ve been infertile,
your age and your partner’s age, and many personal preferences. Infertility treatment involves significant financial, physical, psychological and time commitment.

Treatment for men

Approaches that involve the male include treatment for general sexual problems or lack of healthy sperm.

Treatment may include:
Medication or behavioral approaches.

Addressing impotence or premature ejaculation with one or both approaches may improve fertility.

Surgery, hormones or assisted reproductive technology. 

If a lack of healthy sperm is suspected as the cause of a man’s infertility, surgery or hormones to correct the problem or use of assisted reproductive technology is sometimes possible.

Sperm retrieval

Picture1These techniques obtain sperm when ejaculation is a problem: surgical sperm aspiration, whichallows retrieval of sperm if the ejaculatory duct is blocked, and electric or vibratory stimulation to achieve ejaculation, which can help retrieve sperm in men with spinal cord injury.
Surgery for male infertility
Correction of varicocele
Surgery to correct the obstruction in the passage of sperm


Vasovasotomy

Picture2Some causes of infertility can’t be corrected. However, a woman may still become pregnant with ASSISTED REPRODUCTIVE TECHNOLOGY. We at Sir Ganga Ram Hospital offer all medical as well as surgical treatment for the male infertility in association with state of art IVF center. If there is a light for success we explore it for a successful outcome in all possible way.