Married for 11 years and desperate to have a child of their own, Bengaluru-based couple Mamtha and Pavan (actual names changed on request) were a disappointed duo. While a gynaecologist had told Mamtha that she was fine, she was worried regarding what led to a negative result for her pregnancy test every time she hoped for ‘good news’. It wasn’t easy for Mamtha to convince Pavan to undergo semen testing initially. But now that he has been told he is dealing with azoospermia (a condition in which there are no measurable sperm in the semen), the couple are consulting an andrologist.
“Now, my husband is ready to take treatment. It was a shocker for him to internalise that he was dealing with infertility when he is fit and fine,” says Mamtha, voicing the concerns of many families dealing with male infertility.
Male infertility is a problem with a man’s reproductive system that prevents him from impregnating a female partner.
“Male infertility can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm, and functional problems related to evacuation,” says Dr Divakar, who is also the chair of well woman healthcare committee at the London-headquartered International Federation of Gynaecology and Obstetrics.
Talking about the causes behind infertility, Dr Sneha Sathe, fertility consultant at Nova IVF Fertility, Chembur, Mumbai, says 30 per cent cases are due to problems among men, 30 per cent point towards women, another 30 per cent towards both the husband and wife, and in the rest of the cases (10 per cent) the infertility is unexplained (where the reports seem to be normal but the couples are still unable to conceive).
“The semen-analysis report among men detects if there is an abnormality in sperm count, sperm motility (efficient movement of the sperm) and sperm quality. Abnormalities in semen parameters could be due to hormonal problems, obesity, genetic issues and because of infections like sexually transmitted diseases. Previous surgeries like hernia repair or any testicular surgery can also lead to abnormalities in the semen parameters,” says Dr Sathe. She says infertility could also stem from addiction to smoking and alcoholism. “Smoking has a negative impact on fertility in both men and women,” she says.
Dr SS Vasan, a Bengaluru-based uro-andrologist, says three parameters are checked in men with infertility issues: the movement of the sperm, the number of sperms and the shape of the sperm. He says treatments and procedures can be done to increase the chances of pregnancy. “Fertility is all about two people — female fertility is also extremely important. If the female fertility is very good, it compensates even when the male fertility is a little less. However, if the female fertility is not good, it does not compensate even when the male fertility is good. Because the oocyte (an immature egg cell in females that is involved in reproduction) has the reparative capacity. That is, it can repair the minor defects in the male fertility,” says Dr Vasan.
Dr Sathe says, “The male infertility or sub-fertility can be in the form of low sperm count, poor motility, azoospermia (no sperms), ejaculatory dysfunction or anejaculation, erectile dysfunction or other sexual problems. In such cases, in addition to helping the couple with their sexual life, we need to help them to conceive. Both need to be done simultaneously. While trying to bring their sexual life on track, if the semen-analysis report is normal, the couple can also try intrauterine insemination (IUI) for pregnancy planning. They can go for counselling, meet a urologist and also a fertility specialist simultaneously,” says Dr Sathe.
Doctors say that both the quantity and quality of sperm in semen play an important role in determining fertility. “A sperm count below 16 million/ml, motility (percentage of moving sperms) less than 42 per cent and morphology (percentage of normally shape sperms) below 4 per cent is considered abnormal as per WHO,” says Dr Sathe. She says infertility is on the rise and a large proportion of the semen reports that doctors analyse point to some abnormality. A sperm count of less than 16 million sperms in 1ml of semen is called oligospermia.
Taboo, an added concern
The taboo about male infertility and most men not coming forward to admit the actual problem puts huge pressure on the wives, says Dr Hema Divakar, Bengaluru-based obstetrician, gynaecologist and past president of the Federation of Obstetric and Gynaecological Societies of India, adding that it also causes depression among men.
“When the wife has a problem, it is common for the husband to say, ‘It is your problem, sort it out.’ But when the husband has a problem, the wife says ‘Let’s sort it out together’ and lends all the support. Men feel depressed if they are responsible for infertility, but women digest it as their karma,” says Dr Divakar.
Over the years, doctors have seen men with infertility coming forward to seek treatment, which wasn’t the case a decade ago. “Men who are educated do not shy from testing themselves any more. However, some very traditional, conservative, lesser-educated families still see women as the torchbearer of fertility, and that’s where the treatment gets delayed. However, in the last three decades, a lot of things have changed,” says Dr Vasan.
“Many men have a perception that if they are sexually normal, their fertility is likely to be normal, but that’s not true. It clouds their judgement.”
Dr Sneha says that when a couple are struggling with infertility, be it because of the male or the female partner, they are addressed as a combined unit. “Most of the couples are those who have tried to conceive naturally for a long time and have been married for many years. Having tried treatments at various places, they are already financially and socially drained out, and in their mid- or late-30s. They face the social pressure and feel the stress. They require counselling. The younger couples dealing with infertility have better chances compared to the older ones,” says Dr Sneha.
Dr Vasan points out a myth about infertility. “When the semen-analysis report points out male infertility, many do not agree. There will be a sense of denial, saying ‘How can I be infertile when I am hale and healthy, gymming and being active?’ We talk to both the husband and the wife. In a typical Indian scenario, it’s the wife who plays a crucial role in convincing the husband for further treatment, and not the doctor,” he says. About men who think they are sexually active and hence can’t be infertile, Dr Vasan says, “Sexually being active has got nothing to do with the confirmation of male fertility.”
Treatment of Azoospermia
Dr Sathe says treatment possibilities with IUI, IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) are suggested to couples depending on the semen-analysis result and other factors such as the wife’s age, the duration of their infertility and the presence or absence of other contributory conditions.
- IUI is an artificial-insemination method where the sperms from a male partner are directly placed into a woman’s uterus
- IVF is a type of assisted-reproduction technique in which a man’s sperms and a woman’s eggs are combined in a lab set outside of the human body. Once the egg/s are fertilised, they are transferred to the woman’s womb
- Another method is IVF with ICSI, where the sperm is directly injected into an egg in a lab set-up
“Nowadays are seeing a slight increase in cases where there are no sperms (azoospermia),” says Dr Vasan. He adds that cases of obstructive azoospermia, where a blockage is preventing the sperm from entering the ejaculate, are relatively treatable by retrieving the live sperm through assisted reproductive techniques. “The non-obstructive azoospermia is a condition where there is decreased sperm production by the testis.”
Agreeing with him, Dr Sathe says that infertility is on the rise.
“When couples come to us after being unable to conceive naturally, we evaluate both husband and wife simultaneously,” says Dr Sathe. “Over the years, in urban settings, the men have become open to getting tested. When the wife’s reports are all normal and the issue is found in the husband, they prefer to take medical treatment first rather than immediately going for IUI or IVF. The drawback with this is that they tend to spend a lot of time in trying to get the semen parameters up to try and conceive naturally. In the meanwhile, the wife’s age keeps increasing and the risk of other fertility issues coming in also increases. It is important for couples to understand that just as the chance of natural conception goes down as a woman grows older, even the chances of success with IVF decrease with age.”
Article explains in a detailed manner the Reality of the infertility! A must read for Men, especially!! Kudos to HH.
Interesting story, lot of awareness is required on male infertility. They usually have ego of not undergoing any such test.
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Men must come forward for testing to clear the prejudice that their spouses face. Men undergoing testing, is still not a reality in semi urban areas though.
Very nice article ?
Both Husband and Wife should take firm decision to get treatment for infertility without self-ego, negligence and delay