| |
|
 |
|
|
|
What are the indications for male infertility Statistics show that in at least 40% of infertile couples, there is a
male factor contributing to the problem. Male fertility screening is done
through semen analysis. The general rule is that the lower the sperm count
and the poorer the sperm quality, the longer it will take and the more
difficult it may be for a pregnancy to occur. However, even men with very
low sperm counts may eventually be successful in causing a pregnancy. The
sperm count only needs to be high enough for that one time that ovulation
occurs, in order for a pregnancy to be possible. What are the major factors affecting sperm production Oligospermia is the term used to describe the condition when the sperm count is low. If there are no sperm at all in the semen sample, the condition is termed azoospermia. In such cases, the clinic will wish to see your husband to take a more detailed history and to examine him. In his history, specific questions will be asked about any past condition that may have affected the testicles. For instance, he will have to answer queries regarding whether he has had any operations in the groin area or for undescended testicles in childhood. The specialist will also ask questions to determine whether there has been any major injury or infection in the genital area. Infected semen can be a cause of infertility. Earlier, it was believed
that mumps could cause sterility in men. However, it is now known that
even when the testicles are involved in mumps orchitis (very painful
swelling of the testicles), it is extremely rare for this to lead to
sterility. What other factors affect sperm production Heat can have a detrimental effect on normal sperm production. It is
for this reason that nature has placed the testicles outside the body in
the scrotum rather than in the abdomen like the ovaries. Some infertile
men soak themselves in a bathtub full of scalding water and emerge looking
like lobsters. This can almost stop sperm production completely. Obese men
can also become sterile because the sagging layers of fat can overheat the
testicles. Men whose jobs involve long hours of sitting, e.g. long
distance lorry-drivers may have infertility due to the increased heat to
the genital area. What problems can be identified during examination Every infertile man must be carefully examined. The examination of the external genitalia in the male rarely shows anything out of the ordinary. However, sometimes one or both testicles are very small or rarely may even be absent. Additionally there may be congenital absence of each vas deferens, the ducts through which sperm pass from the testicles to the female at intercourse. Other factors which may contribute to lowered fertility, and which can be identified on examination include: Varicocele is a term used to describe a condition where there are
varicose veins around the testicle and vas deferens. In the case of
varicoceles, there is an increase in the blood flow and temperature around
the testicle. Even a small varicocele may be significant and affect sperm
production. Treatment of the Infertile Male Oligospermia In cases of oligospermia, the man should first try to control the known
environmental causes of the problem. Cutting down on heavy smoking and
drinking and reducing work pressures are a few steps that you can take.
Obese men should go on a weight loss programme. Do not have baths in
scalding hot water. If intercourse is very frequent, a reduction in the
frequency of ejaculation is very advisable. Absence of Testicles There is no treatment for men who do not have testicles or whose vas
deferens is absent from both testicles. The tying off of varicoceles by
high ligation and the surgical removal of hydroceles can bring about
dramatic improvement in spermatogenesis, but there is no guarantee that
these operations will be successful. If the testicles tend to lie in the
groin region, the operation of orchidopexy that keeps them in the cooler
environment of the scrotum can also be beneficial. Retrograde Ejaculation Intercourse on a full bladder can solve the problem of retrograde
ejaculation. This will force the sperm to move in the right direction. The
alternative is to remove the sperm from the urine that is passed
immediately after ejaculation, and then by artificial insemination
introduce the sperm into the cervix. Obstruction in Sperm Flow If tests have shown that there is an obstruction to the outflow of
sperm from the epididymis of the testicles, the operation of
epididymovasostomy can be performed. This procedure removes the blocked
portion of tube and rejoins the open healthy tubes to each other.
Unfortunately the success rate of this form of microsurgery is poor.
Bacterial Infection Any infection indicated by a high white cell count in the semen may be
due to a chronic infection of the prostate gland. Treatment with a long
course of antibiotics can be very beneficial. Antibodies When there is severe agglutination of sperm in the semen sample due to
antibodies in the sperm, the prognosis is not good. Theoretically, it is
possible to remove antibodies from the sperm to prevent them from sticking
together. Some doctors prescribe special steroid therapy to reduce the
sperm antibodies, but there are potential risks to this form of treatment.
Hormone Disorders Save in the case of a hormone deficit, hormone therapy in the male
generally has disappointing results. Treatment with clomiphene, Pergonal,
H.C.G. and testosterone are associated with a limited success rate. A weak
male hormone, mesterolone is frequently prescribed to men with
oligospermia, but here too the results are poor. Sperm Dilution If split ejaculate semen analysis shows that there is a considerable increase in the sperm count in the first part of the ejaculate, then the technique of split ejaculate intercourse carried out only at the time of ovulation can be helpful. In split ejaculate intercourse, your husband will have to withdraw after the first part of the ejaculation has occurred. This will ensure that a higher than usual sperm population is deposited in the vagina. This is not the most comfortable and satisfying way of having intercourse, but to do it this way just once a month is surely not too much to ask if you want a child. The alternative is to use the first part of the ejaculate for artificial insemination. Male Infertilty:
INVESTIGATIONS SEMEN ANALYSIS SPERM INVASION TEST TREATMENTS TREATMENT OF THE INFERTILE MALE What is the post-coital test The post-coital test assesses the ability of sperm to reach the canal
of the cervix and survive in the mucus. One of the signs that a woman is
ovulating is that there is a noticeable change in the mucus secretion. At
the time of ovulation, the ovaries produce more estrogen as a result of
which the mucus secreted by the cervix of the uterus becomes very profuse,
clear and watery like saliva. The cervical mucus also becomes more
receptive to sperm. When should I take the post-coital test A post-coital test will be performed at the clinic and will be
scheduled as close to the time of ovulation as possible. Previous basal
body temperature charts can help to ascertain the time of ovulation. It
will be necessary for you to have intercourse around eight hours before
the test is performed. Isn’t intercourse “on demand” very stressful Being required to schedule your sexual intercourse can put undue
pressure on both you and your partner. Some couples find that they just
cannot seem to go through with intercourse in such a clinical fashion.
Some husbands have even failed to achieve an erection. This, in turn,
increases anxiety and tension. Remember that the clinic has merely made a
request. Men often find it easier to comply with this request if they have
been involved in the investigations and other procedures right from the
start. How is the test carried out A speculum is gently inserted into the vagina, and a sample of mucus is
taken from the canal of the cervix. It is a painless procedure that lasts
for just a few seconds. The mucus sample is then transferred onto a glass
slide. While this is being done the ”stretchability” of the mucus is
noted. The mucus sample is then examined under a microscope. The sperm
population is counted and their degree of activity assessed. How are the post-coital test results analyzed A completely normal post-coital test will show very flowing ”stretchable” mucus containing a significant number of moving sperm. The sperm must be normal in appearance and moving across the slide and not simply shaking on the spot. A post-coital test of this quality implies that the sperm count is normal, that the sperm are gaining access to the canal of the cervix and that there is no major cervical mucus hostility factor. Mucus with fewer sperm does not necessarily mean that there is a
problem. However, there is a greater probability that pregnancy will occur
when the sperm population is higher. When is a post-coital test considered negative A post-coital test is considered negative if no sperm or only dead sperm can be found in the mucus. This does not mean that conception is impossible. It merely indicates the need for further investigation. Sometimes the mucus itself is very thick and tenacious rather than watery and flowing. A negative post-coital test may be due to: Incorrect timing of the test What is semen analysis While a positive post-coital test result will indicate that the sperm
count is normal, an analysis of the semen itself is the most basic test
that can be carried out on your husband. How is the test carried out A semen sample will be collected by asking your husband to masturbate directly into a special sterile container. There is no point trying to collect a sample by withdrawal at intercourse as some of the initial part of the ejaculate is lost. Transferring a sample from a condom does not help either as most sheaths these days contain a potent spermicide. Some specialists recommend that you abstain from intercourse for a few days before the sample is collected. However, others feel that it is better to follow your normal pattern of intercourse. The semen sample should be kept warm and should be delivered to the laboratory for testing within one hour of production. After the sample volume has been measured, the following calculations are carried out. The number of sperm per milliliter (ml). What are the indications for normal semen A normal semen analysis will show: A volume greater than 2 ml. What if the semen analysis results are not normal If your husband’s semen analysis falls short of the figures given
above, it does not imply that a pregnancy will be unlikely. Different
samples from your husband will show different results. This is why a
reduced semen analysis will always be checked with 1 or 2 repeat tests.
Changes in his general health 10 weeks before the collection of the sample
can affect the sperm count and motility. . For example, if he has had an
illness like ‘flu, it can reduce both the count and motility in a sample
produced 10 weeks later, as this is the time taken for sperm to reach
maturity. A repeat sample tested after an additional 2-3 months could very
well be normal. What will the results of the semen analysis tell me If your husband has a good quality semen sample with a count of 10 million per ml and your own fertility is normal, then statistically it will take up to 6 years for you to become pregnant. If this count is 20 million per ml and of good quality it will take up to 3 years, and at 30 million per ml a pregnancy should occur within a year. But keep in mind that these are generalizations that cannot be blindly applied to every couple. The quality of the semen is always more important than the quantity of sperm per ml. Various Male Fertility Disorders Azoospermia Azoospermia characterized by the absence of sperm is either due to an
obstruction in the outflow system from the testicle, in the epididymis or
vas deferens, or due to a failure in sperm production (spermatogenesis).
If a biopsy of the testicle showed that spermatogenesis was normal, this
would then indicate that an obstruction was the cause of his azoospermia.
Vasograms, which are X-rays of the vas deferens can then be performed to
identify the location of the obstruction. Presence of Antibodies Sometimes, a semen sample when seen under a microscope, will show sperm
clumping. This may indicate the presence of sperm antibodies that are
causing the sperm to stick together. A blood sample can be tested for the
presence of agglutinating and other sperm inhibiting antibodies. Klinefelter’s Syndrome Very small testicles may be the manifestation of Klinefelter’s
Syndrome. This is caused by a chromosomal aberration. Thus, a chromosome
investigation will show the presence of an extra X (female) chromosome.
Hormone Disorders Hormone disorders are rare causes of male infertility, but it may
sometimes be helpful to check his F.S.H., L.H., testosterone (male
hormone), prolactin and thyroid hormone levels. Bacterial Infection The existence of an excessive amount of white blood cells in the semen sample may indicate that an infection may be reducing the ability of the sperm to fertilise an egg. The semen sample should then be cultured to determine the type of infecting bacterial organism. Alternative and Natural Remedies We will be providing information on the latest research findings,
cures
|
 |
Viagra
is a trademark of Pfizer. |
|
© 2001 CockUp.com info@cockup.com |
