MALE INFERTILITY (Part 3)

In past editions, we have been discussing on Male Infertility, explaining their causes and diagnosis. This week, we will conclude with the treatments and preventive measures of Male Infertility.

TREATMENT
Often times, the exact cause of infertility may be unknown but one should still visit the fertility clinic so as to plan a treatment option that may lead to conception.
Treatments options for male infertility include:
1. Treating infections: Antibiotic may be administered to treat an infection in the male reproductive tract but this does not always restore sperm functions.

2. Hormone treatments and medications: Hormone medications may be recommended in situations where the blood test reveals low or high levels of testosterone, FSH and LH.

3. Conventional In-Vitro Fertilization (cIVF): This basically involves collecting sperm through normal ejaculation for analysis. If the sperm counts are less than 20 million but with progressive motility, in vitro fertilization (IVF) may be carried out. In-vitro fertilization involves the fertilization of the female eggs and male sperm outside the body in a laboratory setting with an environment that mimics the physical characteristics of the body. Once, the eggs are fertilized by the sperm forming an embryo, the embryo is then placed back in the uterus of the woman.

4. Intracytoplasmic Sperm Injection (ICSI): This treatment is suitable for men with very low sperm count and poor motility after conventional IVF treatments with no fertilization. This technique involves injecting a single sperm directly into an egg by using a delicate hollow needle to immobilize the sperm and then carefully injecting it into the cytoplasm of the mature egg for fertilization.

5. Testicular Sperm Aspiration (TESA): This technique is suggested to men with no sperm in their ejaculate. It is done by retrieving sperm directly from the testis or epididymis using a long thin needle to extract sperm cells from the testicles. Sperm may be produced at a normal rate but a blockage within the testes prevents the sperm cells from the ejaculate. This could be due to abnormalities or vasectomy (male form of contraception). Prophylactic antibiotic is usually given after this procedure.

6. Testicular Sperm Extraction (TESE): This is a more invasive procedure used when the ejaculate produced contains no sperm cells. It involves a surgical procedure to carefully dissect a small part of testicular tissue in the scrotum under anesthesia. A microscope is then used to assess the tissue for mature mobile sperm cells that may be used for fertilization. Medications such as Vitamin E, Fish oil, Ibuprofen or Aspirin should be avoided for at least a week before procedure so as to avoid blood clotting. Patients are advised to abstain from sexual activity after the procedure.

7. Donor Sperm: This is the anonymous use of sperm from donors to fertilize the egg. Sperm donation is a voluntary act which is usually compensated. Sperm donors are young, healthy males screened for infectious diseases before accepted. The donor with the most similar phenotypical characteristics to the patient such as blood type, height, eye or hair colour would be selected.

PREVENTION
The following may be practiced in order to prevent male infertility. These include:
• Limit or abstain from alcohol.
• Reduce or quit smoking.
• Abstain from illicit drugs.
• Maintain a healthy weight.
• Avoid vasectomy (male contraception) when trying to conceive.
• Avoid things that may lead to prolonged heat of the testicles such as hot bath or long distance driving.
• Reduce stress by going on vacation or having proper rest and sleep.
• Avoid exposure to pesticides, heavy metals and other toxins.

WHEN TREATMENT DOESN’T WORK
Finding out that you may be infertile is often a stressful and depressing experience. There is still a common but incorrect belief that infertility is a woman’s problem so men are often unprepared when they are told that there is an issue with their sperm.
In rare cases, male infertility issues may be beyond treatment making it impossible for a man to have a child. In such occasions, some couples may decide to adopt a child or a pet, and in some cases opt for happy childlessness living while still hopeful for a miracle.

CONCLUSION
The most common cause of infertility in men lies in problems that affect the functions of the testicles. Other causes may arise from hormone imbalances or blockages in the reproductive organs. Studies suggest that the cause of male infertility in 50% of cases is usually unknown.
Male infertility may cause psychological, social and emotional distress on the couple as well as their families. This disease can also affect a man’s sense of masculinity, sexuality and potency. It is normal to have an emotional reaction to infertility. Talking with a doctor, a therapist or counsellor can often help with negative feelings.
Stigmas associated with infertility arising from religious and cultural beliefs should be recognized and proper orientation should be given so as to not allow these stigmas become a barrier to treatment.
Couples trying to conceive for twelve months or more without success are advised to visit their gynaecologist /fertility doctor to determine the next line of management towards achieving their dream of successful parenthood.