Male Infertility

Male Infertility

MALE INFERTILITY

Male factor infertility may result from low sperm count or low sperm motility, or decreased ability of the sperm to fertilize the egg or abnormal shape of sperms or lack of semen or absence of sperm or inability of man to deposit the sperm into female privates due to erectile dysfunction.

Male infertility: -
    (1) Oligospermia | Low Sperm Count
    (2) Azospermia | Nil Sperms | Low Sperm Motility.

Improper diet may cause male infertility:

• Drinking over 1 litre of cola a day might decrease sperm quality by up to 30% (study claims there is correlation, but not causation)
• Bevarages rich in caffine or more number of coffees may cause infertility.
• Soy products decrease sperm quality due to the high content of a type of phytoestrogen calledisoflavones.
• A review in 2010 concluded that there is little evidence for a relationship with semen parameters and increased BMI.
• Nutritional deficiencies especially calcium, zinc, iron, magnesium and phosphate also can cause male infertility.
• Gossypol has been associated with reduced sperm production. It is present in crude cottonseed oil, and potentially the organ meats from animals poisoned with cottonseed.

Gossypol is a natural phenol derived from the cotton plant (genus Gossypium). Gossypol is a phenolicaldehyde that permeates cells and acts as an inhibitor for several dehydrogenase enzymes. It is a yellowpigment. Among other things, it has been tested as a male oral contraceptive in China.

A photograph of human sperm. Sperm are not really red and green in colour; the

colours were added to the photograph to make the sperm stand out more clearly.

• LOW SPERM COUNT (Oligospermia).

Oligospermia (low sperm count) is the condition in which the male individual has low level of sperm count, unable to make to conceive a girl in normal ways, In general low number of sperm count is usually mentioned as oligospermia.

Common Reasons for the Cause of Oligospermia (low sperm count).

    * Stress :- reduces sperm count
    * Tobacco:- Nicotine damages sperms motility and its survival rate.
    * Lead :- Workers in printing press have low sperm count
    * Hot climates.
    * Varicocele
    * Avoidance of saunas, hot baths, the wearing of tight underwear, and other situations in which scrotal temperature may be raised
    * Alcohol:- Alcohol damages sperms.

Other Reasons for the Cause of low sperm count.

    * Pus in Semen.
    * Anti-Sperm Antibody.
    * Less Semen Formation.
    * Absent Ejaculation.
    * Dead Sperms.
    * Abnormal Sperms.
    * Immotile Sperms.

• Azoospermia (Nil Sperm).

Azoospermia is called when there is no sperm in semen. This type of semen disorder is found in approximately 3% of infertile men i.e. absent sperm. You should know that testis has two separate functions.

    * Production of normal sperms in semen which needed for pregnancy & normal fertility.
    * The other function of testis is production of male hormones i.e. testosterone & others.

So in most patients with nil sperms though semen has absent sperms still production of male hormones remains normal.

Causes of Azoospermia or Nil Sperms.

Hormone disorder : The various endocrine (Hormone) disorder leading to azoospermia are as follows
(1) Hormone deficiency of pituitary gland as L.H., F.S.H., Prolactin, thyroids hormone, hypothalmic deficiency of GnRH, Pituitary gland failure, Hypopituitarism, Idiopathic hypopituitarism, Kallman syndrome, Isolated hypogonadotropic hypogonadism, Drugs, toxins, Idiopathic hypogonadotropic hypogonadism & due to many more causes.

(2) Obstruction in the outflow of semen (Sperms) from testis to outside through urethral opening.

(3) Absence of germ cells in testis also called sertoli cell only syndrome.

(4) Maturation Arrest (. Spermatid arrest): of primary spermatocytes to secondary spermatocyte, spermatids or to mature spermatozoa. Due to devoid of hormones.

(5) Testicular disorders (primary leydig cell dysfunction), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)

(6) Varicocele (Grade 3 or more severe): A varicocele is a varicose vein in the cord that connects to the testicle. (A varicose vein is one that is abnormally enlarged and twisted.)

(7) Varicocele decreases sperm productions by elevating temperature of the testis, may produce higher levels of nitric oxide chemical in the testis which blocks sperm production, varicocele damages sperms directly & lastly varicocele decrease the oxygen supply to testis.

(8) Presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia

(9) Trauma.

(10) Environmental toxins.

(11) Viral orchits.

(12) Granulomatous disease as tuberculosis, sarcoidosis of the testis.

(13) Defects associated with systemic diseases, Liver diseases, Renal failure, Sickle cell disease, Celiac disease.

(14) Neurological disease as myotonic dystrophy.

(15) Development and structural defects, Germinal cell aplasia, sertoli cell only syndrome, Cypt-orchidism.

(16) Androgen resistance.

(17) Mycoplasma infection.

(18) Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm) and hence a low sperm count.

(19) Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining of the sperm forming germ cell in the testis.

(20) Environmental Assaults: Over exposure to environmental assaults (toxins, chemicals, infections) can cause nil sperm either by direct suppression of sperm production or on the hormone. Some chemicals that affect sperm production men are: Oxygen-Free Radicals, Estrogen emulation pesticidal chemicals (DDT, aldrin, dieldrin, PCPs, dioxins, and furans), plastic softening chemicals like Phthalates, hydrocarbons (ethylbenzene, benzene, toluene, and xylene)

(21) Exposure to Heavy Metals: Chronic exposure to heavy metals such as lead, cadmium, or arsenic may affect sperm production and may cause nil sperms in otherwise healthy men. Trace amounts of these metals in semen seem to inhibit the function of enzymes contained in the sperms, the membrane that covers the head of the sperm.

(22) Radiation Treatment: Over-exposure to radiation & xrays affect any rapidly dividing cell, so cells that produce sperm are quite sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to two years to resume normal sperm production, and, in severe circumstances, may never recover.

(23) Misuse of substances: There are a number of banned substances that can have potentially lethal effects on sperm production. Taking anabolic steroids, for example, to increase performance in sports such as weight lifting, can dramatically alter both the motility and the health of the spermatozoa. Other banned substances, such as cocaine, marijuana and heroin can reduce sperm production & may make a man infertile.

(24) HGH Deficiency.

(24) Medication

• Depo-Provera, Adjudin, and gossypol are examples of substances used as male contraceptives or inchemical castration. Recent studies have found that THC present in cannabis can confuse the movements of intact sperm, reducing their ability to achieve fertilization.

• Selective serotonin reuptake inhibitors (SSRI) may cause low sperm count.

• Many antibiotics, e.g. penicillin and tetracycline, suppress sperm production. It may indirectly reach humans through eating livestock given antibiotics as a growth promoter.

In addition, in vitro studies have observed altered sperm function by the following medications:

• Many psychoactive drugs, including many antidepressants, many antiepileptics (e.g. lithium), andpropranolol
• Opioid analgesics
• Calcium channel blockers
• Phosphodiesterase inhibitors (e.g. caffeine, theophylline, pentoxifylline)
• Statins
• Calcium chelators (e.g. EDTA)

Diagnosis of Cause of Nil Sperm Count

Investigation & Diagnosis:
    * Complete male hormone profile: This profile includes all the male hormone tests which affect testicular development, growth & other genital organ development as well as genital functions. L.H., F.S.H., Testosterone, prolactins, thyroids test.
    * Antisperm antibody
    * USG or

Sometimes complete semen analysis and culture tests are also essential.

Other tests used for Infertility:

Doppler

Study of scrotum & testis
    * Semen culture sensitivity
    * Semen fructose
    * Fine Needle Testicular Biopsy of the testis to look for evidence of spermatogenesis & testicular structure.
    * Human Sperm-Zona Pellucida Binding Ratio
    * Human Sperm-Zona Pellucida Pentration test
    * Genetic Studies
    * FNAC Testis
    * Egg penetration test
    * Molecular genetic studies done in some special cases
    * Chromosome analysis i.e. Karyotype (chromosome analysis)
    * Assessment of androgen receptor
    * Combined Pituitary hormone tests is performed when needed
    * Immunobead test
    * MRI head, Hemogram, test for systemic diseases.
    * Factory test is done to find out kallman's syndrome.

Semen Analysis:- Normal parameters :-

Volume : normally 2-3.5ml for some males up to 5ml.

Colour : white to light pale yellowish

Density : highly viscous to semi solid, solid.

pH : 7.2 to 8.0 (alkaline)

Total count: 80 to 150 million will be considered to be good.

Motility: Actively motile 90% and above,

Normal morphology: 90%

Bacteria and other microorganisms: Nil

Pus cells: 1-2 cells or zero.

TREATMENT OF NIL SPERMS

After the finding out cause of azoospermia treatment is started depending on the cause found.

The various treatments are as follows:

(1) Correction of the Cause: First of all we try to find out the primary cause of nil sperms by above mentioned investigations. Then we correct the basic defect i.e. correction of hormone disorder & other defects. We also give following treatment for permanent cure of low sperm count & motility disorder.

(2) Correction of Hormone deficiencies: Once the hormone disorder is found then it is corrected by any of the below medicines. Usually sperm count normalizes in three month time with proper hormone treatment.

(3) Varicocele: A varicocele is an abnormal tortuosity and dilation of veins of within the scrotum, for which specific herbal medicines gives cure permanently.

Our Treatment:

Before following our treatment system, semen count test is very essential and stop treatment using synthetic medicine, hormonal treatment if any……

Our treatment involves in two main steps (i) first strengthening of entire organ system

(ii) Secondly herbal medicines given for enhanced production of sperm.

Advantage of treatment :

• The treatment is completely free of any side effects.
• Medicine increases Sperm Count, Sperm Motility, and Semen Quantity and corrects Sperm Abnormalities.
• Medicine is effective in 95% in sperm abnormalities i.e. Low Sperm count,  Low Motility, Low Semen Quantity and Abnormal Sperm Cell Morphology. 
•  It is the fastest among all treatment. It raises sperm count fourfold with every month’s treatment till optimum count. So with low sperm count like 3 million per ml. to normal count of 40 million per ml. can be achieved within two to Three months of treatment.
• The maximum level of improvement can up to 60 to 110 million at an average level.
• This treatment can support azoospermia or zero count  to the maximum extent,  If there is infection, low in hormone production, nutrition deficiency etc… in case of  any block it is impossible in normal treatment.
      * It improves not only sperm count but also it’s quality. It raises low sperm motility to high sperm motility. It also improves grades of sperm motility simultaneously.
      * The success rate of system is very high.
•  The greatest advantage is that even after stopping the treatment the higher count remains longer.
• It is quite comfortable to take it, as it has sweet pills and drops only, to take with 2 doses per day. So, this treatment being simpler avoids complicated procedures in case of male infertility.

OTHER RELATED TOPICS:

What it is semen  made up of ?

Semen is made up of sperm (male cells for sexual reproduction) floating in a fluid called seminal plasma. Sperm, also called spermatozoa, are made by a man's testicles and mature (grow up) in the epididymis. The fluids in seminal plasma come from different glands in the man's body: theseminal vesicles, prostate and bulbourethral glands (also called the Cowper's glands). (Glands are special organs in the body that make chemicals.) The table below shows the substances that make up semen and the glands that produce them:

Glands	Rough amount	Substances
Testicles andepididymis	5%	Sperm – in each ejaculation, there are between 40 million and 600million sperm.
Seminal vesicles	40–60%	Amino acids and fructose (a kind of sugar), – these provide food for the sperm. Prostaglandins – these help to stop the woman's immune systemfrom rejecting the sperm. Other substances such as citric acid, enzymes, flavins, phosphorylcholine, proteins and vitamin C.
Prostate	13–33%	Zinc – this stops the parts of the sperm containing DNA from breaking up. If a man does not have enough zinc in his food, he will have lower fertility and be less able to make a woman pregnant as his body will not be able to make sperm well, and the sperm will be weaker. Prostate-specific antigen (PSA) – this is an enzyme (a chemical that speeds up chemical reactions) which causes the semen to become watery so sperm can move easily inside a woman's body. Other substances such as acid phosphatase, citric acid, fibrinolysin, and proteolytic enzymes.
Bulbourethral (Cowper's) glands	5%	Mucus – this is a slippery fluid that gives semen its jelly-like texture. It helps sperm to move through the man's urethra and inside the woman's vagina and cervix, and also stops them from spreading out too much from the semen when it is inside the woman's body. Other substances such as galactose (another kind of sugar), pre-ejaculate and sialic acid.

Seminal plasma protects and provides food for sperm as they travel inside a woman's body. The inside of a woman'a vagina does not suit sperm cells as it is acidic. To protect the sperm from the acid, seminal plasma is alkaline. A woman's immune system also tries to kill organisms (living things) that are not part of her body. Seminal plasma has chemicals called prostaglandins in it to stop the woman's body from killing the sperm.

Some common terms used in sperm counting test

• Aspermia: absence of semen
• Azoospermia: absence of sperm
• Hypospermia: low semen volume
• Hyperspermia: high semen volume
• Oligozoospermia: low sperm count
• Asthenozoospermia: poor sperm motility
• Teratozoospermia: sperm carry more morphological defects than usual
• Necrozoospermia: all sperm in the ejaculate are dead
• Leucospermia: a high level of white blood cells in semen

Sperm Morphology (Shape and Appearance)

The evaluation of sperm size, shape and appearance characteristics should be assesed by carefully observing a stained sperm sample under the microscope. The addition of colored "dyes" (stains) to the sperm allow the observer to distinguish important normal landmarks (characteristics) as well as abnormal findings. Several methods of staining sperm are used, and the method employed should be one with which the examiner is comfortable and experienced.

Several different shapes or forms of human sperm have been identified and characterized. These forms fall into one of four main categories: normal forms, abnormal head, abnormal tail and immature germ cells (IGC), as follows:

Normal forms

Normal sperm have oval head shapes, an intact central or "mid" section, and an uncoiled, single tail.

Abnormal heads

Many different sperm head abnormalities may be seen. Large heads (macrocephalic), small heads (microcephalic) and an absence of identifiable head are all seen in evaluations. Tapering sperm heads, pyriform heads (teardrop shape) and duplicate or double heads have been seen. Overall (gross) abnormalities in appearance may be termed "amorphous" changes.

Abnormal tails

Coiling and bending of the tail are sometimes seen. Broken tails of less than half normal length should be categorized abnormal. Double, triple and quadruple tails are seen and are abnormal. Cytoplasmic droplets along the tail may indicate an immature sperm.

Immature germ cells (IGC's)

White blood cells (WBC's, germ fighters) in the semen should rarely be seen. It is very difficult to distinguish between an immature germ cell and a WBC. Because the presence of WBC's in the semen (pyospermia) can be a serious concern, if a report of "many IGC's" is delivered, it becomes very important to assure that these cells are not, instead, WBC's.

Sperm "Motility" (Movement)

Sperm motility studies identify the number of motile (moving) sperm seen in an ejaculate specimen. Here again, as in many other sperm studies, many laboratories use "normal" values that are out of date and inaccurate. Many labs will assess sperm motility upon receipt of the specimen, and again at hourly time intervals for four to twenty four hours. It is well known that sperm motility is a temperature dependent sperm function, so the handling and processing of specimens is critical. It is for this reason that we, except in very rare instances, require that specimens be evaluated only in a laboratory such as our own, where we are able to tightly control laboratory conditions. We have found the repeated testing of sperm over time for motility adds little to the evaluation of motility over the initial sperm motility assessment. Sperm are known not to survive well for extended periods of time in semen, and in nature, sperm very rapidly leave the semen to enter the cervical mucus. Many laboratories consider "normal" sperm motility to be 60% or greater. Our own studies, in agreement with many others have found men with 40% or greater sperm motility to be "normal". Motility characteristics:

Asthenozoospermia

Decreased sperm motility. If found to be present, exam should be repeated to assure that laboratory conditions did not cause the problem. Frequent causes: abnormal spermatogenesis (sperm manufacture), epididymal sperm maturation problems, transport abnormalities, varicocele. These conditions should all be looked for if sperm motility is repeatedly "low".

Necrozoospermia

A total absence of moving sperm. It is vital, if sperm are seen, but are not moving, to carry out studies (vital stains) to see if the sperm seen are alive. It is possible to have sperm with normal reproductive genetics that are deficient in one or several of the factors necessary to produce motility. We have achieved several successful pregnancies emploting microinjection of healthy, non motile sperm directly into the egg (ICSI).

Chemical and Biochemical Semen Characteristics

Semen acid-base balance (pH)

The pH of semen is measured using a specially treated paper blot that changes color according to the pH of the specimen that it is exposed to. The pH of normal semen is slightly alkaline ranging from 7.2 to 7.8. Prostatic secretions are acidic while the secretions of the seminal vesicles are alkaline. Therefore, alterations in pH may reflect a dysfunction of one or both of these accessory glands. The pH of semen has not been generally found to have a major influence on a man's fertility potential.

Color and Turbidity

Semen is normally translucent or whitish-gray opalescent in color. Blood found in semen (hematospermia) can color the semen pink to bright red to brownish red. The presence of blood in semen is abnormal and should be reported. The presence of particles, nonliquified streaks of mucus or debris requires further evaluation.

Liquefaction

Semen is normally produced as a coagulum. The specimen will ususally liquify within 30 minutes. The failure to liquify within one hour is abnormal. Excellent methods for correcting this problem in the laboratory are available.

Viscosity

Nonliquefaction and excessive viscosity are two separate conditions. Viscosity is measured after complete liquefaction has occured. Viscosity is considered "normal" if the liquefied specimen can be poured from a graduated beaker drop by drop with no attaching agglutinum between drops. The role of hyper (excessive) viscosity is being studied, but it seems possible that htis condition may interfere with the ability of sperm to travel from the site of deposition into the cervix or uterus.