Treatment for Male Infertility

Written by Dr.M.D.Mazumdar, MD

Treatment of male infertility is very difficult. This is because the exact cause of infertility in men is hard to identify. In most men, the semen analysis may show a low sperm count but it is difficult to identify the cause of this decrease in the sperm count.

General Advice

Stop smoking as nicotine impairs both development and maturation of sperm.
Stop taking alcohol or at least decrease the intake of alcohol.
Avoid exposure to heavy metals like lead, cadmium and mercury. Certain anesthetic medicines are also known to cause a low sperm count.
Obesity should be controlled.
Avoid tight underwear, especially non-porous synthetic ones. Heat impairs development of sperm. Cold baths should be encouraged.
Advise to improve general health. Supplementary vitamins of Vit B12, Vit E, Folic Acid and Zinc and thyroid hormones are often prescribed but their value has not been well documented. A lycopene supplement is also necessary.
Avoid injury to the scrotum by wearing protection during sports.
A course of antibiotics may be necessary to cure any infection in the prostate or the genital tract.

Treatment for Low Sperm Count (Oligospermia)

Clomiphene Citrate: Clomiphene citrate is a drug prescribed for both male and female infertility. In females it has been proved to stimulate the ovaries to produce ovum. There is still some controversy about its use in males. But it has been shown to improve the sperm count as well as the motility of the sperm. For males, it is usually prescribed in the dose of 25mg daily for a minimum of three months and the semen analysis is then repeated.

Hormones like FSH, GnRH: Normally FSH is released from the pituitary gland under the influence of GnRH released from the hypothalamus. The FSH in turn stimulates the testes to produce more sperm. In men with a low sperm count, FSH and GnRH injections can be prescribed to stimulate the testes.

Other Hormones: Hormones to normalise levels of thyroid hormones, prolactin and insulin may be needed.

Varicocele Surgery: A varicocele is a dilation of the veins that surround the testes. It is believed to decrease the sperm count by increasing the temperature of the area around the testes, by causing pooling of less oxygenated blood around the testes and by decreasing the production of testosterone. Almost 20 - 30% of men with varicocele have shown increased pregnancy rates after surgery.

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Intra-Uterine Insemination (IUI): This method is used in men with moderately low sperm count. The semen is collected by masturbation, washed and centrifuged to increase the sperm density. This high density semen sample is now injected into the uterus, bypassing the vagina and the cervix. The chances of hostile cervical mucus is thus eliminated. Since the sperm is injected into the uterine cavity, chances of pregnancy is increased. The procedure should be done within 2 hours of collecting the semen.

Insemination with Husband's Semen (AIH) This is done in cases of impenetrable cervical mucous or when disease or deformity of the cervix makes it impossible for the sperm to enter the uterus. It is also carried out in cases of impotence or premature ejaculation.
Insemination with Donor Semen (AID) AID is usually carried out in couples where the husband suffers from azoospermia or complete absence of sperm.

InVitro Fertilisation (IVF): Invitro fertilisation or the 'test tube baby' method is a method by which an egg (ovum) is retrieved from the female partner by careful stimulation of the ovaries. Sperm is collected from the male partner by masturbation. A defined number of sperm (usually 100,000 sperm / ml) is placed with an egg in a petri dish and allowed to incubate in a CO2 incubator. If fertilization occurs, the embryo is replaced back into the uterus. This is, of course, a very simplified description of the process.

Intracytoplasmic Sperm Injection (ICSI): ICSI is a technique in which a single sperm is injected into the centre of the egg, in order to achieve fertilization. Sperm is collected from the male partner by masturbation. A single healthy sperm is then injected into the prepared ovum.

The advantage of this method is that only a single sperm is needed - even men with a very low sperm count can become fathers with this treatment method. In men who have been found to be azoospermic, that is with no sperm at all in the semen, sperm can be suctioned out of the vas deferens ( male tubes). Sperm can also be liberated from the testes itself by careful testicular biopsy and culture by a method called MESA - Microepididymal sperm aspiration.

Prevention of Male Infertility:

Undescended testes should be treated at the earliest during infancy before testicular function is damaged. Infections by mumps and other viruses should be managed by keeping a watchful eye on complications in the testes.

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