Male factor Infertility – Causes and Treatment

Male factor Infertility – Causes and Treatment

 

How common is male factor infertility and what proportion of infertility in the couple is attributable to the male?

Of all infertility cases, approximately 40–50% is due to “male factor” infertility and as many as 2% of all men will exhibit suboptimal sperm parameters.

The rates of infertility in less industrialised nations are markedly higher and infectious diseases are responsible for a greater proportion of infertility.

The fertility rate in men younger than age 30 years has also decreased worldwide by 15%.

Male infertility

Male infertility

Is it necessary for all infertile men to undergo a thorough evaluation?

 If you are facing difficulty in conceiving then semen analysis should be done at the earliest.

Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.

Males with sperm parameters below the WHO normal values are considered to have male factor infertility.

The most significant of these are low sperm concentration (oligospermia), poor sperm motility (asthenospermia), and abnormal sperm morphology (teratospermia).

Semen analysis remains the single most useful and fundamental investigation with a sensitivity of 89.6%, that it is able to detect 9 out of 10 men with a genuine problem of male infertility.

 

What is the clinical value of traditional semen parameters?

Males with sperm parameters below the WHO normal values are considered to have male factor infertility.

The most significant of these are low sperm concentration (oligospermia), poor sperm motility (asthenospermia), and abnormal sperm morphology (teratospermia).

What key male lifestyle factors impact on fertility (focusing on obesity, heat and tobacco smoking)?

Cigarette smoke is a common somatic cell carcinogen and mutagen, and may adversely affect male reproduction factors.

Obesity is also linked to subfertility due to alteration in the hormone environment. Constant exposure to lead for instance, without safety measures, predisposes such individuals to low fertility.

Men who are exposed to high temperature at their workplace – welders, dyers, blast furnace workers and those employed in cement and steel factories – are more prone to infertility. A 1° elevation in testicular temperature leads to 14% depression of spermatogenesis.

Do supplementary oral antioxidants or herbal therapies significantly influence fertility outcomes for infertile men?

 Oxidative stress in the seminal fluid causes damage of the sperm plasma membrane and loss of its DNA integrity. Normally, a balance exists between concentrations of reactive oxygen species and antioxidant scavenging systems. If oxidative damage exceeds natural scavenging capacity then it affects sperm parameters. High dosage of vitamin C & E may rescue from such damage and increase fertility in male factor infertility.

 

What are the evidence-based criteria for genetic screening of infertile men?

Genetic testing is required in all severely oligospermic and non-obstructive azoospermic men. Such men demonstrate small testes and increased FSH. Chromosome structural and numeric abnormalities, YCMD, and other genetic mutations have been implicated in male subfertility. These men may benefit from genetic testing.

How does a history of neoplasia and related treatments in the male impact on reproductive health and fertility options?

Cancer, or post cancer treatments, can interfere with male factor fertility and reduce the ability to have children. Different types of treatments can have different effects.

Higher doses of cancer drugs are more likely to cause permanent fertility changes. The combinations of drugs can have greater effects. The risks of permanent infertility are even higher when males are treated with both chemo and radiation therapy.

 

What is the impact of varicocele on male fertility and does correction of varicocele improve semen parameters and/or fertility?

Varicocele is among the most common causes of male infertility. Varicocele affects fertility and sperm quality in some, but not in all men. The adverse effect of varicocele on sperm parameters may be due to increased testicular temperature, increased pressure, or reduced blood flow.

Male Fertility

Male Fertility

 

 

Effectiveness of varicocelectomy is however not proved and hence not practiced in many infertility setup.

Natural Conception After IVF Treatment

Natural Conception After IVF Treatment

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By Femelife Fertility

IVF is used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult or due to problems in the partner like decreased sperm quality and quantity.

IVF is used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult or due to problems in the partner like decreased sperm quality and quantity. For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed. Pregnancy is a complex phenomenon and many things can change in due course of time. People who had a baby with IVF can get pregnant naturally later. Here are a few theories on what can impact natural success in pregnancies after IVF.

Endometriosis can subside after pregnancy

Sometimes, when a woman with endometriosis becomes pregnant through IVF, her body has time to recover from endometriosis, even if she doesn’t know she has it.

The disease is suppressed allowing the female environment to potentially be more favourable for subsequent pregnancies to occur during 9 months of childbearing.

Release of stress resolves the hormonal environment

For some women, after having their first child through IVF, the pressure of becoming pregnant significantly subsides and with decreased stress and lack of contraception, natural pregnancies may occur. Similarly, at many instances it is seen that women who have adopted a baby conceive naturally later.

Unexplained infertility may get better

About 20 percent of people who had a baby with IVF can get pregnant naturally later and this is more likely to happen if the cause of infertility was unexplained.

PCOS resolves with increasing age

PCOS patients often have regular cycles after a pregnancy, with increasing age the symptoms of PCOS reduce and the hormonal environment slowly returns to normal. This usually corrects defects in ovulation and improves quality of eggs and hence prepares the women for natural conception.

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Successful IUI programme

Successful IUI programme

Intrauterine insemination (IUI) is  a  simple and cost effective fertility treatment.In this procedure healthy sperm is placed into a woman’s uterus when she is ovulating. This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. IUI success is improved when it is done in conjunction with ovulation-stimulating drugs. It can be performed using the husband’s sperm or donor sperm. Before the procedure, the woman should be evaluated for any hormonal imbalance, infection or any structural problems.

Factors for a successful IUI programme :

  • Healthy sperm (Sperm count, motility and morphology should be good)
  • Timing of IUI – for a healthy pregnancy the sperm and egg should meet within 24 hrs. of ovulation. An aged or degenerated egg cannot yield a healthy pregnancy.
  • Fallopian tubes should not have any blockage or obstruction.
  • Similarly, the quality of egg should be good, an egg with thick covering(zona) does not allow sperm to enter inside the egg.
  • The uterus should be prepared well to receive the embryo otherwise implantation does not happen.

When is IUI used?

The most common conditions where IUI is recommended :

  • Low sperm count or decreased sperm mobility.
  • Unexplained infertility
  • A hostile cervical condition, including cervical mucus problems
  • Cervical scar tissue from past procedures which may hinder the sperms’ ability to enter the uterus
  • Ejaculation dysfunction

Success rate in  IUI :

The success of IUI depends on several factors. If a couple has the IUI procedure performed each month, success rates may reach as high as 20% per cycle depending on variables such as female age, the reason for infertility, and whether fertility drugs were used, among other variables.

Pregnancy rate :

Approximate pregnancy rate as a function of total sperm count (may be twice as large as total motile sperm count). Values are for intrauterine insemination. (Old data, rates are likely higher today)

The pregnancy or success rates for artificial insemination are 10 to 15% per menstrual cycle using ICI, and 15–20% per cycle for IUI. In IUI, about 60 to 70% have achieved pregnancy after 6 cycles.

However, these pregnancy rates may be very misleading, since many factors, including the age and health of the recipient, have to be included to give a meaningful answer, e.g. definition of success and calculation of the total population.For couples with unexplained infertility, unstimulated IUI is no more effective than natural means of conception

 

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COST OF IVF TREATMENT

COST OF IVF TREATMENT

Cost of fertility treatment is the single most deciding factor to have a baby

 

 

Why IVF treatment is costly?

IVF cost

IVF cost

 

IVF treatment is a programmed procedure extending from 4 to 6 weeks of time. It includes treatment for both the couples simultaneously. Initial investigations for both the couple may vary from 5000 -50 000 INR depending on the extent of problem. Pre-IVF treatment includes corrections of any underlying disorder which may hamper success of IVF. These include any chronic medical disorders like hypertension, diabetes, autoimmune diseases, heart disorders, skin diseases, infections and inflammatory diseases.

IVF programme starts with daily hormone injections to the female partner which are costly. These fertility medications may cost around one lakh rupees. Along with these injections continuous monitoring of follicular growth is required. Duration of the injections depends on the protocol decided by the IVF specialist. The protocol may be of long or short duration depending on the patient profile. Once the follicular growth is satisfactory the patient is take for collection of eggs. Oocyte retrieval or egg collection is usually done in an operation room under sedation. This procedure cost will be around 30,000 -50,000 INR.

IVF or ICSI procedure is carried out inside a laboratory with advanced microscopes and hi-tech equipment. It usually takes 3 to 5 days to grow the embryos in the laboratory. There are various optional procedures carried in the laboratory apart from IVF/ICSI depending on the need of patient. Some of them are sperm freezing, freezing of oocytes and embryos, IMSI, PGD/PGS, Assisted hatching. Total IVF laboratory cost may vary from 50,000 to 1,50,000 depending on the various steps taken for the couple.

IVF/ICSI is not a sure success treatment. It depends on the patient profile, the expertise of IVF specialist and Embryologist. It also depends on the quality of drugs used, culture conditions which varies among Fertility clinics and IVF laboratories. Due to the repeated failures IVF packages become very costly for the trying couple.

Cost of IVF in India

Cost of IVF in India

The decision to have a baby is the first step in a lifelong commitment of love, time, and financial resources. At Femelife Fertility we understand the long-term implications of the couple’s decision and wish to lessen the financial burden from the beginning. Our attention to quality, coupled with innovations in the treatment of infertility, has led to our excellent success rate.

What are the alternative to IVF Treatment?

Like many aspects of our health, fertility is improved by adopting a healthy lifestyle. Maintaining an ideal weight, a diet rich in antioxidants (found in fruits and vegetables), as well as multi-vitamins may improve the quality of egg and sperm. Avoiding pollution, smoking, junk food, reducing stress and controlling chronic medical conditions such as high blood pressure and diabetes may also improve a couple’s chances of fertility. Couples with underlying medical or genetic conditions should see a doctor so that they can increase their overall health before conceiving. Dr Nabaneeta Padhy at Femelife Fertility evaluates all aspects of the couple and gives suggestions for improving natural fertility.

Is low cost IVF Successful?

 

The costs of fertility treatment depend on individual needs. Treatment options range from intrauterine insemination (IUI), which is the least expensive, to in vitro fertilization (IVF) with donor egg, which is the most expensive. Often there are less expensive options than IVF that may work for the couple. The only way to find out how much treatment will cost is to set up an initial consultation. Cost of IVF treatment in India is expensive but at Femelife Fertility infertility treatment is cheaper with high IVF success. Hence Femelife Fertility is the best IVF centre in INDIA.

Wide network of IVF clinics of Femelife makes IVF treatment easily accessible for patients from all regions of the world.

What are IVF packages?

 

Is it wise to go for IVF packages?

 

Femelife Fertility has designed several discounted packages to meet the varying needs of patients.  Many centres charge for each service individually, and these pays can significantly increase the total IVF cycle costs paid by the patient. Femelife Fertility prefers discounted fees, which are designed as a single price that is paid prior to starting of IVF cycle.