In conversation with Dr Akriti Bharati, MD obgyn fertility specialist, Vatsalya IVF

What do you mean by Infertility in both men and women? Can one be infertile after having a baby?

Basically, if a couple is unable to conceive a baby for a year, despite trying without taking any contraceptives, is called infertility, for both male and female.

When it comes to being infertile, age plays a very important role. If the woman's age is less than 35 and she has been trying for a year and still failing, then she can be considered to be infertile. If she is more than 35 years old, and she has been trying for about six months, and is still unable to conceive, it can be termed as infertility.

For men, with their growing age, the sperm count decreases, and with that the fertility rate is also decreased. So for men over 35 years, the possibility to conceive is less, which is rapidly decreased after they cross the age of 50.

If a couple has given birth or just been able to conceive before, they can be infertile afterwards, it is called secondary infertility.

How common is infertility in men? What are the symptoms and causes behind infertility in men?

It is found that 40% of infertile couples are due to the infertile nature of men. When it comes to symptoms, for most cases, it is hard to tell from the outside if there are symptoms or not. For men suffering from retrograte exaculation, the exaculated sperm goes back to the bladder and the volume of the sperm might be less. While, in some cases, people might have sexual dysfunction or erectile dysfunction or exaculatory dysfunction, where there are no symptoms seen leading the male to think that their exaculation is completely normal. In these cases, the male is not necessarily infertile, they are just unable to produce what they are capable of for various reasons.

A very common misconception is that everything that is exaculated is sperm. When in reality, one of he exaculate content is the secretion from a gland called seminal fluid, along with which, there is a semem that is produced from the testes of a male and all of them are combined together and exaculated. In cases, the secretion comes out alone, without any semen, which therefore leads to failure in conceiving due to the absence of semen.

What are the risk factors that can lead a man to be infertile? Does one’s over lifestyle also contribute to them being infertility?

When talking about the risk factors, the first thing is smoking. If a man smokes more than 20 cigarettes per day, it has a huge effect on his sperm count. Alcohol, tobacco and recreational drugs can also directly cause harm to one’s fertility rate. Drinking more than 80 grams per day regularly can have side effects on their sperm count.

Another factor is Obesity. If a male is overweight, it has an effect in their spermatogenesis. Then, as mentioned before, age also plays a big role in a man’s fertility.

Similarly, if a male is used to working in a very hot environment on a daily basis, their body temperature is slightly higher than the production of sperm needs and it can lead to the decrease in sperm count. While, if a male is working in industries, with pesticides, chemicals, as well as working with radiations there is a chance that these external factors can contribute to infertility.

Sleep also plays a very important role when it comes to one’s fertility.

To add on, men with health conditions such as thyroid or diabetes, genetic diseases can also be considered as a factor that can lead to infertility.

 

What are the types of medical tests that can be done to test one’s infertility?

Firstly, the most common one is Semen analysis where the sperm is counted. It requires abstinence for about 3 to 7 days for accurate results. This is one of the best testing options as here we can see the volume of the sperm. According to WHO, the normal volume of a sperm should be 1.5 ml, the sperm count should be 15 million per ml, its motility should be at least 40 % among which the progressive motility should be at least 30%, and the morphology should be 4%. These are the parameters based on which a semen is analyzed and compared to determine if someone is fertile or not.

If the semen analysis is less or the sperm count is absent, the blood tests that can be done are FSH Hormone, LH Hormone, Testosterone and Thyroid Prolactin Hormone.

In cases, there might be no observant sperm in the semen report, but still the patient can be fertile as even if the sperm is produced inside the patient’s body, but it’s pathway is obstructed. If so, we can retrieve the sperm directly from the testes and then go for in vitro fertilization (IVF) and be able to have their own biological child.

What are the non-medical/natural treatments of infertility in Men?

The first thing is to avoid all the risk factors I’ve mentioned before, like avoiding smoking, quitting alcohol, exercising daily, maintain weight, maintain heat/chemical exposure etc. When it comes to diet, the main thing I would say is to avoid fatty foods or excessive soya protein. Instead of that go for food that is rich in vitamin C, zinc, cellinium, antioxidants, etc.

If the cause of infertility is by other diseases or health conditions, obviously the answer is to treat the disease first.

 

6% of infertility cases for men are caused by sexual dysfunction. If a man is suffering from a psychological condition or their psychology is being disturbed due to some reason, their semen count is also affected and they may have less interest in sexual activities.

 

How can infertility be treated medically?

When it comes to medical treatments, there are some antioxidant drugs that help in increasing the sperm count and motility.

If it is a case of obstructive azoospermia, where the sperm isn’t able to come out after being produced, percutaneous testicular sperm extraction (TESA) is done, where the sperm is retrieved from the testes through a needle and IVF is done. Another process is intracytoplasmic sperm injection (ICSI) where a single sperm is taken from the testes and injected inside the ovary under the microscope, which is also called forced fertilization.

In case of non obstructive azoospermia, where the patient doesn’t show any sperm count, fertilization can be done by taking donor sperm from a sperm bank, which is injected to the female’s body with the help of intrauterine insemination (IUI). So the sperm is taken from the lab, washed and inserted inside the woman so she can be able to conceive.

For men with past health conditions, such as if they have been a cancer patient, it is recommended that before introducing their body to any sort of radiation, they undergo semen freezing so they can still be able to conceive a child one day after their medical treatment is over.