Male Infertility: Symptoms, Cause, Diagnosis & Treatment

Male infertility is more prevalent than one might think. We are used to seeing women as the ones with issues, but the contribution of men toward infertility is almost equal. 

Fertility in men revolves around three primary parameters, namely sperm count, sperm motility, and sperm morphology. When for some reason, any of the parameters mentioned above is altered, it results in male infertility. 

What is Male Infertility? 

Male infertility is when a man cannot help his female partner conceive after having sexual intercourse without contraception for 12 months or more. 

Statistical Data for Male Infertility 

Scientists have stated that infertility in men has witnessed a drastic increase during the past few decades owing to numerous factors.

According to the data put forward by the Indian Society of Assisted Reproduction (ISAR), around 10-14% of Indian couples are affected by infertility issues. 

Data shows that one-third of cases of infertility are due to females, one-third to males, and one-third to both males and females. 

Infertility is more prevalent in metropolitan cities where people are more exposed to risk factors that pace the way to problems in conceiving. 

Understanding the causes and risk factors of infertility in men is essential. 

Causes of Male Infertility 

Infertility in men is caused due to altered semen parameters, including sperm count, sperm motility, and sperm morphology. 

Sperm Count-: 

A normal or healthy sperm count means the sperm concentration is more than 15 million sperm/ml of the semen sample. If your sperm count is less than 15 million/ml, it may cause problems in conceiving. 

Sperm Motility-: 

In simple terms, we can say sperm motility is the ability of the sperm to swim toward the egg for fertilization. Normal sperm motility is considered to be around 40%. 

The number 40% signifies that out of the total sperms produced, 40% are efficient enough to swim through the uterus and reach the egg. 

Sperm Morphology-: 

Sperm morphology is defined as the shape and size of a sperm cell. If there is a problem with the shape or size of the head, midpiece, or tail of the sperm, it may lead to infertility. 

Male infertility is associated with many hormonal, physical, psychological, and behavioural problems and risk factors. The causes of male infertility are stated below: 

  • Hormonal imbalance-:

    Hormonal balance is vital for the healthy upkeep of the body. However, if the balance is disturbed, this may affect the normal functioning of the thyroid, hypothalamus, adrenal, and pituitary glands. This imbalance can lead to complications in conceiving. 

  • Genetic dysfunction-

    Kallmann’s disorder, Kartegener’s disorder, Klinefelter disorder, and cystic fibrosis are commonly witnessed genetic conditions that can lead to infertility in men. Genetic dysfunction accounts for 10-15% of cases of low sperm count.

  • Varicocele-:

    The production of sperm by the testicles is a temperature-dependent process. If the temperature becomes high, sperm production reduces. 

The scrotum is that part of the male reproductive system responsible for maintaining the ideal temperature in the testicles. But when the vein in the scrotum gets enlarged, blood flow to the testicles increases, and sperm production decreases. This medical condition is termed scrotum varicose veins or varicocele.

  • Infections-: Sexually transmitted diseases and inflammatory bacterial infections can lead to scars that may negatively impact sperm production. 
  • Previous Surgeries-: Surgeries of the male reproductive system, like the bladder, testicles, scrotum, or the organs surrounding it like the stomach, hernia, abdominal region, prostate, and rectum, can hamper sperm production and fertility.
  • Excessive Drinking and Smoking-: Alcohol and tobacco affect sperm motility. Excessive consumption of alcohol and smoking results in defective sperm, poor sexual performance, and deteriorated testosterone levels. However, controlled intake of alcohol and tobacco doesn’t contribute to infertility in men.
  • Spinal Cord Injury-: Any injury in or around the spinal cord can lead to infertility issues in men.
  • Retrograde Ejaculation-: Normal ejaculation occurs when the semen darts through the penis. But in some cases, the semen enters the bladder instead of flowing out through the penis. This medical abnormality is known as retrograde ejaculation and significantly affects fertility in men.
  • Testicular Cancer-: Testicular cancers and even non-malignant tumours adversely affect male fertility.
  • Testicular Trauma-: Testicular trauma can be caused by an injury, surgery, or bacterial infection. An immune response is triggered in the testes that results in sperm damage.
  • Hemochromatosis-: Haemochromatosis is a medical abnormality in which iron gets deposited in the testes.
  • Drugs and Steroids-: Drug intake and supplementation have been linked directly to decreased sperm count.
  • Obesity-: Being overweight also contributes to male infertility.
  • Excessive Exercise-: Exercise helps boost your reproductive health, but excessive exercise is seen to decrease testosterone levels.
  • Stressful Regime-: Stressful regime increases your body’s production of stress hormones. This overproduction of stress hormones adversely affects the production of testosterone and other hormones responsible for sperm production.

Symptoms of Male Infertility

Well, a majority of times, male infertility may go asymptomatic. However, there are cases where men witness evident male infertility symptoms that may warrant a medical checkup, including: 

  • Inability to ejaculate
  • Decrease in volume of seminal fluid
  • Infected semen (coloured semen)
  • Pain or swelling around the genital area
  • Poor sex drive or reduced sexual desire
  • Erectile dysfunction
  • Abnormal increase in breast size
  • Evident reduction in facial and body hair

Diagnosis of Male Infertility

The diagnosis begins with male fertility tests from an advanced laboratory. The second step is to repeat the test from a different laboratory. If both the times the results highlight a problem, seek medical guidance. 

Infertility Tests for Males 

conducted to identify the root cause of infertility are: 

  • Semen analysis
  • Hormone testing
  • Ultrasound – TRUS
  • Scrotal Doppler
  • Genetic testing
  • Testicular biopsy

You can successfully treat male infertility based on the cause and duration of infertility. There’s no need to worry endlessly about infertility test reports. You can use various surgical procedures to help you welcome a healthy baby. 

Surgical Treatment for Male Infertility

Depending on the test reports and cause, male infertility treatment takes into account various reconstructive procedures to restore fertility in men-:

  • Varicocele surgery
  • Vasovasostomy
  • Vasoepididymostomy
  • Trans-urethral resection of ejaculatory duct

In some infertility cases, surgeries are not required. Medications and lifestyle changes can help bring positive results that boost male fertility. 

Surgical Procedure to help Conceive-: 

IVF-: In vitro fertilization treatment may help conception as fertilization occurs in a laboratory under controlled conditions. Good quality sperm are detected and stored and then fused with the egg. This fertilized egg gets impacted into the uterus or your female partner. 

ICSI-: Another ART is ICSI treatment which stands for intracytoplasmic sperm injection. The best part about ICSI is that only one sperm is required to carry out the treatment. This single sperm is injected directly into the uterus, fusing with the egg and leading to pregnancy. 

Donor Sperm Insemination-: If nothing improves sperm health, you may opt for donor sperm insemination. During donor sperm insemination, a male with good sperm count, motility, and morphology is reached. His sperm is collected and stored. Then this sperm is fused with the egg using ART, resulting in pregnancy. 

Sperm Harvesting Procedures 

For IVF and ICSI, sperm for fertilization with the eggs are harvested side by side from the male using the below-mentioned sperm harvesting procedures: 

  • Testicular Sperm Aspiration (TESA)
  • Percutaneous Epididymal Sperm Aspiration (PESA)
  • Testicular Sperm Extraction (TESE)
  • Micro Epididymal Sperm Aspiration (MESA)
  • Microdissection TESE (microTESE)

Conclusion 

Male infertility has become as common as female infertility. Data cement that fertility issues due to men are equal to those due to women. But the good news is like female infertility issues, male infertility is also treatable. You need to consult an experienced urologist who can diagnose and guide you. Also, ensure you undergo treatment from a highly trusted fertility centre like Imprimis IVF, Srinagar.  

Sperm Morphology

Your semen analysis reports indicate sperm morphology normal range– of 2%. Chances are you have no clue about what this 2% stands for. And sperm morphology treatment might be a ghost term for you. You are eager to know if this means you are infertile or if there are other concerning issues. Is it possible to figure out what the term ‘sperm morphology’ implies so that you don’t have to go and see a doctor?

Imprimis IVF, Srinagar, will help you navigate sperm morphology treatment and the associated problems if any.

What is Sperm Morphology

Morphology is a biological term that studies the form and structure of a living organism or any of its body parts. So, when we are using this term with sperm in simple words, we can say that sperm morphology is the study of the form and structure of sperm, i.e. its shape and size.

Every part of your body has a specific shape to perform particular functions. For instance, your blood vessels are designed to have a tube-like shape. And their primary function is to carry or supply oxygen and nutrients to various organs of your body. For some reason, if the condition of your blood vessels gets deformed or there is a blockage in any of the blood vessels, it will lead to severe problems. It will disrupt the whole process of blood circulation.

The same is true for your sperm. To help your female partner conceive, your sperm must be of a specific shape and size. If there is any deformity, then it is bound to create difficulties in getting pregnant.

Sperm Morphology Normal Range

The sperm cell is produced in your testes. A sperm has three parts: head, midpiece, and tail.

If all the parts of a sperm cell are of standard shape and size, then it is known as normal sperm morphology. A typically shaped sperm cell has the following dimensions and functions:

  • Head-: The head of the sperm cell has a smooth oval shape with a pointed front end. The nucleus that carries the DNA of the sperm cell is present in the head.

A normal-shaped sperm is 5-6 micrometres long and 2.5-3.5 micrometres wide.

  • Acrosome cap-: Acrosome cap makes up nearly 40-70% of the sperm’s head.

A protective membrane surrounds the egg produced by the ovaries. The sperm cell has to penetrate through this membrane to reach the egg for fertilization. The well-pointed acrosome cap is used for this purpose.

  • Midpiece-: The midpiece of the sperm cell is thinner than its head and provides it with energy to swim.
  • Tail-: Ideally, the tail is around 45-50 micrometres long. It’s thinner than the other two parts of the sperm cell.

The sperm has to swim through the uterus to fuse with the egg to fertilize it. The tail of the sperm helps it to swim through the uterus.

Apart from this, the head of a customarily shaped sperm should not contain large fluid-filled drops or vacuoles.

Which factors determine Normal Sperm Morphology? 

The male hormone, testosterone, is responsible for regulating the production of sperm. It might surprise you, but the male reproductive system also produces the hormone estrogen.

For sperm to have a normal sperm morphology, there must be a proper balance between the production of these two hormones. If due, for any reason, this balance is disturbed, then It will hinder the process of sperm formation.

This process of sperm formation occurs at its own natural pace. It takes about 65-90 days for a sperm to be formed. It starts with a single round-shaped cell that slowly grows into the sperm we see in the diagram.

Optimum testosterone levels ensure that as the sperm cell grows, each part, i.e. the head, midsection, and tail, have the proper shape and size. It is due to poor levels of testosterone that result in abnormal shape and size of the sperm cell. Abnormal sperm morphology or teratozoospermia refers to abnormalities or defects in the form and dimensions of the head, midsection, or tail. 

Abnormal sperm morphology is characterized either by head defects, midsection defects, tail defects, or in some cases, the sperm is acrosomeless. 

Abnormal sperm may have the following defective characteristics:

  • Two heads or two tails
  • An elongated and deformed head
  • A rough head
  • Bent, asymmetrical, or irregular midpiece
  • Bent, short or coiled tail
  • Vacuolated head

These are some of the abnormalities that occur in a sperm cell.

You must be wondering, is abnormal sperm morphology a matter of concern? Data shows that typically 30-40% of a man’s sperm have abnormal morphology. The problem in conceiving starts when most sperm are abnormally shaped.

You have a normal sperm morphology if your semen sample has 4-14% usually shaped sperm. This range is defined under Kruger’s criteria. However, if it falls to less than 4%, you have a low sperm morphology. 

You must note that abnormal sperm morphology is not a parameter that indicates infertility. It simply represents the concentration of typically shaped sperm in your semen sample. 

Factors leading to Abnormal Sperm Morphology

  • Age-:. Sperm morphology deteriorates with your age. The testosterone levels decrease, leading to a decrease in sperm morphology.
  • Obesity-: As we know, testosterone is responsible for the production of sperm. For sperm to have a normal sperm morphology, the testes must produce an optimum testosterone level. 

If you are obese, then your body produces estrogen in high amounts. It leads to the underproduction of testosterone. And it further affects your sperm morphology.

  • Stressful regime-: If you have a stressful regime, then the amount of stress hormones in your body increases and adversely affects testosterone production. It further reduces your sperm morphology.
  • Smoking and drinking alcohol-: Excessive consumption of alcohol and tobacco can negatively impact the shape and size of your sperm.
  • Drugs and steroids-: Drugs like cocaine, marijuana, etc., affect your sperm morphology adversely.
  • Diabetes-: If you have diabetes, you are at a higher risk of abnormal sperm morphology.

Sperm abnormalities like double heads and round and elongated spermatids are more prevalent.

  • Genetics-: Heredity plays a role in deciding sperm morphology in a male. A family history of teratozoospermia is likely to be inherited genetically.
  • Exposure to chemicals-: If you come in close contact with herbicides, pesticides, paints, organic compounds like benzene, and heavy metals like lead, then you may have a large number of abnormal sperms.

Abnormal Sperm Morphology Treatment

Sperm morphology treatment starts with a semen analysis. Before concluding anything, it’s advised to go for multiple semen analysis tests from top-notch laboratories to ensure maximum accuracy.

Lifestyle changes that can help boost morphology sperm count 

Surgery is not the only option to improve sperm morphology. You can enhance sperm morphology treatment by making small and simple changes in your day-to-day life.

  • Lose the extra weight-: If you are obese, you must manage your weight to improve your sperm morphology. Maintaining a healthy Body Mass Index will ensure good levels of testosterone.
  • Bid goodbye to recreational drugs-: Any drugs should be avoided to improve sperm morphology. 
  • Go for loose clothing-: Testes function at a proper temperature. A tight dress can hamper sperm production by increasing the temperature of the testes. I prefer wearing comfortable and breathable cotton underwear for healthy and normal sperm production.
  • Keep your alcohol and tobacco intake under control-: Yes, you need to limit your alcohol and tobacco consumption if you desire to improve sperm morphology.
  • Consult a trusted fertility specialist-: People often skip consulting a specialist and start taking medicines blindly without knowing the root cause that needs diagnosis. Reaching out to a good clinic like Imprimis IVF, the best Infertility treatment centre in Srinagar proves beneficial.

As already stated, sperm production takes around 65-90 days. Maintaining a healthy lifestyle for 3-6 months is essential to gather positive results.

Data shows that 90% of the time, You can improve sperm morphology with these simple lifestyle changes. The remaining 10% of cases can rely on treatment options to improve sperm morphology.

Treatments for Poor Sperm Morphology

Certain Assisted Reproductive Technology methods have helped men with abnormal sperm morphology. The most promising and trusted ART treatment methods include:

  • IUI-: IUI, which stands for Intrauterine Insemination, has helped tackle abnormal sperm count in men with high sperm count and sperm motility.

IUI treatment is cost-effective because a washed or processed sperm is injected directly into the uterus.

  • ICSI-IVF-: If the sperm count, as well as motility, is low, then in-vitro fertilization with ICSI can help you conceive if you have abnormal sperm morphology.

In ICSI treatment, the egg is fertilized with the help of a single sperm cell. After getting fertilized, this egg is then implanted in the uterine lining.

This method has summoned encouraging results when sperm morphology is as low as 2%.

Final Words 

The test results of semen analysis can spark many questions about abnormal sperm morphology treatment. There’s no need to stress about this unknown term sperm morphology. Remember that stress plays a crucial role in the process of sperm production. So it would be best if you keep stress at bay. Consult a reproductive specialist if you cannot stop worrying about the complications of abnormal sperm morphology. Follow a healthy and stress-free lifestyle. It will not only help improve sperm morphology but will also help you stay fit in the long run.

IVF Success Rate By Age

With medical advancements, IVF has emerged as a boon for infertile couples. In-vitro Fertilisation has registered massive success rates around the globe. IVF success rates are influenced by a plethora of factors. A woman’s age is one of the predominant factors in deciding the IVF treatment success rates. So, quite naturally every couple wants to dive into the depths of IVF success rates by age. Imprimis IVF, the best IVF centre in Srinagar, is here to help you with your questions. 

IVF success rates by age and number of embryos

Medical experts have concluded that the best age for a woman to welcome a baby is between 24 to 30. During this age, the woman is both physically and mentally armed to start a family of her own.  However, there have been cases where a woman cannot conceive at an early age and has to turn to IVF. 

The IVF success rate lies between 30-40%.

IVF success rates revolve around the age of 35. Doctors divide the IVF success rate into two age groups. 

  • IVF success rates under 35
  • IVF success rates after 35 

Two important parameters describe IVF success rates. One is the “clinical pregnancy rate” and the other is the “live pregnancy rate“. 

Clinical pregnancy rate means how many women successfully conceive a baby per IVF cycle. Whereas live birth rate means how many women give birth to a healthy baby with IVF. 

Now, let’s understand how these two parameters determine the IVF success rate with the help of two cases. 

IVF Success Rates Under 35

Suppose a 31 years old woman is undergoing IVF treatment at Imprimis IVF, Srinagar. We can describe the success rate for 31-year-old women with the aforementioned parameters. The chances of conceiving a baby or clinical pregnancy rates are around 40%. But the live birth rate for this woman with IVF treatment is between 33-36%

IVF Success Rates Over 35

As a woman crosses the border age of 35, a steep decline is witnessed in clinical pregnancy and live birth rates. The clinical pregnancy rate declines from 40% to 25-30%. Whereas the live birth rate over 35 stands at 20%.

IVF success rates over 40 

After hitting 40, there is a natural and consistent decrease in both the quantity and quality of your eggs. As a result, the success rate of IVF at 40 decreases considerably. The clinical pregnancy as well as the live birth rates plummet further. The chances of pregnancy between 40-42 with a woman’s own eggs are about 16% and the live birth rate is around 10%

  • The chances for women between 43-44 are further reduced to 7%.
  • After clocking 45, the IVF success rate is just 2-3%.

Women over 40 can consider taking the help of donor egg IVF treatment after consulting with their reproductive specialist. 

IVF Success Rate By Number Of Embryos.

The number of embryos and their quality can increase or decrease the distance between you and your baby. The uterus must produce many good-quality eggs that can be implanted in the uterus during IVF and help in conceiving. 

But this doesn’t mean implanting more embryos will increase your stakes of achieving pregnancy. Let’s understand how the number of embryos influences IVF success rates. 

Single vs. Multiple Embryos-

Single embryo transfer is preferred over multiple/double embryo transfer in IVF treatment. The most pronounced reason is that multiple embryo transfer results in more complications and negative outcomes. Multiple embryo transfer increases the risk of twin pregnancy which further impacts the baby’s health. The risk is higher when the woman is over 35. The efficacy rates of single embryo transfer are observed to stand at around 42%. 2 embryo success transfer rates are around 45%

Frozen Embryo Transfer Success Rates-

Frozen embryo transfer technology is on the rise these days in India. In some cases, excellent results are summoned with frozen embryo transfer instead of fresh egg transfer. 

The embryo transfer success rates lie between 50-60%

Why IVF Success Rate Decreases with Age

1. Diminishing Ovarian Reserve (Reduced Egg Quality and Quantity)-: The ovarian reserve diminishes as a woman ages. Reduction in egg quality and quantity is natural and irreversible. 

The IVF treatment cost in Srinagar also increases accordingly. 

2. Poor Embryo Quality-: There’s a difference between an embryo’s appearance (morphology) and quality. Defected/abnormal embryos fail to implant into the uterus after their transfer. 

Other Factors Impacting IVF Success Rates- 

1. No Ovarian Response -: There are 4 stages of IVF, during the first stage a woman is on medications to increase the production of eggs. In women with low levels of AMH, the ovaries will not respond to these medications and IVF treatment will not yield success. 

2. Sperm Quality-:Fertilization involves the fusion of eggs with sperm. Poor quality sperm is bound to impact IVF success rates.

3. Lifestyle-: Consumption of alcohol, smoking, and being underweight or overweight directly impact IVF success rates. 

How to make IVF successful the first time?

No IVF treatment centre can guarantee 100% success rates. However, there are certain precautionary steps that you can take to reduce your number of IVF cycles.

  • Choosing the right IVF clinic-: IVF is a complex Assisted Reproductive Technology. Choosing the right clinic that is armed with excellent medical expertise, and state-of-the-art lab fertility technology like Imprimis IVF which delivers the best IVF treatment in Srinagar can increase your chances of having your little human by a good percentage. The right IVF clinic can be a game-changer! 
  • Keep your dosage and medication timing in check-: Don’t risk skipping your IVF medications. Take your daily dose of IVF medications at the proper time without fail. 
  • A healthy lifestyle with a balanced diet-: After the embryo implantation, the woman should consume a diet rich in fruits and green leafy vegetables. Some doctors recommend consuming small and frequent balanced diets. Adequate water intake is a must. Refrain from consuming bakery products that contain excess sugar. Abstain from smoking and drinking to increase the efficacy of the IVF treatment. 
  • No strict bed rest-: It might come as a shock, but it can prove to be an enemy. As a woman is constantly dreaded with thoughts about conceiving, what if it fails? If strict bed rest is followed then these negative thoughts thrive. This in turn increases the secretion of stress hormones which contract the uterus.
  • Positivity and belief are important-: Staying positive and believing that your IVF journey will push you toward your baby is vital. 

Donor Egg IVF Success Rates-

As we’ve already learned that the number and quality of eggs decrease sharply once a woman crosses 35. This means the chances of conceiving with one’s own eggs also decrease. But that doesn’t mark the end of the road to pregnancy. Donor egg IVF treatment has summoned a promising live birth rate of around 19% in elderly women. 

IVF success rate by age with PGS.

One of the pronounced reasons why IVF treatment fails is genetic abnormalities in the embryo. Either this abnormal embryo will not implant in the uterus lining or will result in miscarriage. The genetic abnormalities in the embryo increase with age. This significantly hampers the IVF success rates amongst women over 35.

PGS or PGD or PGT stands for Preimplantation Genetic Testing. This medical test involves genetic testing of the blastocyst (day 5) embryos before implantation. PGS removes the hurdle of chromosome abnormalities and increases success rates. However, PGS is prescribed in special cases only:

  • Women over 38 years of age
  • Multiple IVF failures 
  • Recurrent pregnancy losses
  • History of previous abnormal pregnancy 
  • Severe male infertility issues
  • Background of serious genetic conditions 

Shedding light on the success rate of IVF treatment with PGS, positive results are summoned amongst elderly women. 

IVF success rate by age and AMH 

AMH, which stands for Anti-Mullerian hormone, is secreted by primordial follicles in your ovaries. Why do AMH levels play a vital role in determining IVF success rates? AMH is a predictive biomarker that predicts/indicates a woman’s ovarian reserve. 

Normal AMH level for healthy pregnancy ranges between 1.0-4.0ng/ml. The anti-Mullerian hormone is an age-dependent parameter. Studies have shown that the ovarian reserve or the AMH level is reduced by 10% yearly. As a woman ages, the number of primordial follicles decreases. So, the AMH level decreases. AMH levels for different ages decrease in the following order: 

  • At 25 – 3ng/ml
  • At 30 – 2.5ng/ml
  • At 35 – 1.5ng/ml
  • At 40– 1ng/ml
  • At 45 – 0.5ng/ml

The AMH level varies and provides crucial data about ovarian reserve to predict success rates. 

Conclusion

Before choosing IVF, doing proper research about IVF success rates by age proves helpful. But nothing can beat talking to a reproductive specialist to chalk out a plan for your age. For example, if you are at 25, discuss what are the IVF success rates at 25, medical requirements, and everything that concerns you. Make sure you visit the best IVF centre in Srinagar like Imprimis IVF and Fertility Centre, take your medications religiously, and stay super positive!