Published in "Panorama"
ART in treating male infertility
On an average, at any given time, 10% of any given population is infertile, says Dr.Rajan, Consultant Gynaecologist and Specialist in Infertility, Reproductive Endocrinology and Operative Laparoscopy, Zulekha Hospital, Sharjah. Contrary to what books on the subject may indicate, the ratio of male to female infertility is fifty-fifty, claims Dr.Rajan. Also, by and large, it is very difficult to correct male fertility compared to female infertility. The good news however, is the breakthrough in treatment modality with the accent on artificial methods to induce pregnancy. In this era of Assisted Reproductive Technology (ART), the couple who are benefited most with ART, are those with male infertility because these are the totally intractable group.
Elaborating further, Dr.Rajan reveals, “Among women who get married and are trying to conceive, 75% of them conceive within six months, 90% of them will become pregnant between nine months to a year and 10% fail to achieve pregnancy. And the reason for this may be due to problems in either or both partners.”
The commonest cause of male fertility according to the Specialist is genetic in nature with the presence of chromosomal abnormalities, leading to Azoospermia or absence of sperms production in the male. The cause, alternatively may be hormonal, with a poor functioning of the pituitary or hypothalamic glands; consequently they are not able to produce any sperms. “The difference between these two conditions,” explains Dr.Rajan, “is that the former condition is not correctible whereas the latter can be rectified by hormone treatment.”
A third cause of male infertility is due to infection like tuberculosis for instance, which lead to a block of the tubes through which the sperms have to pass. Clarifying the correlation between childhood mumps in boys and male infertility, Dr.Rajan explains, “Only if a boy develops mumps after attaining puberty, is there cause for concern that he may become infertile in adulthood. This is so because the infection which is essentially an inflammation of the parotid glands near the neck, may also involve the testicles. Here again, the problem of infertility may arise only if both testicles are involved, leading to azoospermia.”
Structural abnormalities in the male genital tract, like varicocele involving blood collection in the scrotum, particularly the left side, could reduce sperm count and motility, making for male infertility.
Of the environmental factors contributing to male infertility, the most important is smoking and addiction to any tobacco related products. Dr.Rajan emphasizes, “Carbon monoxide produced by cigarette smoke is extremely harmful to the sperms. So when couples come to me, my first advice to them is asking the man to give up smoking totally. Again excessive alcohol taking and drug addiction, like tobacco, produce free radicals which are harmful to the sperms.”
Heredity factors and poor diet with a deficiency of the anti-oxidant keratanoid may add to the condition in males. Men on hypertension medication are likely to suffer from infertility since these drugs can produce some sympathetic blockade, reducing sperm motility, according to Dr.Rajan.
In the case of females, factors leading to infertility include: Polycystic Ovarian Disorder (PCOD) and irregular or improper ovulation; blocked or kinked fallopian tubes; endometriosis, a condition in which the inner lining of the uterus grows outside the uterus, on the surface of the fallopian tubes or elsewhere in and around the region, affecting tubal motility; sperms not being deposited in the vagina properly; the woman doesn’t have the normal implantation site due to the uterus not being developed properly.
The risk factors for female infertility explains Dr.Rajan, include delayed marriage, say beyond 35 years, diabetes, hypertension, heart disease and obesity. “All these people may fail to ovulate. Again, women with infections, venereal diseases and sexually transmitted diseases, could have a block in their genital tract, resulting in infertility.”
Throwing light on the treatment modality Dr.Rajan reveals, “With the conventional methodology, if there is a male factor involved, the success rate may not be more than 25%. Whereas under ART which includes Intra Cytoplasmic Sperm Injection (ICSI) or In Vitro Fertilisation (IVF), the success rate is 30%. On the contrary, if the female is infertile on account of not ovulating, or is having endometriosis, and we treat her with laparoscopic surgery, the success rate is 60%; if she is treated with follicular puncture for PCOD, the success rate may be between 50-70%. Of course these rates are true for women below the age of 30 years and whose husbands are normal. ART would be the last procedure to deal with female infertility. If within one year of proper treatment for PCOD, anovulation or endometriosis she doesn’t conceive, then there’s a definite role for ART and its success rate is about 20%. ”