Dr Deepthi Bawa, Consultant – Reproductive Medicine & IVF, Aster CMI Hospital
In the last couple years there has been a significant rise in infertility rates in India. Recently doctors from AIIMS reported that 12-18 million couples are diagnosed with infertility every year. Infertility is unfortunately a sensitive topic among many people in India even today. The innate capability to reproduce is deeply ingrained in the mind as a sign of biological well-being and the news of infertility can come as a shock and is difficult to accept for a lot of people. Usually, when a couple has been trying to conceive for a long period of time, the focus falls on the woman and strategies to improve her fertility are discussed. However, this is an old myth – a recent report by WHO exploring fertility in India concluded that approximately 50% of infertility cases could be attributed to ‘male infertility’ or anomalies in the male’s reproductive system.
Increasing infertility today is a result of many factors and cannot be tied down to a single cause alone. Likewise, there is no conclusive evidence pointing towards one specific reason for the increase in the infertility rates in men, but lifestyle factors are considered to be one of the influences. We all know that poor lifestyle habits contribute to a maximum of the disease burden on the planet. People today do not have the time to follow a balanced, healthy diet with adequate exercise, which has been affecting the body in various ways ranging from mild health effects to severe, irreversible lifestyle diseases. The levels of stress that the average individual today faces has skyrocketed, which also contributes to imbalance in the body.
If a couple has been trying to conceive without any success for a period of one year or more, it is time to consult a doctor. Male infertility can be caused by several factors, including lifestyle factors, genetic factors or other associated health conditions. Lifestyle factors contributing to male infertility are alcohol, tobacco or other drug abuse and obesity. A trend that has often been noticed in the youngsters of today is the intake of steroids or supplements that causes imbalance in the hormonal levels. There is a dire need to advise body-builders or those interested in building muscles to be careful of the supplements they are taking in the form of protein shakes or tablets as they are messing up their hormone levels without realizing it. Apart from lifestyle causes, infertility can also run in the family or may arise out of exposure to environmental toxins such as heavy pesticides, or industrial waste. Infertility can also be a side effect of testicular infections, tumors, damage or trauma to the testicles, under-developed testicles or exposure to heat for long periods of time.
While lifestyle and other factors can cause infertility, it should be noted that there are treatments for male infertility though awareness about them may be less. There are many treatment options that one could choose and experts will suggest some listed below:
Sperm and semen analysis: You have to provide the doctors with a fresh sample of semen and experts will then assess your sperm count, their shape, movement, and other variables. Generally, a higher number of normal-shaped sperm means higher fertility.Exceptions are however common. Many men with low sperm count or abnormal semen have been found to be fertile and some infertile men have normal semen and plenty of normal sperm. There is also the possibility of absence of sperm in the semen. According to experts, this might suggest a blockage that can be however corrected with surgery.
Physical examination: A rigorous and comprehensive physical examination can detect varicocele and offer clues to hormone problems. A urologist would be the right person to undertake this test.
Genetic testing: Genetic tests are crucial to identify specific obstacles to fertility and problems with sperm. While there is no consensus among experts about when genetic tests should be undertaken, there is agreement that genetic tests are a way to find out if genes are responsible for infertility.
Hormone evaluation: Hormones and hormonal balance would be evaluated by experts. It should be noted that testosterone and multiple hormones control sperm production. However, experts are of the view that hormones are not the main problem in most infertile men.
Testicular biopsy: This is undertaken for men with very low or no sperm count in their semen. A needle biopsy of the testicle can show whether a man is making healthy sperm. Incase abundant good sperm are found in the testicles, the possibility of a blockage elsewhere cannot be ruled out.
Medical specialists will tell you that if as a couple you have doubts about fertility, both can go in for different tests as individuals, and depending on the results, go in for the right treatment. This will break the stereotype that women alone are infertile if they cannot conceive. There is very low awareness that men too can be infertile and that there are treatment options for men. The endeavor of both the government and the various health concerned NGOs should be to collaborate and build greater awareness on this front.
