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Male infertility 


Male infertility i.e. difficulty in getting wife pregnancy due to defect in semen as decreased sperm count & low (Poor) motility or abnormal sperms occurs due to above causes. Treatment of low sperm count & motility are discussed below.

Nil sperms (Azoospermia)


Low sperm count (Oligospermia)/ low motility /or abnormal sperms  

 


What is Low sperm count
Causes of low count, motility 
Investigations & Diagnosis
Treatment
Response of treatment
   

What is Low sperm count: When sperm count is less i.e. decreased in number or amount or have abnormal sperms is called Oligospermia i.e. low sperm count. This leads to difficulty in conceiving i.e. wife does not becomes pregnant. This is one of the common causes of male infertility. This is also one of the most common semen abnormalities.

How sperms develop:
When boy becomes of 14 years then L.H. & F.S.H. hormone secretion from pituitary increase. The rise in these hormones lead to proliferation of sperm forming cells in the testis called Germ Cells. These germ cells start multiplying under the effect of above-mentioned pituitary genital hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes.

Then further maturation of primary spermatocyte into mature spermatozoa occurs under the control of above-mentioned hormones. After few weeks of progressive maturation these spermatocyte become fully developed & motile sperms (i.e. spermatozoa). This total sperm cycle, is of three months. Any hindrance in the development of these spermatozoa will lead to less count of sperm & decreased motility, immotile or even dead sperms.


Cause of low sperm count: The various causes of low sperm count & decreased motility or abnormal sperms are as follows:

 
1) Deficiency of central sperm producing hormones: 

Hypothalamic pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome, Hypothalamic deficiency, pituitary hypoplasia, Trauma, post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis) Autoimmune hypophysitis, Drugs (drug-induced hyperprolactinemia,genital steroids use) 
Untreated endocrinopathies, Glucorticoid excess, Hypopituitarism, Isolated gonadotropin deficiency (non acquired): Pituitary, Hypothalamic, Associated with multiple pituitary hormone deficiencies: Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions (craniopharyngioma, Rathke pouch cysts, hypothalamic tumors, pituitary adenomas), , Laurence-Moon-Beidl syndrome Prader-Willi syndrome , Frohlich syndrome, Hypergonadotropic hypogonadism : Klinefelter syndrome,  Noonan syndrome,  Viral orchitis, Cytotxic drugs, Testicular irradiation.
2) Testicular disorders (primary leydig cell dysfunction)
, Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone),
3) Partial obstruction in outflow tract from testis to penile pening in epididymis or of vas deferens (cystic fibrosis, diethlstibesterol exposure) also called obstructive azoospermia.
4) Varicocele
5) Drugs (e.g. spironolactone, alcohol, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)
6) Autoimmunity i.e. presence of Antisperm antibody. These Antisperm antibodies bind with spems & either make them less motile, totally imotile or even dead which is called necrospermia.
7) Trauma
8)  Environmental toxins
9) Viral orchits
10) Granulomatous disease as tuberculosis, sarcoidosis
11) Defects associated with systemic diseases, Liver diseases, Renal failure, Sickle cell disease, Celiac disease
12) Neurological disease as myotonic dystrophy
13) Development and structural defects, Germinal cell aplasia, sertoli cell  only syndrome, Cypt-orchidism
14) Androgen resistance
15) Mycoplasmal infection
16) Immotile cilia syndrome

Investigation & Diagnosis: For completes diagnosis of causes of decreased sperm count & motility one or more of the following tests may be required as

1) Complete male hormone profile: This profile includes all the male hormone tests which affects testicular development, growth & other genital organ development as well as genital functions. L.H., F.S.H., Testosterone, prolactins, thyroids test,
2)
Antisperm antibody  
3) USG or Doppler study of scrotum & testis
4) Semen culture sensitivity
5) Semen fructose
6) Immunobead test
7) Sperm Function Tests
8) Human Sperm-Zona Pellucida Binding Ratio
9) Human Sperm-Zona Pellucida Pentration test
10) Genetic Studies
11) FNAC Testis
12) Egg penetration test
13) Molecular genetic studies done in some special cases
14) Chromosome analysis i.e. Karyotype
15) Assessment of androgen receptor
16) Combined Pituitary hormone tests is performed when needed 
17) MRI head, Hemogram, test for systemic diseases.

At our center facility for all the above tests are available.

 

Treatment: Once the cause of low sperm count & motility or abnormal sperms are found then with in three months of treatment sperm count & motility becomes normal.  


The various treatments are as follows:   

Correction of the  Cause: First of all we try to find out the primary cause of infertility by above mentioned investigations. Then we correct the basic defect i.e. correction of hormone disorder & other defects as varicocele surgery, stopping of alcohol & smoking, stopping of offending drug. We also give following treatment for permanent cure of low sperm count & motility disorder.

 

1)      Gonadotropin Therapy: Gonadotropins are most potent natural stimulators of sperm production in the testis. Once we start gonadotropin therapy, these gonadotropins stimulates the sperm producing cells in testis. Under the stimulating influence of gonadotropins dormant sperm forming cells which were not producing any sperms, they start dividing & produce multiple immature sperm cells. These are further matured in next two to three monthe into mature sperm under the influence of gonadotropin treatment. Thus in more than 95% cases sperm production can be normalized in three to four months time.gonadotropin therapy is most successful af all the treatment available till now for sperm count & motility enhancement. Gonadoropin therapy is indicated & effective all cases of hypogodotropic Hypogonadism& almost all case of low sperm count & motility. In many cases of low sperm count when all other treatment has failedeven in those cases gonadotropin therapy is effective. It is given in form of Gonadotropin releasing hormone, Human chorionic gonadotropin, human menopausal gonadotropin or purified follicle stimulating when we start treatment with any of the above mentioned gonadotropins

2)      Free Radial Scavangers: These are drug to reduce the free damaging oxidative radical in the testis. For your information every minute lot of oxidant radicals are generated inside the testis which damages sperm forming cells. These special antioxidant drugs scavange these damaging oxidative free radicals thus leading to production of normal sperms by the testis. In many study these free radical scavengers have been found to be very-very effective in normalizing sperm count.

3)       Coenzyme ubique: These drugs improve the nutritional status of the testis. Thus testis as well as sperm forming cells get enough nutrient which helps in fast generation of sperms in good number with good motility & fertilizing capcity

4)      carnititine supplimentation increases the production of sperm, with normalization of sperm count in three months.

5)      Vitamins

6)       zinc

7)      MethyPredinisolone

8)      Antibiotics

9)      Antiestrogens

10)    Tamoxifen

11)    Clomiphene

12)    Hgh

13)    Antimicrobials

14)    Antiinflammatory

15)    AIH

16)    ART'

17)    Certain Newer Drugs has been found very effective

18)  Treatment of antisperm antibody is achieved by steroid therapy, intrauterine insemination intra-cytoplasmic sperm injection (ICSI)

19)  Intra-uterine insemination: In certain patients motile sperms are selected by various methods & then transferred directly in uterine cavity leading to improved pregnancy rate.

20)  Test tube baby is also delivered with our efforts by use of intra-cytoplasmic sperm injection (ICSI), then transfer of embryo to uterus of mother.

  1. Semen Bank: Facility for good quality sperm is semen bank in also available. At our center we have facility for all the testing & treatment facility required for low sperm count to achieve pregnancy.

    Response of treatment: When we start treatment, maturation of spermatocyte to mature spermatozoa start occurring in three to 4 weeks time and achievement of normal sperm count in three months. Thus cure rate is achieved in almost 99% of patients. Similarly varicocele surgery achieves good successful result in most patients. Similarly in antis perm antibody case good results are achieved in almost all cases.

    Side effects: This treatment is harmless because we give well proven drugs which are prescribed in scientific literature. These medicines have to be purchased from medical store by patient himself.

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