In nearly 30 per cent of all infertility cases, the cause is attributed to a problem in the male. M&B takes a closer look at male infertility, its implications and the promise of a solution.
Words Poornima Kartik Iyer
NOT WHAT I EXPECTED
For Pramod Prabhakaran, 34, life seemed blissful. He was happily married, a successful entrepreneur and enjoyed life to the fullest. After three years of unprotected sexual intercourse, he never once suspected that something was amiss. “We weren’t thinking about having a baby so we took it as a positive sign,” he says. When the couple entered their fourth year of marriage, they decided to take the plunge.
He continues, “We visited a gynecologist who advised us to undergo some tests. My wife’s reports were in proper order, but my sperm analysis showed that I had oligozoospermia, which meant that I had a low concentration of sperm in my semen. We were immediately referred to a urologist so we could be advised on how to proceed further.”
FEELING AT LOSS
For Pramod, his world had turned upside down. “I knew it wasn’t my fault but I still couldn’t help feeling sad about my situation. I felt like I was incomplete in some way. I felt defeated as if I had disappointed myself and my wife. I decided to meet the urologist alone,” he says. The gynaec had prescribed some medicines to Pramod which he had been taking. “When the urologist checked the prescription, he got upset. He told me to immediately discontinue those meds and go for a retest 15 days later. I was worried but he assured me that sometimes collecting the semen sample and submitting it on time are major criteria for test accuracy. So there might be a chance of improvement in the second test,” he recalls.
After a week of abstinence, Pramod went for a retest. The results were similar to the previous reports. It still showed low sperm count and low motility. “Thankfully my doctor was hopeful. He prescribed medicines for two months and asked me to quit smoking. I would have to do the test again after two months. That’s when the pressure started building up. Giving a sperm sample can be extremely stressful. I would have to collect the semen and then rush to the lab within a few minutes. I would always be worried about traffi c and check the time frequently,” he admits.
LEARNING TO ACCEPT
After two months, there was no improvement in the reports. The medicines were changed and Pramod was asked to go for a retest after one month. “Things were not improving. I felt guilty. All these years we didn’t care, and just when we wanted a baby, things were looking bad for us. Finally, after a month when we went back to the doctor, he told us that I wasn’t responding to medication. He advised me to freeze my sperm for future use as my sperm level would go down further as years passed. He suggested we go in for a fertility treatment—Intra-cytoplasmic sperm injection (ICSI). My wife was very supportive during that period. She asked the doctor if my sperm was healthy and he replied in the affi rmative. She assured me then there was nothing to worry about. I still blamed myself because in spite of not having a problem she would have to go through an IVF procedure because of me. But my wife was confi dent that this was our best chance and we were in this together,” he explains. The couple is expecting twins now.
Dr Ashok Bapat runs the Bapat Urology Centre in Thane, is a renowned urologist, practicing for three decades. He says that there is a natural tendency in males to not accept a fault with themselves. “The moment there is an infertility problem, the couple rushed to the gynaec. Only after it is confi rmed that there is no problem with the woman that the man agrees to get himself tested,” he explains. To be clearer, he gives the example of King Dasharatha from Ramayana, who first married Kaushalya. When she was unable to conceive, he married Sumitra, who also could not bear a child and lastly, he wed Kaikeyi with the the same result.
“Finally, wise sages explained to him that the problem was with him and not the women. Dasharatha was advised to perform a Putrakameshti Yajna. The issue of male infertility has been around since ancient times and even the Mahabharata has examples. Dr Bapat stresses on the importance of an awareness of male infertility. “I explain to my patients that a man and woman are needed to produce a child. So if a spouse is detected with a problem, they have to accept and treat it,” he says. There are so many children who are born blind, deaf and mute. They learn to accept it and move on in life. So like that, you need to accept the problem,” he says.
According to Dr Bapat, there are hardly any noticeable symptoms of male infertility. “Once the tests are done, we will know the problem and it can be corrected. The sooner the infertility is detected, the better. Women have an ovulation cycle every month but men go through sperm production only once every three months. If the medicines are given today then its effect on the male testis, that produces sperm, will be seen only after three months,” he says. When it comes to the causes of male infertility Dr Bapat points towards unhealthy lifestyle. “I meet many patients from the software industry. Radiation through excessive laptop and mobile use can lead to infertility,” he reveals. “Those who are working night shifts come home late and don’t have time for sex. Today, six percent of the population is infertile. Between the ages 15 to 45 which is the normal reproductive life of a couple. Out of that 30 per cent are males,” he adds. The doctor suggests that men and women should get themselves examined if they do suspect infertility. M&B
” I explain to my patients that a man and woman are need to produce a child. So if a spouse is detected with a problem, they have to accept and treat it “
CAUSES OF INFERTILITY
• Drugs are primarily responsible for low libido and infertility – especially psychiatric, depression, blood pressure and diabetic drugs.
• Mumps is rare at present but it affects the salivary glands, pancreas and can also affect the testes.
• There is obstructive and nonobstructive infertility:
• Physical obstruction is when sperms are not allowed to come in the semen.
• Non-obstructive is when the sperm quantity is very low.
• Varicocele is an enlargement of the veins within the scrotum that affects the temperature of sperm.
• Excessive smoking, drinking and chewing of tobacco.
• Radiation through electronic gadgets such as laptops and cell phones.
• Accidental injury to the groin.
• Primarily, semen analysis shows you how many sperm are present and how many are motile. Motility has to be beyond 50 percent.
• Sixty to 120 million sperm was considered normal but now if there is 20 million, pregnancy is possible.
• Treatment is based according to severity and reasoning.
• If there is low sperm count, medication is given to increase the sperm.
• It is varicolele then, it is treated surgically.
• If there is an obstruction spermatozoa, an operation is done to remove the obstruction.
• Today, there is the advantage of assisted reproductive technology. If medication is not effective, then based on the doctor’s advice, the couple can opt for artifi cial insemination, in vitro fertilization or surrogacy.