Male Infertility Treatment explained A-Z

Male Infertility treatment A-Z & everything you should know today before you decide to jump on to treat male infertility

Vanakkam and welcome to Dr Shah’s Clinic, I have been a practicing male fertility specialist in chennai for the better part of half a decade. I can tell you one thing very clearly, there is a lot of confusion and a LOT of misinformation about male infertility treatment in the fertility industry (even among the so called fertility experts).

There are now are range of bogus and unproven medical technologies that are being promoted to treat male infertility.

Much of these newer medical therapies have not been scientifically validated to treat male infertility. Lets try to dissect and understand the various male infertility treatments & male infertility medicines. You will find this article very valuable. Keep reading!

Male infertility causes

Male factor infertility affects close to anywhere between 24 to 50 percent of married couples. Moreover, the prevalence of male infertility varies depending on the geography as well ethnicity of the specific population. In India, male factor infertility is definitely on the RISE.

Now, without complicating things, some of the common causes of male infertility are as follows

  1. Low sperm count problems
  2. Low sperm motility issues
  3. Poor sperm morphology
  4. Poor lifestyle habits including obesity, excessive smoking and alcohol consumption
  5. Idiopathic male infertility (interestingly seen in roughly about 30% of patients where all testing shows everything is normal yet they are infertile)
  6. No sperm in semen or azoospermia
  7. Genetic conditions like Y-Chromosome micro-deletion
  8. Testicular failure
  9. Obstruction in the male reproductive tract
  10. Sexual problems like erectile dysfunction or severe premature ejaculations also contribute to about male infertility
  11. Sexually transmitted diseases like Chlamydia and Gonorrhea also contribute to the disease burden

While their are numerous other causes not listed above, here is separate article you can read on male infertility causes. The list above is what we commonly in the clinic. Next, lets briefly look at Male infertility tests and then we can jump into the treatments

Male infertility tests

Male infertility tests or testing for male infertility is fairly straightforward. A patient is diagnosed with male infertility if he is unable to father a child after 1 year of regular unprotected sexual intercourse. Recommended tests for male infertility include a semen analysis , an in-depth clinical history taking session combined with a hormonal assessment.

 

Furthermore, advanced genetic testing is only recommended in very specific conditions like testicular failure, Kallman syndrome, Klinefelter’s syndrome or non-obstructive azoospermia (a condition were sperm production is essentially zero). I have written an in-depth article on male infertility assessment, do read it!.

The cause of male infertility, the clinical history and findings ultimately decides on exactly what specific tests have to be prescribed for each and every patient. All said and done, male infertility tests and male infertility treatments must be individualized to the patient.

Male infertility symptoms

The most important symptom of male infertility is ‘the absence of a pregnancy after 1 year of unprotected intercourse’. However, some other symptoms of male infertility include

  1. Problems with erection
  2. No ejaculation or painful ejaculation
  3. Low semen volume (1 or 2 drops only)
  4. Severe premature ejaculation (where ejaculation occurs before penetration)
  5. Testis that are very small and soft (indicates testicular failure or Klinefelters syndrome)
  6. Sparse hair distribution with micropenis is also suggestive of poor androgenization (pointing out to male fertility issues)

Moreover, patients may also report various non-specific symptoms like sexual weakness, fatigue, exhaustion et cetera. While these are not directly a cause of male infertility, a proper evaluation of the patient is definitely required.

Male infertility treatment home remedies

On the subject of male infertility treatments, following some simple male infertility treatment home remedies can go a long way into boosting male fertility potential. Some popular food items that contain natural anti-oxidants and that are considered home remedies for male infertility include

  1. Taking orange and lemon juices that are rich in Vitamin C
  2. Taking a combination of Apple + carrot + beetroot juice (which are rich in flavonoids and carotenoids that can help boost sperm motility)
  3. Taking Mucuna Pruriens (dosage recommendations depends on the condition)
  4. Lowering carbohydrate intake and sugar intake
  5. Taking a lot of fats and protein like sundals, dhals and lentils also helps
  6. Ensure your diet has adequate ginger + garlic
  7. Restrict the intake of sugar sweetened beverages and in general all carbohydrates
  8. Try regular exercise and walking. Hit atleast 10000 steps a day
  9. Ensure you get atleast 6-7 hours of sleep everyday
  10. Quit the smoking and alcohol completely

All the aforementioned tips can be used or considered as a home remedy for male infertility. I have personally seen excellent clinical results with my patients when I put them on the aforementioned diet and lifestyle plan for the treatment of male infertility. Do try them out!.

However, remember one thing, if you are suffering from male infertility due to zero sperm count, also called azoospermia, the aforementioned treatment strategies will not work.

Now, lets learn a bit about male infertility medicines

Male infertility medicines

A big part of male infertility treatments lies in prescribing medications to patients that actually work. Sadly, today numerous superfluous drugs, vitamin and b-complex supplements including plant extracts are being prescribed rampantly by well renowned fertility experts for male infertility treatment.

Patients sadly end up spending 10,000 to 20,000 rupees (excluding the cost of testing) on these largely unproven anti-oxidant treatment for male infertility. Poorly designed scientific studies with biased results are often referred by fertility doctors while prescribing such medicine.

The truth is very hard pill to swallow

Their are very specific indications were male infertility medicines are believed to work. They are as follows

  1. In patients with hypogodatrophic hypogonadism a combination of FSH and testosterone is given to help restart sperm production. This is a proven example were male infertility medicines work
  2. Moreover, in patients with erectile dysfunction leading to male infertility, the use of PDE-5 inhibitors has shown good clinical benefits
  3. Lastly, in some patients with impaired sperm production due to testosterone and estrogen imbalance, the use of letrozole and anastrazole has shown some benefit.
  4. The use of cabergoline is recommended in patients who have a prolactin secreting tumor resulting in male infertility due to erectile dysfunction. This is also proven
  5. Tab folic acid has shown to lower sperm DNA fragmentation index (a very low cost male infertility medicine) we have found excellent result with this
  6. Mucuna pruriens is another molecule with some benefits for improving sperm count or motility

Numerous male infertility medicines that are unproven or do not work include

  1. CoQ10
  2. Lycopene
  3. Astaxanthin
  4. L-Carnitine
  5. Levo-Carnitine
  6. Methylcobalamine
  7. Selenium
  8. Zinc
  9. Lycopene
  10. Blah Blah Blah

Truth be told, all the aforementioned molecules are antioxidants that are claimed to improve sperm count and also improve sperm motility by reducing oxidative stress. Don’t fall for these bullshit, fake science based treatments. The data is clear, these male infertility medicines do not work.

What male infertility treatments do actually work?

Apart from the male infertility home remedies as listed above, the next section below outlines some proven scientific treatments for male infertility that do work. Read on!

Treatments for male infertility that actually work

IUI (Intra-uterine insemination) a simple cost effective male infertility treatment

IUI is preferred second line treatment of male infertility when conventional treatment strategies such as lifestyle modification and medications fail. For IUI to be done, the patient should have atleast 8 to 10 million spermatozoa per ml of semen with atleast 40% progressive sperm motility. For values lower than this, the success rates of IUI actually start to decline.

The process of IUI is fairly simple to understand. Given below is briefly the steps of an IUI procedure

Step 1 – Medications like clomiphene or letrozole is given to stimulate egg growth in the female partner

Step 2 – The growth of the egg is monitored via trans-vaginal ultrasound scans

Step 3 – When the eggs grow to a paticular size usually >18 mm, an injection called hCG is given to trigger egg release from the follicle that encloses the egg

Step 4 – Within 32 to 36 hours of hCG, the male partner or husband gives a semen sample that is then subjected to a sperm preparation. During this sperm preparation, the motile sperm fraction, which contains DNA intact spermatozoa are separated loaded in a soft cannula and inseminated into the female

Step 5- The objective of IUI is fairly simple and it is to place the spermatozoa close to the site of fertilization

IUI as a procedure is safe and is particularly beneficial as a technique in patients with unexplained infertility. Moreover, the per cycle success rate of IUI is about 12 to 15 percent. Depending on the patients and clinical profile, we normally recommend 3 to 6 cycles of IUI during a typical male infertility treatment

The advantage of multiple cycles of IUI is that, cumulative success rates add up to hit about 30% ! (especially when the IUI cycle is done 1 after the other consecutively).

The next male infertility treatment of interest is called ICSI (Intracytoplasmic sperm injection)

ICSI (expensive male infertility treatment indicated only for select patients)

ICSI was accidentally discovered way back in the 1990’s. In recent years a large number of fertility clinics are resorting to using this technique for almost all patients who are diagnosed with male factor infertility. ICSI as a male infertility treatment although widely popular involves many technical steps and is expensive.

The cost of ICSI ranges from anywhere between 1,50,000 INR to 3,00,000 INR in most fertility clinics atleast in India. But the most important point to bear in mind is that ICSI is not a guaranteed treatment for male infertility. The true treatment success rates for ICSI is never more than 35% in terms of take home baby rates. Sadly, once again numerous fertility clinics are claiming falsified success rates of over 70% with the technique, but this is never far from the truth.

Moreover, ICSI is NOT A RECOMMENDED MALE INFERTILITY TREATMENT for all

ICSI as a male infertility treatment is recommended in patients as follow

  1. In patients were a semen analysis report shows counts <1 million/ml or the report shows ‘occasional motile & immotile sperm seen’
  2. Also in patients in long standing duration of infertility >5 or >7 years, with older female partners > 37 years of age
  3. ICSI is recommended in patients whose semen analysis report shows ‘no sperm motility seen’
  4. Moreover ICSI is recommended in patients with Globozoospermia (a genetic defect where in sperms are produced without an acrosomal cap)
  5. Furthermore, ICSI is also recommended in patients with Azoospermia, where in sperm is retrieved from the testis
  6. ICSI is also recommended in pateints with ‘unexplained infertility’ but where multiple IUI treatment cycles have failed

The steps of ICSI briefly are as follows

Step 1 – A combination of medications are used for a controlled stimulation of the ovaries in the female partner. The aim of the stimulation is of course to obtain 6 – 8 eggs for the process

Step 2 – Egg growth is carefully monitored with ultrasound and when the egg reached >18 mm an injection called hCG is given to facilitate egg release from the follicle

Step 3 – Next, the eggs are gently aspirated via ultrasound guidance and are placed in a specialized media for holding these cell

Step 4 – The embryologist (the person who does the ICSI) takes these eggs from the gynecologist and removes the surrounding cumulus cells

Step 5 – The semen obtained from the male partner are prepared to isolate the healthy motile sperm fraction

Step 6 – The denuded eggs are then prepared for the actual injection procedure. The eggs are placed under a device called micromanipulator that helps to manipulate and move the egg at a cellular level. A single morphologically normal appearing sperm is selected, its tail broken and then gently it is injected into the egg.

Step 7 – All eggs are subsequently injected one after the other, after which they are placed in specialized media within a CO2 incubator for culture at 37 degree celsius

Step 8 – Fertilization is assessed the next day, the zygote is then shifted to another media for further developement

Step 9 – A repeat check is done on day 3 after ICSI, the day 3 embryos formed can either be transferred to the female partner or cultured further upto day 5 or frozen for a future transfer.

Step 10 – Embryo transfer is done with the help of specialized embryo transfer catheter.

Step 11 – A patient can go home the same day post transfer. Medications are given, this is called luteal support

Step 12 – Pregnancy test is done 2 weeks after the transfer.

So, that about sums up the post on male infertility treatment. Now, the important question that we should answer is

Which doctor to consult for Male infertility ?

Definitely  you do not want to consult a gynecologist or even a fertility specialist. You definitely need to consult an andrologist (a fairly rare breed of doctors who specialize in the male reproductive health). A well trained andrologist can help you overcome male infertility and will also provide you the right male infertility treatment.

I hope you enjoyed reading this article on male infertility treatment. Keep watching this space for more & feel free to reach out to me in case of doubts or queries. I practice at the address below

Dr. Shah’s Clinic for Male Infertility & Sexual Health
No 5, Hindi Prachar Saba Rd, Parthasarathi Puram, T. Nagar, Chennai, Tamil Nadu 600017
Ph:  +91-9789843856
Email: – drsdk123@gmail.com
Timing:- 9:00 am to 6: 00 pm
Working Days – Monday to Saturday

Oh, most importantly stay healthy & stay happy

References

  1. Male infertility & its causes in humans
  2. Unexplained infertility – potential causes and management
  3. Pregnancies after testicular sperm extraction for patients with non-obstructive azoospermia

 

 

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