Do you run an IUI center??? Have you had any
occasion when the concerned husband failed to procure fresh semen when trigger
has been done and there is Situational anejaculation?? Every media and is ready
but there is collection problems in IUI ? Magnitude of the problem ?? How big is the
problem??
-
10
% of men are unable to give a semen sample
-
Some have never
masturbated
-
Some are inhibited in the clinic
-
Some fail
on demand (DEMAND EJACULATION)
Failure to procure a
sample can be very embarrassing and disheartening for a man
and can produce long delays in
treatment/ cancellation of the cycle unless frozen sample is ready well ahead which
is costly . To avoid this problem
always ask whether a man can collect a
sample when advising a semen test. If he
reports difficulty in collecting semen
instruct him to try collecting at home
using coitus interrupts . Special non spermicidal condoms are also available. Those who are still unable to collect a sample will
usually be able to ejaculate when stimulated with a vibrator .
Message on male subfertility :--1) It is important
to remember that semen analysis is only a rough predictor of fertility 2) So reassurance is very important when the semen is sub normal because
the male ego is very threatened
by a poor semen report 3) It is not uncommon
to see that many pathology laboratories still quote the old
norms misleading the doctor and making the couple
unnecessarily nervous.4) Many men
with poor semen parameters will still father children while others with seemingly normal parameters will be infertile. 5) The
duration of infertility should be considered in addition to the
semen analyses. If the duration is
short then even with a low count
the chances of pregnancy are
good while if the duration of infertility is long then even with a normal analysis the chances of pregnancy are poor.
Time acts as a filter sorting
out the fertile from the sub fertile regardless of the semen
parameters Hence young
couples who have been trying only for a short time should not rush into advanced
reproductive techniques.
Further
Evaluation
Semen tets
done & no coital problem: Next what??? After clinical examination, Routine
seminal assay some other Investigations are needed only in elected cases
depending on the semen report: - e.g,..
Hormone assay: Not required in every case for the
simple reason that : Be
judgemental
1)
If
count > 5 mill/ ml FSH will be normal
-
2)
If count < 5 mill/ ml then FSH alone
should be done
-
3)
LH & testosterone assay only if there is hypo androgenisation or ED
-
4)
Prolactin assay only if there is ED.
Routine USG : This is not
needed for every case since a
good clinical examination can detect the relevant findings . Since surgery of sub clinical varicoceles
does not improve the semen quality routine
ultrasound to screen for a sub clinical varicocele is of no value. USG is mainly done to confirm the diagnosis of a clinical
varicocele when surgery is being
planned. USG of the scrotal contents is also useful is very obese
men in whom clinical examination
is difficult.
-
Do
not waste time and money treating
azoospermia or isolated sperm defects medically these need surgery or ICSI. But some simple tips may work
_ Advise correct timing of intercourse
-
Prescribe sildenafil
if man has situational Ed
-
Correct personal habits
-
Avoid sauna/steam
-
Regulars
meals more salads fruits
-
Loose underwear
-
Therapy
for stress relief
-
Reduce smoking alcohol stop drugs
Don’ts Unnecessary or harmful treatment
should be avoided
-
Do
not give testosterone injections
they may cause suppression of spermatogenesis through
pituitary feedback
-
Do
not give antibiotics for pus cells without confirming pyospermia by stained
smear examination.
-
-
-
-
Not
all Pus cells looking cells in semen are P cells: Kinds of cells which look
like P cells in semen!!!! There are 3 types
of round cells in the semen
leucocytes macrophages and spermatocytes
only leucocytes indicate infection
Most labs do not distinguish
between these cell types
and erroneously label all
round cells as pus cells
leading to a false diagnosis of infection and unnecessary antibiotic therapy .
Hormone
injections for hypogonadotropic hypogonadism does it work??
HMG and HCG injections mimic the action of natural FSH and
LH. In men with genuine hypogonadotropic
hypogonadism where hormone levels are well below normal treatment with HCG
followed by HCG + HMG can induce
spermatogenesis in an azoospermic
main . However these injections are expensive and men with known
pituitary failure need therapy for 1-2 years . Hence the cost of complete therapy
is very high Before starting therapy ensure that the patient can spend
on the full course since stopping midway will be a waste
of all that he has spent In
our country the majority
of hypogonadotropic
patients cannot afford
gonadotropin therapy. The value
of empirical gonadotropin therapy
in men with normal hormone
levels is unproven.
Few added Tips :-
-
Varicocele affects 15% of all men
-
Many men with
varicoceles are fertile
-
A
varicocele in an infertile man may be coincidental
-
After
varicocele surgery only some men will have improved
semen
-
Some infertile men with varicoceles may improve on medical
therapy alone
-
Hence
not every infertile man with a varicocele
needs surgery .
Microsurgical ligation
-
Preferred
technique
-
Artery
and lymphatics can be preserved
-
All
veins can be identified lower recurrence rate
Laparoscopic ligation
-
No longer
recommended
-
Higher recurrence
rate
-
More
invasive than the open microsurgical approach
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