Male factor subfertility

 

What we need to refresh our knowledge on MALE FACTOR SUBFERTILITY?

An interview with Prof S K Pal of Kolkata ,

Q. 1: What is the prevalence of male factor subfertility ?:-  Males are entirely  responsible for subfertility in  1/3 rd of all subfertility problem, and is partly responsible for another  20% cases.    In total about 50% of all cases of subfertility males are involved.

Q,2: Up to how much we can call that Seminal Parameters  are normal  and fall within the range of “Fertile semen”  ??

 Ans: WHO Lab Manual(2010)- in App. A1.1 declares of all fertile men(whose partners were  able to conceive by 12 months of trying):- in 5% of such fertile men the seminal  criteria were Density = 15 million/ ml; 32% for good forward progression ( motility  within 60 minutes of  ejaculation) ,   and normal  morphology of 4%  . We used to prescribe antioxidants and mitochondrial medicine for such cases up to 2010. But  after publication of 5^th centile of so called normal seminal parameter we usually wash off our hands and don’t proced  for treating male factor subfertility, to which I disagree. Such apparently though suboptimal (5^th centile of fertile men) seminal parameters may cause male factor subfertility too by sperm function defects. This study of WHO , however will offer an  anxiety free life to the couple for at least first few yrs of trying  if they are young and the concerned man , according to WHO can’t be just called  be infertile ,albeit may be called as substandard semen sample.

Q,3: What are the common causes of male subfertility?

Ans; In about 50% of cases of male subfertility no obvious cause is detected. Possibly monogenic disorder .There is no watertight separation between different causes of which contributes to male subfertility. Thereby I mean many minor abnormality may lead to   1) OAT(oligozoospermia . 2)  asthenozoospermia, & 3)  Teratozoospermia .

Q. 4. What are the common causes of male subfertility?.

However a) Nonobstructive azoospermia 30%; b) Idiopathic (no obvious cause-)-25%; c) testicular failure 9%, d) seminal disodreds-7%, e) Obstructive azoospermia-6%; f) Cryptorchidism-6%., g)  MAGI(Male Accessory Gland Infections) . But with advancement of science of andrology people are becoming aware that excess ROS is a chief factor in male subfertility which may even impair functions  of normally ejaculated  sperms .

Q.5: How do we classify  the common causes of male subfertility?

 Basically there are three   types of diseases which can be clinically diagnosed. Such are A) complete absence of sperms in the ejaculated semen-“azoospermia” B) Sperms are present but their quality or quantity is far less to yield fertilization and to develop embryonic competency and successful pregnancy. C) The third group is that male sexual disorders where the male partner is unable to deposit semen at the right time of fertile period.