Tips of semen anlusis the denial component

 

Tips of semen analysis  the denial component  : How tough is to motivate a man for his semen analysis!!! Often masculinity / Virility are equated seminal reports. Attitudinal factors have a major role.  However ,  counseling for semen analysis –is a tough job for Gynaecologits.

Few men are very reluctant and adamant too.

Myth:: Societal problem: Taboo: Reproduction and carrying a foetus is her job .Why I should be tested?? Fact:  In 40-50 % of couples presenting with fertility problems male factor is responsible either partially or completely. In our social set up even today males do not accept this   fact and therefore they do not agree for examination or investigations. This problem is more prevalent in people who are less educated.  Proper tactful  counseling is a must with   the male partner before  subjecting the female  partner  for treatement   of infertility.

The couple must be explained that according to the recent WHO criteria 2010 , 15 million sperms / ml  motility and   4%  sperms with normal  morphology  are considered as normal physiological semen criteria . We have to remember  when sperm  count is 15 million / ml or more no treatment is required . So, up to 86 % abnormal sperms is accepted as normal and physiological  and no treatment is warranted. As a matter fact even male persons with only 4 % - 14 % normal sperms can make their wife conceive either naturally or by intrauterine insemination. Only when < 4% of sperms are normal , IVF / ICSI may be required.

Medical management of a subfertile   male :: What to do When the sperm count is < 15 million / ml ?? Ans:- When the sperm count is < 15 million / ml semen analysis must be done at least  three times –at 2 weeks apart  preferably 2 months  apart to confirm  the diagnosis . These patients should directly not be subjectedto IVF or ICSI.

Instead we must try medical treatment for these males to improve the sperm count so that they become father    naturally or with IUI. The whole moto of medical management of a subfertile   male is not to increase   the sperm count 5-10   times or to achieve excellent semen parameters. The motto is to increases the count by a few million so that ICSI  can be converted to IVF  , IVF  to IUI  and perhaps   IUI  into natural  conception  .

Medical management  like CC, HMG & HCG and only HCG may be employed in selected cases but control of infection of Male Accessory Glands(MAGI) is very important  but more relevant is  avoidance of alcohol, smoking, life style modifications antibiotics (in cases of Pyospermia) & antioxidants empirically!!