Male fertility issues are a significant concern, affecting many couples’ ability to conceive. An understanding of the physiology behind male fertility and the potential interventions, particularly In-Vitro Fertilization (IVF), help us better understand the infertility challenges and the role of IVF in combating infertility. The male reproductive system is regulated by a series of hormones produced in the brain. The brain releases Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which act on the testes to produce testosterone and stimulate sperm production. This process, known as the gonadal axis, involves a delicate balance between the brain, testes, and hormone levels.
Dr. Arunima Haldar, Consultant – IVF & Reproductive Medicine, Manipal Hospital Whitefield, says, “The infertility problems in men primarily stem from sperm abnormalities. Sperm abnormalities can vary in severity. Mild abnormalities might be managed with medication or Intrauterine Insemination (IUI), a procedure where sperm is directly placed into a woman’s uterus.” Severe abnormalities, however, may require more advanced techniques such as IVF or Intracytoplasmic Sperm Injection (ICSI). In general, if a man’s sperm count is less than 5 million per milliliter, IVF is recommended. If it drops below 1 million, ICSI, where a single sperm is injected directly into an egg, is necessary.
Understanding Male Fertility Problems
Dr Haldar shares that male fertility issues can occur at different stages of sperm production and transport that can be categorized as:
• Pre-testicular Issues: These involve problems at the level of the brain that affect hormone production and can be treated with hormonal therapy, and IVF may not always be required.
• Testicular Issues: These refer to problems within the testes themselves, where sperm production is impaired. This could be due to low testicular volume or other issues that make sperm extraction difficult.
• Post-testicular Issues: In these cases, the testes produce sperm normally, but blockages prevent the sperm from reaching the ejaculate. Surgical options might be available to correct these blockages. If surgery is not possible, sperm can be directly extracted from the testes for use in ICSI.
In addition to problems at different stages of sperm production and transport there are a few specific conditions affecting male fertility including:
• High DNA Fragmentation Index (DFI): Sometimes, sperm may appear normal in semen analysis, but the DNA within the sperm is highly fragmented. This condition can lead to recurrent implantation failures or pregnancy losses. In such cases, sperm can be extracted directly from the testes (a procedure known as TESA) and used for ICSI. These sperm are less likely to have DNA damage since they haven’t been exposed to oxidative stress.
• Globospermia: This rare condition involves the sperm’s inability to fuse with the egg, leading to fertilization failure. In such cases, ICSI is required, often with an additional treatment called oocyte activation media to facilitate fertilization.
How IVF Overcomes Male Fertility Challenges
Dr Haldar adds, “IVF and its advanced form, ICSI, allow direct handling and manipulation of sperm and eggs, these techniques bypass many obstacles that naturally prevent conception, thereby, offering solutions to various male fertility problems. For men with severe sperm abnormalities or specific conditions like high DFI or globospermia, IVF with ICSI can significantly increase the chances of successful fertilization and pregnancy.” For those facing fertility issues, consulting with a specialist can help determine the most appropriate course of action based on individual circumstances.
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