Andrology is the field of medicine that studies health issues that afflict men. Like its counterpart, gynecology, which focuses on issues of female health, andrology is mainly concerned with issues of male reproductive health, including infertility and sexual dysfunction. Andrology, however, may also deal with urological issues that are specific to males, as well. A specialist who concentrates in this medical field is called an andrologist.
The first test in the evaluation of the infertile male is the semen analysis. This test is inexpensive, easy to perform and gives valuable information.
A perfectly normal semen analysis report generally precludes a significant male factor component and investigation and treatment should be more appropriately targeted at the wife. In fact, in many countries, the first test in the evaluation of an infertile couple is the semen analysis. This is generally performed before any tests are conducted on the wife.
Often, in the case of male infertility, the semen analysis is abnormal. Either the count is low (oligospermia) or sperms are altogether absent in the ejaculate (azoospermia).
Sometimes, sperm motility is seriously affected (asthenospermia) and sometimes the sperms are totally immobile or dead (necrospermia). There are many other anomalies that one may find on semen analysis.
When one finds anomalies in the semen analysis, the next step is to try and find a cause for it. To do this, one must perform additional investigations. Some of the other tests that may need to be performed are a semen culture, anti-sperm antibody estimation, scrotal ultrasound, hormonal assays, karyotyping, vasography etc..
Male infertility is usually caused by problems that affect either sperm production or sperm transport. Through medical testing, the doctor may be able to find the cause of the problem.
About two-thirds of infertile men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that are made do not work properly.
Sperm transport problems are found in about one in every five infertile men, including men who have had a vasectomy but now wish to have more children. Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen.
Other less common causes of infertility include: sexual problems that affect whether semen is able to enter the woman’s vagina for fertilisation to take place (one in 100 infertile couples); low levels of hormones made in the pituitary gland that act on the testes (one in 100 infertile men); and sperm antibodies (found in one in 16 infertile men). In most men sperm antibodies will not affect the chance of a pregnancy but in some men sperm antibodies reduce fertility.
If a couple has been trying for a pregnancy without success, they should go to their local doctor, family planning clinic or women’s health clinic, and have some initial tests. Both partners should be tested, even if one has a child from another relationship. Diagnosis can involve a medical history from the man and a physical examination along with a semen analysis to check the number, shape and movement of sperm in the ejaculate.
Blood tests may also be done to check the levels of hormones that control sperm production. Genetic investigations and testicular biopsies are sometimes done.
Treatment of male infertility is difficult and sometimes frustrating. Immediate results are hard to produce and persistence with therapy is required.The following modalities of treatment are generally employed.
This consists of the administration of certain drugs to improve seminal quality. Clomiphene citrate, mesterolone, tamoxifen, gonadotropin injections, antibiotics, steroids etc. are commonly used.
Microsurgery in progressObstructions in the sperm conduction pathway, varicoceles, undescended testes etc. can be treated by operation.
Modern microsurgical techniques are of great help. Even patients who have undergone a vasectomy in the past can have their vasectomy reversed and the tubes recanalised successfully using microsurgery.
In many cases, neither medicines nor operations are of help. In such cases, an attempt is made in the reproductive laboratory to improve semen quality and facilitate the penetration of the sperm into the ovum. This includes sperm washing/capacitation, intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), in vitro fertilisation (IVF), and micro-manipulation (ICSI).
Microsurgery and assisted reproduction require considerable training, skill and infrastructure. Despite the availability of so many treatment modalities, some patients remain incurable and no treatment, cheap or expensive, can improve their fertility prospects. One then has no alternative but to recommend an AID (donor insemination) or adoption.
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