MALE INFERTILITY

INTRODUCTION :

Male Infertility

CAUSES :

Lifestyle Factors and Male Infertility :

Obesity and Weight Loss :

Statistically Significant relationship between obesity & semen analysis parameters
Obese men more likely to be oligospermic or azoospermic
Paternal obesity negatively affects ART outcome
Conflicting results regarding effect of significant weight loss on semen analysis parameters

Diet :

Vegetables , fruits , fish , poultry , cereals & low-fat dairy products – positively associated with sperm quality
Processed meat , full-fat dairy products , alcohol , coffee & sugar-sweetened beverages – poor semen quality & lower fecundity rates
Favourable effects of selenium , zinc , omega-3 fatty acids , coenzyme Q10 & Carnitines on Semen Parameters

Vitamins and Antioxidants :

Oxidative Stress (OS) can impair sperm motility, reduce fertilizing ability & cause sperm DNA damage
Antioxidants can protect cells from OS
Many antioxidant supplements commercially available , but none has high-quality clinical data
Antioxidant use : increase live birth rate (OR 1.79) increase clinical pregnancy rate (OR 2.9 )
Overall low quality evidence

Cigarette Smoking and vaping :

Smoking negatively affects semen quality but underlying mechanism not yet clear
No definite relationship between smoking & male infertility but current available evidence supports smoking cessation & decreasing tobacco exposure for couple trying to conceive
Smoking associated with decrease semen count , motility & abnormal morphology – leads to decrease in sperm quality in both fertile & infertile men ( higher effect in infertile )
Worsened semen quality in moderate & heavy smokers
Oligospermia more prevalent in smokers ( RR 1.29 )
Paternal smoking adversely affects ART outcomes
Risk of treatment failure (specially miscarriage ) reduces by 4 % in former smokers with each additional year following smoking cessation
Vaping refers to e-cigarettes which contain propylene glycol , vegetable glycerine , nicotine , food-grade flavouring & water . Generally viewedas less harmful but does have negative effect on spermatogenesis & OS

Alcohol :

>50 % men drink alcohol yet effect on male fertility not understood
Overall –lower semen quality but variable & dose – dependent effect on semen parameters
Habitual alcohol intake – decrease semen quality & changes in reproductive hormones
Semen volume , sperm count , motility & number of morphological normal sperm ALL decreased significantly

Caffeine :

Apparently unaffected semen characteristics but male coffee drinking associated with prolonged time to pregnancy
May be associated with sperm aneuploidy & DNA breaks but no other DNA damage

Stress :

Psychological stress – decrease sperm concentration , progressive motility & increase fraction of sperm with abnormal morphology
Primarily caused by suppression of testosterone by increase corticosteroid levels
Antidepressants drugs – Negatively affect sexual function & semen quality
Manage stress non – pharmacologically – CBT , Psychotherapy , fertility counselling & support

Sleep :

Slepp duration associated with testis size in healthy young men
Sleep disturbance may contribute to male infertility
Testosterone has diurnal pattern & increase coinciding with REM Sleep ( rather than melatonin )
Prolactin increase during sleep & levels are sleep – dependent
Co-effects if stress / depression & poor sleep on fertility
Long –term use of hypnotics – not recommended

Sperm assessment and selection

Semen Analysis ( SA )

Essential in evaluation & initial lab test
Single SA usually sufficient to decide the most appropriate management pathway
If initial SA ≥ 1 abnormal parameters – consider Repeat
Men with risk factors or abnormal semen parameters – refer to male reproductive specialist for full evaluation

Sperm DNA Fragmentation

SA has limited diagnostics accuracy & cannot predict ART outcomes
Association between high Sperm DNA Fragmentation & poor reproductive outcomes in natural conception / IUI but unable to predict with ART outcomes
No treatment for high Sperm DNA Fragmentation proven yet

New developments in sperm selection in ART :

Sperm selection –Standard methods are density gradient centrifugation or swim-up both with similar ART outcomes
Live births after ICSI – 25-30% per ( fresh )treatment cycle

Genetic testing in male infertility :

Genetic Testing and karyotyping– in klinfelter Syndrome ( 47,XXY), testicular disorder of sex development ( 46 , XX ) , translocation ( balanced or unbalanced ), inversions, insertions or deletions