When should a couple consult an andrologist for infertility?

• If a couple is married and has tried conceiving naturally for 12 months or more
• Older couples and couple who have a family history of infertility should consult after 6 months of marriage

Physiology and Anatomy of the reproductive system

Sperm is the primary requirement for reproduction. The process of production of sperm is known as ‘Spermatogenesis’. Spermatogenesis takes place in the testis and an average cycle of spermatogenesis requires approximately 60-70 days. The pituitary gland secretes FSH and LH hormones. These hormones control the process of spermatogenesis.

What is the cause of infertility?

Varicocele (Dilatation of Pampiniform Plexus):

These are the veins which surround the spermatic cord and dilatation of these veins increases scrotal temperature. This increased temperature hampers spermatogenesis.

Mumps:

Mumps is a contagious disease that is caused by a virus. It occurs in children, however it leads to infertility in adult age.

Infections:

Infections like Genitourinary 7B, Filariasis cause infertility.

Smoking:

Excessive and prolonged smoking can affect sperm count and cause infertility.

Late marriages:

Older ages of the couple could make it difficult to conceive naturally as there are greater chances of infertility

Stress:

Excessive stress and mental pressure can affect the production and quality of sperm

Drugs:

Use of non-regulated drugs like testosterone supplementation can lead to an increase in the testosterone level. Increased levels of testosterone have a negative effect on sperm production.

Idiopathic:

Sometimes there is no medical explanation for infertility and tests reveal no cause.

Semen Analysis

According to the WHO 2010 criteria, for healthy sperm, the following parameter should be within the given range:

• Volume: 1.5-3 ml
• Liquefaction time: Within 10-30 minutes
• Fructose: Positive
• Sperm Count: 15 million/ml
• PH: Alkaline
• Morphology: 4%
• Motility: 740%

Evaluation

History: To look for obvious causes

Examination:

1. General examination (secondary sexual character)
2. Testis
3. Epididymis
4. Vas
5. To look for varicocele

Semen Analysis: To check for any abnormal parameters

USG + colour Doppler of scrotum: To check if suspected varicocele present

Hormonal evaluation: To check if oligospermia is present.

FSH, SLH, S. Testosterone: If hypogonadism is suspected.

Management

When an obvious cause of infertility is found, treatments could be as follows:

• Obstructive Azoospermia:

1. a) VEA (Vaso Epididymal Anastomosis)
2. b) VVA (Vaso Vasal Anastomosis)

• Vacuole: Varicocelectomy
• Hypogonadism: Hormonal supplementation
• Oligospermia:

1. a) Antioxidant supplementation
2. b) Lifestyle modification

• If no cause found:

1. a) PESA (Percutaneous Epiclidymal Sperm Aspiration)
2. b) TESA (Testicular Sperm Aspiration)

• If sperm found: IVF (In vitro fertilization)

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