Andrology

Male factor contributes equally as female factor. Hence evaluation of male partner is very important.

Normal Semen Analysis (WHO 2010)-

• Normal Concentration – 15 million per ml / 39 million per ejaculate
• Normal motility – 40% (Rapidly progressing – 32%)
• Normal Volume – 2 ml
• Normal morphology – 4 %

Abnormalities

• Oligospermia – Reduced count of sperms
• Teratospermia – Abnormal morphology (<4% of normal sperms) – structure of sperms is defective. Problem can be at the level of head, neck or tail of the sperm.
• Asthenospermia – Abnormal motility (movement) of sperms.
• Oligoasthenoteratozoospermia (OATS) – Problem at all levels of sperms. ICSI is indicated in these cases.
• Azoospermia – No sperms in the semen.
• Cryptozoospermia – No sperms in the semen but found after centrifugation of semen in lab.
• Hypospermia – Decreased volume of the semen.

• Causes of Azoospermia (absent sperms in semen) – 
  • Testicular failure – Testes are not able to produce sperms. FSH hormone will be high in these cases.
  • Hypogonadotrophic Hypogonadism – The brain will not be able to stimulate the testes to produce sperms.
  • Obstructive Causes – Sperms will be produced but will not be able to come in the ejaculate due to obstruction.
  • Idiopathic – When no cause can be found. This is most commonly seen.
  • Maturation defects – Sperm precursors are produced but are not able to mature.
  • Genetic defects – Y micro deletions, Klinefelter’s syndrome etc.

• Causes of Sperm defects –
  • Obesity
  • Stagnated life style
  • Smoking
  • Alcohol
  • Drug abuse
  • Excessive heat exposure (occupational)
  • Poor nutrition
  • Idiopathic – where no cause can be found

• Tests for male partner
  • Usually if semen analysis is normal, no further evaluation is done.
  • For minor issues medical treatment is tried for a few months, before advanced tests and treatments.
  • In case of azoospermia, further evaluation is done which includes-
    • Examination
    • Ultrasound
    • Hormonal evaluation
    • FNAC – Fine Needle Aspiration Cytology – Some cells are extracted with the help of a thin needle and they are studied under microscope.
    • If sperms are found on FNAC – ICSI (Intra Cytoplasmic Sperm Injection) is the best technique to have pregnancy. In ICSI, sperms are directly injected inside the eggs with the help of a very advanced machine and microscope.
    • Other advanced treatments are based on requirement.