Author Name: Dr. Dhondiram Bharati || Mentor Name: Dr. Mayuri Assudani on April 27, 2020
The secret of life is happiness
Every individual is starving for happiness !!! After marriage life of couple changes completely. Their priorities change and there is new meaning to life .In this new beginnings of any individual after marriage in an indian culture one of the most important priority is having a child .About 90% of females conceive within 1 year of marriage.Those couple who are not conceived after 1 year of regular intercourse without using any contraceptives is called infertile . of these 30 to 35 % cases are due to problems in males while another 30 to 35 % cases are due to problem in females. Infertility in remaining couples because of both male and female problems or in some couples inspite of all investigations causes are unknown which is known as unexplained infertility.
Human life starts in the uterus when healthy sperm from male partner fertilize with an egg in fallopian tube, which results in formation of embryo. This embryo is carried to uterus where it grows for entire duration of pregnancy. So for successful pregnancy and healthy baby we need healthy sperm and healthy egg. Healthy sperms come from healthy semen hence semen parameters needs to be normal.In males semen analysis is often used as screening test to detect male factor infertility, These parameters are evaluated as per standered prescribed by WHO ( World health organization)in 2010. Ideally, 2-3 days abstinence is must before semen analysis. Less than 2 or more than 3 days will affect the results of semen analysis.
Semen parameters examined are, Number of sperms (sperm concentration),volume of semen , motility, colour of semen, PH, morphology of sperm,Viability, viscocity and liquefaction time.
Sperm are formed in testes and mixed with fluid of seminal gland and fluid of prostate gland in urethra. Normal volume of semen is 1.5-4.5ml Per ejaculate,Volume below 1.5 ml is called hypospermia. Semen contains fructose that comes from seminal vesical, seminal vesical fluid forms majority of semen volume (70%) and also renders high PH to semen. Remaining 30% volume comes from prostate.
Number of sperms may vary from 15 million/ml to more than 200 million/ml or 39 million per ejaculate volume. Sperm count less than 15 million per ml is called oligospermia, whereas complete absence of sperm in semen is callled azoospermia.
Motility means ability of sperm to move in female genital tract, forward movement above 25 micrometer per second is normal and is progressive forward motility, sperm movement may be zigzag but in forward direction. Non Progressive motility means movement less than 5 micrometer per second, sperm that vibrate in place but not move forward is comes under non progressive motility ,total motility include both progressive and non progressive movement , poor sperm motility is called asthenozoospermia where less than 32% sperms are able to move. Sperms are not visible with nacked eyes , we have to see it under microscope.
Sperm morphology means studying size and shape of sperm. Normal sperm have head, neck, body and tail. Shape of the head is ovel and 4-5 micrometer in length and width is about 2.5 -3.5 micrometer, body is about one and half times that of head length width is about 1 micrometer and tail length is 45 micrometer. Abnormal morphology may lead to male infertility.
VIABILITY is number of live sperm. It should be performed immediately after liquefaction. At least 58% of the total sperms must be viable in a semen sample. Colour of semen is clear, whitish or grey and it’s pH is 7.2 to 7.8.
Viscosity and Liquefaction time – Normally semen liquify in 15 to 20 minutes, as initially it is viscous, if semen does not liquify in time it is termed as hyperviscous and it hampers sperm quality.
Abnormal semen parameters may be due to varicocele, undescended testes, infections, retrograde ejaculation, genetic causes. Other causes are hormonal, like decrease in testosterone and increase in prolactine level, medical conditions like diabetes and hyperthyroidism, intake of few medicine like alpha blockers, antiandrogens, finasteride, also alcohol intake, tobacco, cocaine and stress. Erectile dysfunction, hypospadias also hamper the sperm quality. Total absence of sperms in semen can be obstructive or non-obstructive. In obstructive azoospermia there is blockage in the path between testes to urethra, means sperms are produced in testes but not seen in semen due to block in the path, whereas in non obstructive azoospermia sperms are not produced in testes. Causes of non obstructive azoospermia may be testicular or pre testicular. Testicular causes are genetic, infections like mumps in late puberty, tumours, chemotherapy, radiation therapy, varicocele, diabetes, pre testicular causes are genetic or inherited disorders like Kallmann syndrome, pituitory and hypothalamic dysfunction.
For those with fertility issue, improvement in normal semen parameters can be achieved by life style modifications like weight reduction, avoiding hot environment, quiting tobacco chewing, smoking, management of stress, yoga, control of diabetes with exercise and diet modification may be benefited. Other treatment options are medical management for infections, hormonal therapy, treating hyperprolactinemia. Surgical management of grade 3 and grade 4 varicocele, orchidopexy for undescended testes.
10-15% of men who are not benefited by above treatment options and still don’t have normal semen parameters require ART(assisted reproductive techniques) procedures like IUI, IVF or ICSI. For IVF or ICSI sperm retrieval can be done by various techniques like PESA (Percutaneous epididymal sperm aspiration), MESA (Microsurgical epididymal sperm aspiration), TESA (Testicular sperm aspiration), TESE (Testicular sperm extraction), Micro-TESE (Microsurgical testicular sperm extraction).
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