The Basis of Infertility Treatment

Last week I got a call from one of my patients, who conceived after long period of infertility. She called me to remind me that, that very days was the birthday of her son, that is the wealth that she gained after long battle. And even the son tried to talk to me over phone with his soft voice. And this success is really rewarding for any Infertility Specialists.

Now, the inability to conceive- INFERTILITY, the problem is prevalent in our society and is increasing. But majority of common people don’t have clear idea about the concept of fertility and the problems. Ability to have pregnancy depends on many factors both in male and female. Even in a normal couple (where both husband and wife are totally normal), there is chance of pregnancy if they practise regular intercourse in a particular time of the menstrual cycle (around ovulation). And even with that, the best chance is only 15-20%. But within one year of regular trying, 80% of couples manage to conceive. And out the rest 20%, 10 will conceive within next one year and the rest 5 in 3rd year. So, ultimately 5% of couple will have difficulty in conception.

So, we advise, if you tried regularly for one year and there is no pregnancy, don’t get depressed. It may be due to some defects in husband, wife or both; or may be due to chance factor. But we have to make sure that there is no defect in any of the partners. If there is any defect, we will treat that. If no defect is found, then we have to increase the chance.

So, infertility treatment is actually based on stepwise manner. We initially advise some tests and then advise a treatment. If that treatment fails, we move to next treatment.

So, all the time, you have to keep patience. Eventually, majority of the couples will conceive. Don’t give up hope. You have to win the race ultimately

Low Sperm Count

Semen analysis is an indispensable part of evaluation of an infertile couple. But the results of semen analysis often creates confusion. It is accepted that if semen analysis report is normal, male factor is usually said to be normal.

Now what, if abnormality is found. Remember, semen abnormality is very common, even in those who are already having children. Because sperm production takes almost 3 months. So, your current semen analysis reveals your health 3 months ago. If you had fever or any heat exposure to scrotum (may be even tight underwear or hot tub bath) 3 months ago, your today’s semen analysis will be abnormal. So, mere abnormality does not draw a conclusion, unless it is severely abnormal.

Now, what we see in semen. There are various parameters. I’m not going into details. But to be simplified, sperm abnormality may be due to two basic reasons. 1) sperms are not produced by the testes in good quantity (amount) or quality (healthy- motility and looking normal). 2) sperms are produced normally by the testes but cannot come in semen due to defect in the sperm-carrying pathway (may cause low count, defective sperm and also low motility).

One important thing is to remember, sperm production has nothing to do with manliness. You may feel absolutely normal with normal sex life but sperm production may be defective. So, first thing is not to feel depressed when the report comes abnormal.

So, whenever we find abnormality, we have to detect the cause. Treatment without detecting thee cause is more likely to fail. So, first thing is- whether sperms are produced or not.

Sperm production may be hampered due to diseases in testes- that may present since birth or may be due to some factors occurring later life. These include undescended testes, chromosomal defect, varicocele, diseases in the body (like tb, diabetes, kidney/ liver disease etc), heat exposure to scrotum, smoking, environmental poisons and even some drugs (including alcohol, marijuana, chemotherapy). These are called” testicular defects. In some cases, testes are normal but cannot produce sperms because of problems in other glands situated in brain (hypothalamus and pituitary). We call them” pre-testicular defects.

Sperm carrying pathway may sometimes get obstructed due to diseases like infection, operations, some genetic defects. These are called” post-testicular or obstructive defects.

In most cases of semen defect, treatment is not needed, as we can bypass the normal pathway and use the sperms produced in semen to make your partner pregnant with your own sperm. In severe cases, we can collect sperms from testes and impregnate your wife. In only very few unfortunate men or who cannot afford costly therapy, only option is donor sperm.

In very few cases of testicular or pre_testicular defects, medicines can help (but in very few cases). In obstructive cases, surgery may be needed to correct the defect. But, often we don’t need these treatments as the results are not good and take long time to get the results.

So, why to wait and try doubtful treatments, when your prime aim is to father a baby? just one thing, don’t get depressed and talk to doctor, he will find out the cause and give you the best result.



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CMC Hospital Vellore

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