- State of Art Infertility facility
- IVF Lab set up with GMP standards, Class 10000 and SS Grade 216 walls with Electrostatic flooring (polyvinyl with copper lining)
- Point of care counseling for male and female partners with reproductive failures
- Ovulation Induction is a process which helps the ovaries in releasing eggs, in order to improve the chances of conception through artificial insemination (IUI) or intercourse.
- Women with low hormone levels for ovulation, or woman who are not ovulating at all may be aided with this process.
- Medication through tablets or injections may be required to stimulate hormones.
- Intrauterine insemination (IUI) involves injection of washed sperm into the uterus with a catheter
- A female under 30 years of age has optimal chances with IUI; for the man, a total motile sperm (TMS) of more than 15 million per ml is optimal
- Simple, easy and less time consuming process.
- Higher success rate.
IVF (since 2004)
- In vitro Fertilization (IVF) is the technique in which fertilization of male and female gametes (sperm and ovum) occurs outside the human female body.
- State of Art facility with GMP and Class 10000 facility
- Sterile environment for maintaining embryos and gametes using CO2 incubator
- Vitrification or cryopreservation facilities for cold storage of gametes (sperm and egg)
a) ICSI (since 2004)
- Sophisticated method of IVF by injecting a single sperm in egg for fertilization
- The solution for reproductive issues related to severe male infertility by Intra Cytoplasmic sperm injection (ICSI).
- Practiced since 2004 with higher success rate at our center
- Useful for infertile couples either having too few motile and morphologically normal sperm or where eggs cannot easily be penetrated by sperm. Also can be used for those male who have undergone vasectomy.
b) Pre-implantation Genetic Diagnosis (PGD) / Pre-implantation Genetic Screening (PGS)
- Pre-implantation Genetic Diagnosis (PGD) is a process in which one or two cells from an embryo on Day 3 or Day 5 are extracted and the cells genetically analyzed.
- Couples who are at a high risk of having abnormal number of chromosomes or who have a history of single gene defects or chromosome defects are ideal candidates for this procedure.
- It is used to diagnose a large number of genetic defects at present.
- The term preimplantation genetic screening (PGS) is used to denote procedures that do not look for a specific disease but use PGD techniques to identify embryos at risk.
- The PGD allows studying the DNA of eggs or embryos to select those that carry certain mutations for genetic diseases.
- It is useful when there are previous chromosomal or genetic disorders in the family and within the context of in vitro fertilization programs
- We have highly experienced and trained genetic counselors who would meet with you to discuss your genetic issues and your odds of having to do PGD.
Sensitivity Issues: What Men Need to KnowThe wish to establish a family is a primal desire; however, 19 million of Indian couples this may not be possible. Male Infertility is most commonly due the problems with sperm either due to quantity, motility or size and shape. High DNA fragmentation in the sperm head can impact once ability to become a father. Sometimes, semen sample collection can also be a difficult issue for men even though there are no specific reasons.
Reasons of Male InfertilityInability to conceive a child can be due to -
- Problems with sexual function (difficulty with ejaculation, low libido, erectile dysfunction & painful erection)
- Swelling or lump or pain in one or both testicles
- Recurrent respiratory infections
- Decreased facial or body hair or other signs of hormonal abnormality
- Low sperm count (total sperm count less than 20 million per mm3 of the ejacualte)
Our Doctors Team Can Help!
- For many men who have difficulties in fertility issues, Doctors at Prasad Hospitals have offered a very patient ear to listen to and understand the sensitive issues.
- Excellent counseling sessions and a timely medication helped many men to successfully procure a sample and allow doctors to assist their reproduction.
- Technology came as a boon for both male infertile patients and Doctors as well.
- Electro ejaculator and other aids for a comfortable sample collection are suggested whenever necessary.
- Many chronic conditions can also impact a man’s fertility. For instance, diabetes, which is affecting about 30% of men (who have visited the clinic).
- Poor sugar regulation can result in nerve damage including those which are responsible for coordinating ejaculation.
- Liver cirrhosis can also impact fertility, as the condition is often associated with hormonal imbalances that can interfere with sperm production.
- Additionally, drugs and environmental exposures can interfere with viable sperm production. Although it is well known, that drugs like alcohol, marijuana, heroin and cocaine can all impact the quality and quantity of sperm, even some prescription drugs can interfere with normal production.
- Antibiotics, antacids, antidepressants, gout, and blood pressure medications can also impact fertility.
- Similarly, exposure to heavy metals, such as lead and mercury, influence its production.
Risk Factors for Male Infertility
- Made up of enlarged veins in scrotum on one or both sides
- Veins make inside of scrotum warmer and can reduce sperm production
- Low sperm production
Physical Problems With Testicles (e.g., Undescended Testicle)
- An undescended testicle (or "testis") is when it fails to drop into the normal place in the scrotum.
- This issue is found in about 3 or 4 out of 100 newborns (and up to 21 out of 100 premature newborns).
- About half of these testicles will drop on their own during the first 3 months of life. But testicles won't drop on their own after 3 months of age. Thus, about 1 or 2 out of 100 boys with undescended testicles will need treatment.
- The testicles need to be 2 to 3 degrees cooler than normal body temperature to make sperm. Testicles that don't drop into the scrotum won't work normally.
- The longer the testicles are too warm, the lower chances are that the sperm in that testicle will mature normally.
- This can be a cause of infertility, especially when both testicles are affected.
- They are also linked to a higher risk of:
- Testicular cancer in adulthood (though the risk is still less than 1 in 100)
- Testicular torsion (twisting of the chord that brings blood to the scrotum)
- Developing a hernia near the groin
Blockages in the Ducts That Carry Sperm
- Some men are born with a blockage or other problems in the epididymis or ejaculatory ducts (Vas deference) that later affect fertility.
- Some men lack the vas deferens, the tube that carries sperm from the testicles out through the penis.
- Blockages in the different ducts that carry the sperm from the testes to the urethra can cause problems for sperm transportation.
- The three main categories of problems arising in sperm transportation can be classified under the categories of
- Congenital disorders
- These are birth disorders that affect male fertility.
- They include incomplete development of the sperm ducts, atresia of duct (natural blockage), and no seminal vesicles present to store sperm.
- Acquired disorders
- These are caused due to a disease or infection of the reproductive system.
- Inflammation can lead to scarring.
- Sperm transportation can be affected by scars in the ducts leading to no place for sperm to travel.
- Motility is also affected by the severing of sperm transportation ducts during hernia repair.
- Functional obstruction
- These are disorders which can stop sperm movement, thereby causing male infertility.
- These include conditions such as nerve damage caused in an accident, surgery which has had an adverse effect on the ability of the ducts to transport sperm, and injury to the spinal cord affecting muscular motion.
- The nervous system can also be affected by tranquillizers, anti-depressant medication, and blood pressure medication.
- The brain can fail to release gonadotrophic-releasing hormone (GnRH) properly. GnRH stimulates the hormonal pathway that causes testosterone synthesis and sperm production. A disruption in GnRH release leads to a lack of testosterone and a cessation in sperm production.
- In about 30 – 40% of cases, the problem is in the testes, the glands that produce sperm and testosterone (the main male sex hormone). Damage to the testes can result from infections such as mumps, treatments for cancer such as radiation or chemotherapy, trauma, or surgery.
- Rarely, infertility results from a hormone deficiency.
- Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) cause the testes to produce testosterone and sperm.
- The pituitary gland, located in the brain, makes these hormones. Any condition that lowers LH and FSH levels, such as a pituitary tumor, can result in low or no sperm production and low blood testosterone levels.
History of High Fevers or Mumps
- Mumps is caused by a virus that, in uncomplicated cases, causes the salivary glands to swell up like tomatoes.
- Patients at any other age other than child or adolescent, though, infection can have terrible repercussions.
- Adults, even healthy young adults, can suffer inflammation of the brain and spinal cord, as well as the pancreas.
- Men who develop orchitis, inflammation of the testicles, are slightly more likely to be rendered infertile.
- This does not happen to the majority of men infected with mumps, but it can happen.
- Many men who get the mumps experience some negative fertility effects.
- One out of ten men will have a drop in their sperm count, and about half will notice some shrinkage of their testicles.
- Actual permanent infertility is rare.
- The most common genetic causes of infertility are chromosomal conditions that affect sperm production. These include:
- Klinefelter’s syndrome
- Y chromosome deletions
- Other genetic problems, such as Down syndrome.
- Infertility due to mutations in single gene is less common. Congenital absence of the vas deferens, where there is a blockage to sperm flow, is caused by mutations in the cystic fibrosis gene.
- The most common genetic causes of infertility are chromosomal conditions that affect sperm production. These include:
Lifestyle or Environmental Factors
- Excessive stress, anxiety, lack of sleep and exercise all adversely affect fertility.
- Infertility itself can sometimes become a long-term, discouraging problem, therefore producing more stress.
- Overheating the testicles: Frequent use of saunas or hot tubs or laptop or mobile radiation can elevate core body temperature, which may impair sperm production and reduce the sperm count.
- Use of tight clothing such as jeans or tight under garments made of polyester or polycot can increase the temperature near scrotum leading to male infertility and fungal infections in certain cases.
- Body cells, including sperm cells, cannot function properly in an acidic and toxic environment.
- When the diet is nutrient poor and chemically loaded, the body eventually becomes toxic and disease follows.
- Specific issues include excessive caffeine intake and deficiencies in such nutrients as vitamin C, selenium, zinc, and folic acid.
- Environmental exposure to pesticides and other chemicals:
- Herbicides and insecticides may cause female hormone-like effects in the male body and may be associated with reduced sperm production and testicular cancer.
- Lead exposure may also cause infertility.
- Smoking, excessive alcohol consumption, abuse of illegal drugs, emotional stress, obesity and age
- Abuse of cocaine or marijuana:
- Drug usemay temporarily lower the number and quality of sperm.
- The use of certain drugs can also contribute to male infertility.
- For example, anabolic steroids, which are testosterone injections that are frequently taken by body builders and performance athletes, can cause the testicles to shrink and sperm production to decrease.
- Abuse of cocaine or marijuana:
- Congenital disorders
- Men who smoke tobacco may have a lower sperm count than do those who do not smoke.
- Alcohol or drug dependency can be associated with poor health leading to affect the nerves and blood stream as well as in some cases pituitary gland thereby causing reduced fertility.
Excessive or Prolonged Emotional Stress:
- This may interfere with hormones needed to produce sperm, thus lowering the sperm count
Age:Older men may be less fertile.
Overweight & Obesity:
- A healthy BMI is considered to be between 18.5 and 24.9.
- A BMI between 25 and 29.9 is classified as ‘overweight’ and over 30 as ‘obese’.
- Overweight and obese men have worse sperm quality than men of healthy weight.
- Being overweight or obese can also cause hormonal changes that reduce fertility and make men less interested in sex.
- Men who are very overweight are also more likely to have problems getting an erection.
- Together, these factors reduce the chances of men who are overweight or obese fathering a child.
- Being underweight can also reduce a man’s sperm quality and therefore his fertility. A BMI under 18.5 is classified as ‘underweight’.
Fertility Gradually Decreases in Men Older Than 35 Years
- Changes in sperm:
- Abnormal sperm cause the majority of male infertility problems.
- When a man reaches age 40 and beyond, he gradually experiences several changes in his sperm.
- Lower sperm count
- A decline in sperm movement
- A decline in sperm quality
- Abnormalities in sperm shape and structure (morphology)
- DNA in sperm begins to break down, causing chromosomal abnormalities
- As men age, increase incidence of erectile dysfunction (ED)
- Erectile dysfunction, or ED, is another cause of age-related male infertility.
- ED occurs more often as men age.
- This can occur for a variety of physical and psychological reasons, which need to be diagnosed and treated.
- Age causes changes in the male reproductive system and organ that can cause the system to operate less efficiently.
- Changes to male reproductive organs also begin to occur gradually at age 40, including smaller, softer testes and less elasticity in the tubes that carry the sperm.
- These physical changes can make it more difficult for the body to properly produce and transport sperm for fertilization.
- Changes in sperm:
Men with Normal Sperm Counts And Abnormal Morphology
- Those men who present with normal counts above 20 million/mm3 with abnormal morphology of sperms can lead to infertility.
- Various reasons can be due to-
- Chronic Stress
- The test conducted at Prasad Hospital:
- Repeat semen analysis with three days absence
- Scrotal scan and color Doppler test
- Sperm DNA fragmentation test
Men Present With Low Counts With Normal Morphology
- The approach for fertility management in these men is encouraged with the help of IVF procedures.
- Our center experiences 60 to 70% success rates in conceiving a healthy baby with help of innovative techniques
Men With Extremely Poor Sperm Count Less Than 1 Million/mm3
- Intra-cytoplasmic sperm injection (ICSI) is the best suitable method
- The success rate depends on the skill of the IVF specialist
Non-Surgical Sperm Retrieval
Microsurgical Epididymal Sperm Aspiration (MESA)
Percutaneous Epididymal Sperm Aspiration (PESA)
TESA: Percutaneous Testicular Fine Needle Aspiration (TFNA)
Surgical Sperm Retrieval
4.Testicular BiopsyHow it is done
- Simple procedure to remove a small sample of tissue from one or both testicles
- The tissue is then looked at under a microscope to see if the man is able to father a child.
- Local anesthesia is usually adequate for a comfortable procedure. Occasionally required anesthesia is offered.
- The man's semen does not have sperm.
- Hormone test results are within the normal range.
- A testicular biopsy may also be done to get sperm for in vitro fertilization or intra cytoplasmic sperm injection (IVF/ ICSI).
- For the confirmation of obstructive azoospermia in men with normal size testes and normal reproductive hormones and no sperm in the ejaculates.
5. CryopreservationSuccessful sperm cryopreservation allows the opportunity for multiple ICSI cycles without the need for additional sperm retrieval procedures.
- Since ICSI enables even severely impaired sperm to effect oocyte fertilization, as long as sperm are viable, cryopreserved sperm can achieve rates of fertilization and pregnancy similar to fresh sperm.
- Cryopreservation also allows the potential for temporal separation of sperm retrieval procedures from assisted reproductive techniques.
- For obstructive azoospermia pregnancy rates for frozen and fresh epididymal sperm are virtually identical for Non Obstructive Azoospermia (NOA), fresh sperm is preferable.
- Freezing of isolated spermatozoa from testicular tissue is difficult because of the low number of spermatozoa present in testicular tissue and the limited sperm motility of testicular sperm, which makes documentation of sperm viability difficult.
- Sperm retrieval from men with non-obstructive and obstructive azoospermia is now possible with excellent pregnancy rates for obstructive azoospermia and acceptable pregnancy rates for NOA when ICSI is applied.
- The ability to use cryopreserved epididymal and often testicular spermatozoa will continue to limit the number of sperm retrieval procedures necessary to achieve fertility for a couple.
- These advancements, both in sperm retrieval and assisted reproduction, provide the potential of fertility treatment where the only management options were donor insemination or adoption only several years ago.
- Specific genetic abnormalities are associated with azoospermia in men and careful evaluation of the cause of azoospermia is indicated for all men.
- Multiple TESE procedures may cause both transient and occasional permanent alterations in testicular function including testicular atrophy and decrease testosterone levels.
- Therefore, sperm retrieval should preferably be performed by physicians experienced in testicular anatomy and physiology and using an operating microscope.
- Varicocoeles are present in 15% of all men
- 23% of varicocoeles are large
- 3% of all men have large varicocoeles
- Large varicocoeles cause more severe impairments in semen quality
- Varicocelectomy, carefully performed in selected cases
- Results in significant improvement in semen analysis in 60 to 80% of men
- Natural pregnancy rates of 43% and 69% at one and two years respectively, controlling for female factors.
- Reported pregnancy rates after varicocelectomy vary from 20 to 60%.
- As part of the fertility workup, you’ll make an appointment to either produce your sample in office or drop it off at the clinic or lab after you produce a sample at home.
- With sperm, timing is of the essence, so plan accordingly.
- You’ll need to refrain from any sexual activity for at least two to three days, but not more than 10 days before you collect your sample. This means no sex or no ejaculation of any kind, including masturbation.
- Longer or shorter periods of abstinence may result in a lower sperm count or decreased sperm motility.
- Samples produced after two or three days of abstinence will usually have the highest numbers of motile sperm with the greatest forward velocity, when compared to samples produced after shorter or longer abstinence.
- Some men think saving up all their sperm for the day of their test is what’s preferable, but waiting too long between ejaculates is a big mistake
- Older sperm begin to die if ejaculations are infrequent and the percentage of live sperm decreases with increasing abstinence.
- Clean up your act.
- No smoking, drinking, or drugs during the 10 days preceding your sperm collection (of course, you may want to consider these lifestyle changes even further in advance).
- Perfumes and body sprays
- Usage of lubricants
- Too short abstinence less than one day
- High temperature
- Heavy smoking
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