I am doctor Rita Bakshi chairperson of international infertility centre in New Delhi. I have been treating infertility for over two decades and I have seen male infertility as a big factor of infertility per se. Causes of male infertility are many. But let me tell you how to diagnose male infertility and what to do when male infertility is there.
Now... It is very easy when a couple comes to me I always ask them that you know for a woman there are so many tests but for a man one single test of semen analysis. Just one semen analysis will diagnose whether everything is all right with a man or not. Semen analysis should be done when there is an abstinence of three to five days. That means a woman and man should not have been in contact for minimum three days and not more than five days. A very long abstinence is also bad and a very short abstinence is also not good.
So it is important to have abstinence for three to five days when one is going for a semen analysis. It is done very simply. Take any clean container and person can masturbate and release ejaculate completely. You know some times when I have seen that when men are collecting the semen and they drop a few drops here and there and first few drops are very rich in sperms. So it is important that the whole sample is collected well in a container and then in this container can then be given for examination. It is seen that you know there are men who will have a normal count is around 60 million to 120 million. So one single ejaculate per ml should have 160 to 120 million... Million..
You can imagine the kind of number sperm that each ejaculate should have. Anything less than 20 million we call oligospermia or less sperm count. And anything less than five million is severe oligospermia that means severely reduced sperm count.
Not there is not only the count but also the mortality. So one has to see not only the number of sperm but how many of them are motile. So it is only the motile sperm which are important and ones which are progressively fast forward motile sperms. So it is important that more than 50% or at least minimum 30 to 50 percent of the sperms should be motile. Only then can you have a nice pregnancy. Also important is the morphology of the sperm.
That is how do they look. Is there anything wrong in the sperm head or in the sperm tail. So what is called the morphology of the sperm. So it is important to look at the morphology, the mortality and the number. All three functional parameters together to call a good sperm analysis. Now this is very simple.
There will be times when there will be not a single sperm. What do we do now? We do a hormone analysis of the males. We see what is the testosterone level we see the FSH, the LH. So what are the hormones that are being produced from the pituitary which go to testes to produce sperm. Are they enough? Is there any failure? So hormonal test, Thyroid, Prolactin, Testosterone, FSH, and LH levels are done. After you have done a hormone analysis and you find... If you can do a physical examination of the male it is important to feel and palpate the testes.
Is it a firm testes? Is it a very small atrophic testes? A small atrophic testes means probably there are no sperms. Probably it is a testicular failure. But if it is a nice firm testes that means there are no sperms outside but it is a good firm testes. That means the factory, the testes is all right so all you have to do is take a needle and go inside the testes and take out the sperm. That means probably there is an obstruction somewhere. Third examination that you can do is an ultrasound of the testes. You can go and do the ultrasound and see the kind of structure that is there.
Is the testes the size the structure of the testes can be seen. Besides this one can do genetic testing of the male to confirm that, you know, one looks like a male but sometimes there is an extra... You know... There is an extra X in the genetic make up. For example Klinefelter syndrome which is XXY. So you know there are the males which will not have enough sperm or no sperms in their testes.
So it is important to do a genetic make up. This is how one diagnoses male infertility.
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