The Crucial Role of Male Partner Assessment in Fertility Treatment
This session presented by subject expert Dr. Venugopal M, who is an excellent teacher, IFS (Indian Fertility Society) Andrology SIG (Special Interest Group) besides being Secretary, Kerala chapter IFS.
WEBINARS
KEY TAKEAWAYS
When is comes to diagnosis of infertility, the first contact is a gynaecologist, and it is a common misconception that it is all about female. Do not forget the male partner who deserves a better evaluation.
Preliminary requirement is good semen analysis- from a reputed and reliable lab; besides a good history taking from both partners, about coital pattern/problems, drug abuse, alcoholism, binge drinking, going to the gym, previous surgeries, sexual history. Spend time with the male partner.
Look beyond sperm count and use caution while interpreting the reference values which may differ for the population in your area; importance of volume, viscosity, pH, motility, morphology all to be considered to help decide whether to offer IUI or not
Additional tests may be left to specialist, but nowadays there is a lot of genetic contributions to male infertility, do not forget that.
Approach for medical management should be examine, investigate, and compartmentalise - most patients will have either a hormonal problem, or infections or male oxidative stress. No blanket prescriptions to be given - categorise, then prescribe.
Testosterone is never to be given as treatment - it will cause reverse feedback and lead to azoospermia - also taking testosterone derivatives by gym goers is disastrous. Find other ways to increase the testosterone.
Rational use of antibiotic may be used. Remember, only 5% men with mumps become sterile.
Male oxidative Stress Infertility (MOSI) is one reason for low count, and antioxidants should be given.
Lot of antioxidants are available, look for quality and rational use of combinations to be given for a minimum of 3 to 6 months. Too much of use can lead to antioxidant paradox - we need some oxidative stress in the body for bodily functions.
Azoospermia is no longer synonymous with sterility - there are options available.
Varicocele surgery is not needed in case sub-clinical, DNA fragmentation of the ovum and sperm need attention
Most important is counselling of the infertile couple by the gynaecologist, being the first point of contact. Being updated with the latest information and knowledge of all the points mentioned will go a long way in treating male infertility.
