World IVF Day: How does IVF help men in overcoming infertility?

Infertility is a growing concern worldwide, affecting roughly 1 in 6 couples according to the World Health Organization (WHO), with male factors contributing to around 50% of these cases. While the focus often falls on women's health, a significant portion of infertility cases involve male factors. Beyond celebrating the incredible strides in assisted reproduction, World IVF Day, marked annually on July 25th, serves as a vital reminder that male fertility is just as crucial for conception as female fertility. Often, the conversation surrounding infertility focuses on women's health. However, this day brings the spotlight to the significant role men play in family planning. On World IVF Day, Dr. Kshitiz Murdia, CEO and co-founder of Indira IVF and Dr Priyank Kothari, consultant andrologist and assistant professor at B.Y.L Nair Ch Hospital, Mumbai delve into fertility challenges faced by men, and the benefits of assisted reproductive technology.

Prevalence and causes of male infertility in India

"We are facing a pandemic of non-communicable diseases in India, with a manifold rise in diabetes, hypertension dyslipidemia and other environmental and lifestyle-related illnesses. Infertility is among these and it is estimated that 15 to 20 per cent of couples in India suffer from infertility. Infertility in a couple can be due to either male factors, female factors or both. Male infertility contributes to 40 to 50 per cent of all cases. Exposure to environmental toxins such as lead and mercury, age, lifestyle factors such as smoking, obesity, drug and alcohol abuse and lifestyle stresses are the main causes of decline in male fertility over the past decade," explains Dr Priyank Kothari.

Comprehensive diagnosis and understanding of male infertility

Unfortunately, despite the high prevalence of male infertility in India, there is still a lack of awareness about the condition and its causes. "The 1st step in evaluating a couple for infertility should be a Semen Analysis and any couple unable to conceive after 12 months of unprotected intercourse can be labelled infertile and needs to consult an expert for evaluation," poses Kothari.

He elaborated, "The diagnosis of the male factor contributing to infertility is confirmed by a semen analysis done after 2 to 3 days of abstinence. At least 2 semen samples a month apart are usually required for an accurate estimation as there is considerable physiological variation in the semen parameters of a normal male. There can be a decrease in count, Concentration (Oligozoospermia), motility (Asthenozoospermia), quality of sperms (Teratozoospermia), or a combination of factors. The cause can be due to hormonal deficiency, testicular dysfunction, or external factors. Varicocele can be a very common cause of poor counts and motility (dilated veins above the testis signifying poor blood flow) and is a surgically correctable cause of male infertility. In 10 % of men with sub fertility there can be a complete absence of sperms in the ejaculate (Azoospermia)."

Murdia adds, "ART employs a range of diagnostic tools, including semen analysis, DNA fragmentation testing, hormonal evaluations, and genetic screening. These tests provide comprehensive insights into sperm quality, quantity, and genetic integrity, as well as potential structural or hormonal issues. This thorough approach enables fertility specialists to develop tailored treatment plans and select the most appropriate ART techniques for each case, maximising the chances of successful outcomes."

Targeted and effective treatment options

The advent of assisted reproductive techniques like IVF (In Vitro Fertilization) and ICSI (Intracytoplasmic sperm injection) in the past two decades has revolutionised the treatment of male infertility. Murdia tells us about the range of targeted treatments tailored to address specific male fertility issues identified during the diagnostic phase. He shares, "Intracytoplasmic Sperm Injection (ICSI) is a notable procedure that assists men with low sperm count or poor sperm motility. ICSI involves the direct injection of a single sperm into an egg, significantly increasing the likelihood of successful fertilisation. Studies have shown that ICSI results in fertilisation rates of 80-85 per cent demonstrating its efficacy in overcoming many barriers to natural fertilisation.".

How can we know the parameter of being fertile? Kothari answers, "Fertile men usually have counts in the range from 15 - 100 mill/ml and motility of 40 per cent or more(forward movement of sperms under the microscope). In men with borderline decrease in count ( > 10 million) with good motility IUI(Intrauterine Insemination) is an option. In IUI the semen sample is purified and concentrated using various laboratory techniques and a high-quality aliquot is injected at the time of ovulation(egg rupture) into the uterus as a simple side room procedure."

He goes on to stress how the motility of sperm is important for the success of Intrauterine Insemination(IUI). "IUI is also beneficial for female factor infertility or when women have PCOS and irregular menstrual cycles. Men with very poor counts of less than 5 million/ ml sometimes even less than one million(occasionally a very few live sperm) in the ejaculate, where natural conception hasn't taken place after years of attempting unprotected intercourse need advanced techniques like IVF or ICSI to be able to father a biological child."

Kothari briefly explains the most well-known ART, "IVF entails harvesting oocytes from the ovary under ultrasound guidance at the appropriate time in the women's cycle and adding the sperms to the media containing the egg. The media resembles the physiological fluid present in the uterus facilitating the formation of an embryo (1st few cells of a newborn) which is then incubated (at optimal temperatures) till it reaches a stable form and is transferred back into the uterus (womb) at an appropriate time in the cycle. The embryo then implants into the uterus and further grows as a fetus in the women achieving successful pregnancy which then continues as usual process of 8-9 months followed by childbirth. Thus, even 15- 20 sperm can be used for IVF and a successful pregnancy is achieved. Men with low counts who haven't benefitted from other conservative measures are advised for IVF after appropriate evaluation of the female partner.

Benefits of assisted reproductive technology for men

ART has significantly advanced fertility treatment for men, leading to numerous successful pregnancies through its combination of cutting-edge techniques and personalised care. The benefits of Assisted Reproductive Technology for men are extensive and impactful. From accurate diagnosis and targeted treatments to advanced retrieval techniques and fertility preservation, ART offers comprehensive solutions to address male infertility. As technology and medical expertise continue to advance, the
prospects for men facing fertility challenges will only improve, offering them greater opportunities to achieve their dreams of fatherhood.

Advanced sperm retrieval techniques

"For men with conditions such as non-obstructive azoospermia, where no sperm is present in the ejaculate, advanced sperm retrieval techniques like Micro TESE (Microdissection Testicular Sperm Extraction) offer a viable pathway to fatherhood. This surgical procedure involves extracting sperm directly from the testicular tissue, enabling men with severe fertility issues to produce viable sperm for fertilisation. Data indicates that Micro TESE can successfully retrieve sperm in approximately 50 per cent of cases, providing hope for men previously deemed infertile," says Murdia.

Fertility preservation strategies

ART also plays a crucial role in fertility preservation for men, highlights Murdia. He elaborates, "Sperm cryopreservation, or the freezing of sperm, is an invaluable option for men who may undergo treatments or face conditions that could compromise their fertility in the future. The success rate of sperm cryopreservation and subsequent use in ART procedures is well-documented, with live birth rates comparable to those using fresh sperm. By preserving their sperm, men can ensure the possibility of fathering biological children at a later date, offering peace of mind and strategic family planning options."

Psychological and emotional benefits

The psychological and emotional impact of infertility on men can be profound, affecting self-esteem, relationships, and overall well-being. ART provides not only medical solutions but also emotional support and hope, as per Murdia. "The advancements in ART offer men concrete options and a sense of control over their reproductive futures, alleviating some of the stress and uncertainty associated with infertility. Studies have shown that successful ART treatments can significantly improve psychological well-being and relationship satisfaction among couples facing infertility," concludes the expert.

Also Read: The monsoonal blues: Navigating mental health in the season of rain