Male Infertility: Cause for Alarm?
Male infertility indicates an inability of the sperm in bringing about a healthy, viable pregnancy in the absence of a clear female factor. Male factor infertility can arise due to a number of problems in either the macroscopic or microscopic sperm parameters. Most significant among these, are low sperm concentration (oligozoospermia), poor motility (aesthenozoospermia), and abnormal sperm morphology (teratozoospermia). Other less common parameters include semen volume, and markers of epididymal, prostatic and seminal vesicular function which could serve as surrogate markers for male fecundity.
Over the years, there have been many publications on the subject of semen quality, many showing a trend towards a decline in semen parameters, with some others dismissing the findings. Retrospective analysis of the data indicates that sperm parameters have declined in many parts of the world, but there does seem to be a bit of geographical variation, the reason for which still seems to be unclear. This variation could be due to a number of reasons. Firstly, population studies many a times do not include data from infertile individuals and this may bias the data. Secondly, in many countries, especially patriarchal societies, male infertility is not as well reported as female infertility and therefore accurate statistics may not be available. In some African countries, the tradition of “Chiramu” allows an infertile male to bring in a brother or a relative to impregnate his wife. In this way, the man retains his masculine identity and status in his community’s eyes. Finally, the refusal to classify Infertility, especially male infertility as a disease has resulted in sparse statistics. However, the latest WHO (2010) reference parameters seem to suggest that the general trend does point to a decline in semen quality.
Male infertility as a global health issue is on the rise and therefore, a holistic approach to male fertility assessment and sperm analysis is essential if we are to deal with this issue. In light of the emergence of ICSI, other possible options for management of male infertility generally tend to take a backseat. However, a proper initial assessment of the male can often aid in directing the correct course of treatment. Thus, a well taken history, followed by a meticulous semen analysis still form the backbone of any treatment aimed at alleviating male factor infertility. Therefore, the focus should be to improve our technical acumen and understanding of the subject of Andrology. For this reason it is necessary that we should,
To truly get a sense of the prevalence of male infertility and to find effective means to tackle this widespread problem, there is still a great need for further research into the underlying etiology and treatment of male infertility.