The society around us has ingrained thousands of preconceived notions in us. Things we don’t usually second guess before believing in. And one of them is certainly the fact that getting pregnant is easy. What the majority of populations fail to recognize, is that the male and female reproductive systems are anything but simple. Each step, from the production of the sperm and eggs to their movement, fertilization, and implantation, is an extremely delicate and intricate process. A misstep at any point may lead to a barren womb.
Infertility is thus a common issue- and has become even more common with the lifestyle of today. Globally, almost 15% of couples in their reproductive age are unable to conceive. Males can contribute to infertility in around 30-50% of all cases, understanding what causes this becomes vital. Defects in sperm production and their morphology are leading causes of male-related infertility. These abnormalities can be classified under sperm disorders and can be determined by a sperm analysis test. Sperm disorders may occur when-
- The Quantity of Sperm in the semen or the ejaculate is too low. In some cases, there may be no sperm cells present at all. And as a result, pregnancy without external assistance becomes very hard.
- The Motility of the Sperm in the semen or ejaculate is too low which, after the process of copulation, prevents them from crossing the distance between the vagina to the fallopian tube to fertilise the egg.
- The Shape and Structure of the Sperm in the semen are abnormal, which apart from contributing to issues in motility, also contributes to the inability of the sperm to fertilize with the egg, making conception unlikely.
The quantity and motility of sperm present in the semen are often the most defining characteristics that affect fertility. Some of the disorders concerning these parameters of the sperm present in an ejaculate are:
1. Azoospermia
This condition means that there are no sperm cells present in the semen or ejaculate. The reason for this could be either obstruction in the sperm pathway or a lack of sperm due to hormonal defects. In some cases, especially where there are physical obstructions to the path of the sperm, such as a vasectomy, or an abnormal growth of a mass of cells in the pathway, the condition can be reversed through surgical interventions. In other cases, the sperm is extracted directly from the testes using an aspirating needle. These procedures include Testicular Sperm Aspiration(TESA) or Percutaneous Epididymal Sperm Aspiration (PESA).
2. Oligospermia
Oligospermia is a condition where you have a lower-than-normal sperm count. It is termed mild oligospermia when there are 10-15 million sperm per ml of the ejaculate; moderate oligospermia when it is 5-10 million sperm per ml; and severe oligospermia when the sperm count lies between 0-5 million sperm per ml. The reason why this phenomenon occurs is not very clear and in a lot of cases, especially milder ones, this condition may even go undetected. However, the time to conceive significantly increases with mild oligospermia. Intrauterine Insemination (IUI) is a common and popular option considered when diagnosed with mild or moderate oligospermia. Intracytoplasmic Sperm Injection (ICSI) is a good option for severe oligospermia. Lifestyle factors such as smoking, tight clothes, etc have an impact on sperm count and production.
3. Aspermia
When no semen is ejected during ejaculation it is referred to as Aspermia. Aspermia can often confused with azoospermia. However, in aspermia, there is no ejection of any sort of fluid during an orgasm or ejaculation. The causes include retrograde ejaculation, androgen or hormonal deficiencies resulting in absence of semen production, or even blockages to the semen pathway due to extra, abnormal growths. The treatment plan for this condition would depend entirely on the underlying cause of it.
4. Asthenospermia
Asthenospermia describes low sperm motility. Motility basically refers to its ability to be able to move swiftly in a straight line. Such movement of sperm cells impacts their ability to move in the female reproductive tract and fertilize the egg. Motility in sperm is the primary property of sperm which helps in conception. When or if the sperm cells are unable to move, or move extremely slowly, it results in infertility. IVF or ICSI procedures used to treat Asthenospermia.
5. Teratospermia
Also known as teratozoospermia, this occurs when there is an increase in the percentage of abnormal sperm cells in the ejaculate. In general, it is said that at least 4% of the sperm present in the ejaculate must have normal morphology to be able to aid fertilisation. When the percentage of abnormal sperm is 96% and above, it directly impacts fertility. The causes for Teratospermia are diverse- it can be caused by smoking, varicoceles, or even increasing age. The treatment options for this condition include IVF or ICSI
The underlying causes for these disorders to arise can be varied – spanning from genetic abnormalities to hormonal imbalances or even physical obstructions – and their impact on fertility is significant. A semen analysis identifies various parameters such as the pH, sperm volume, motility, its shape and count, and the white blood cell count present in the semen that helps investigate the cause of the disorder. This, then, helps in identifying an appropriate treatment protocol to overcome these limitations.
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