The word subfirtile means an inability to conceive after trying for one year without using any method of contraception.
Whatever the cause of subfertility, the final effect is either a severe reduction or the absence of sperms in ejaculated semen. Sometimes sperms are present in large numbers, but lack in quality at the time ejaculation. This can also result in Subfertility. Male Subfertility could happen due to several conditions. This can be divided as endocrine problems or intrinsic problems with the testis. Among endocrine problems, we have pituitary dysfunction or pituitary tumors as a cause of hypogonadism – among these pituitary tumors a prolactin in secreting a pituitary tumor can be treated medically whereas the rest are treated surgically. Severe forms of hypothyroidism if left untreated can result in Subfertility but this is usually recognised and treated early. Intrinsic problems with the testis or to are more common forms of Subfertility.
Some changes in the appearance can give a clue to the cause of Subfertility in men. Lack of facial and body hair, a lower pitched voice, lack of muscular build are some of the symptoms which represent features of hypogonadism. Very tall is a feature when combined with features of hypogonadism increase the suspicion. In a chromosomal disorder, also called Klinefelter syndrome, the male has a tall stature with very long legs, also called long leggedness.
There are some conditions which are treatable forms of Subfertility, such as hyperprolactinemia, hypothyroidism and hypogonadotropic hypogonadism. Usually these conditions are treated via experienced Endocrinologists.
Some forms of male Subfertility are not permanent and are treatable. Azoospermia combined with normal testosterone usually indicates that there is a severe problem which may be very difficult to treat. In such instances ST cooler sperm extraction (TESE) is an option. In this procedure sperms are extracted from the testis directly and are used for ICSE (intra cytoplasmic sperm injection).
At Magna, we treat patients with fertility problems with a combined approach of an ologist who will take care of the structural issues in the testis and Endocrinologist who will look at hypogonadism, hypothyroidism and hyperprolactinemia.
Endocrine treatment for Subfertility is well-established for specific conditions. Gonadotropin therapy with HCG can restore fertility to a great extent in men with pituitary disease and hypogonadotropic hypogonadism and conditions like hyperprolactinemia are easily treated using cabergolin. Hypothyroidism is a very common treatable cause of Subfertility. In men with hypogonadotropic hypogonadism – treatment is to be done for six months to a year before the sperm counts can improve. Those who stick with a prolonged course of treatment, eventually find success. The prolonged course of treatment is because the spermatogenesis cycle itself is close to 90 days and if there is no spermatogenesis happening, it takes 3 to 4 such cycles for a good amount of sperms to be produced.