Treating male infertility

Dealing with the psychological factors

Most infertile couples or males would go through several emotional states on learning that they are unable to achieve a pregnancy by the man being infertile or the woman being infertile. They go through feelings such as having:

• States of shock
• Anxiety and fears
• Sadness
• Anger and resentment
• Shame
• Feeling of loneliness
• Self blame

While it’s normal to struggle somewhat with these feelings, there comes a point when these emotions may get out of hand and potentially become dangerous. Most men risk ending up with depression. To know about it, he may start having the following symptoms of depression:

• Feeling hopeless
• Lack of interest or motivation to perform normal daily activities
• Poor concentration
• Lethargy
• Poor sleep patterns, insomnia or sleeping too much
• Unintentional weight gain or loss
• Obsession and preoccupation with fertility
• Increased anxiety
• Worsening of the anger and resentment
• Persistent suicidal tendencies

These factors must be handled as early as possible before going in to treatment. The following actions tend to help or reduce such tendencies and help in dealing with the fears after receiving the news.

• Accept the verdict and try to deal with the emotions and disagreements that may become magnified during this trying time. It is easy to start blaming each other , friends, colleagues  and members of the family for certain actions that may be related to the diagnoses made
• Communicate with your spouse and healthcare provider on a regular basis. Finding a support group or a church group is important where you may discuss your emotions and fears
• Participate in other activities and avoid having many thoughts. Engaging in outdoor activities, picnics, mountain climbing, swimming, and other teamwork activities is very helpful
• Never abandon sex after this. In fact you may enjoy dates out to have “fun sex”, have times together with your spouse and have activities that you can do together, to help you focus your energy on your relationship.
• Seek professional counseling to help you get through the situation.

Treating obstructive lesions in males

Obstruction of the ductal system of the male genital tract is a common cause of infertility and may account for around 15% of all infertility in the male. These lesions can occur either in the ducts that lie within the testes themselves or in any part of the ductal system which ends in the urethra. If these obstructive lesions are both found in both ducts and are complete then azoospermia (total absence of sperm) will result. However, if the obstruction is one sided or incomplete then only oligozoospermia (reduced sperm levels) will be present. These lesions of the male genital tract can be congenital (born with) or acquired from infections or trauma.

It is important to pinpoint the site of the obstruction with some accuracy, to be able to decide on the mode of treatment

Types of obstruction in the duct system

1. Intratesticular obstructive lesions such as the one involving the seminiferous tubules themselves and the obstruction that occurs within the rete testis. Another type of Intratesticular syndrome is the hypercurvature syndrome. In this condition the tubules are said to be so tortuous to a point where this change could induce obstruction. There is however no disorder of sperm production and the testis size and FSH levels are normal.
2. Epididymal obstruction. This is the most common site of all the obstructive lesions in the genital tract and makes up more that 50% of all such lesions. The main cause of obstruction is not known but other causes such as
   •    Infections with gonorrhea, chlamydia, viruses like small pox
   •    Infection with either Bancroftian or Brugian filariasis can result in an acute epididymo-orchitis leading to obstruction.
   •    Congenital absence of portions of the epididymis
   •    Infiltrative diseases such as sarcoidosis
   •    Fabry’s disease. This is a rare X-linked metabolic disorder that results in the defective activity of the enzyme galactosidase leading to an accumulation of triglycosylceramide and diglycosylceramide in the tissues. When there is deposition of these substances in the sertoli cells, within the rete and the walls of the epididymis, it causes obstruction
   •    Polyarteritis nodosa is a very rare cause of obstruction
   •    Young’s syndrome. This condition was first described more than 30 years ago (Young 1970). The clinical syndrome consists of bronchiectasis, sinusitis and obstructive azoospermia. The site of the obstruction involving the epididymal duct at the junction between the upper and middle thirds of the epididymis.
   •    Small cysts called microcysts are also an uncommon cause of epididymal obstruction

The treatment of epididymal obstruction

The alleviation of obstruction of the epididymal duct can be done by surgical epididymovasostomy

Epididymovasostomy

This procedure consists of joining the epididymal duct form the portion before the obstruction (proximal portion) to the obstruction to the vas deferens