“Test-tube babies” – The role of the father (Male sub-fertility)

“Test-tube babies” – The role of the father (Male sub-fertility)


dahasak mal by Lanka Hospitals

Childlessness if often clinically and socially attributed to the female partner or the potential mother mostly in Asian societies. Scientifically however, difficulty in being able to rear offspring (sub-fertility) is proven to constitute equal reasons on the part of the female as well as the male counterpart in a relationship. About one third of sub-fertility can be attributed to male factor, and about one third to female factor. The remaining one third can be due to a combination of issues concerning both partners and in about 20 percent of such cases the condition is unexplained. These internationally proven statistics suggest that equal investigation of the male partner gives rise to equal chances of the female being conceived with a baby.

Miuru Jayaweera spoke to Dr. Madara Ralapanawe – Clinical Embryologist / In Charge of Fertility Centre of Lanka Hospitals about Male Factor sub-fertility.

Q: How important it is to test the male partner in cases of sub-fertility?

A: Investigating the male partner is equally important as investigating the female partner during sub-fertility because the results of these tests determine the whole treatment process that is aimed at creating a new life.

Q: What are the tests that a male partner has to undergo?

A: The most basic test is to determine the sperm count. Then there are tests to determine the motility, concentration and the morphology of the sperms. There are investigations such as ROS (Reactive Oxygen in Human Semen), Sperm DNA Fragmentation Analysis and treatment methods such as IUI (Intra Uterine Insemination), ICSI (Intra Cyto-plasmic Sperm Injection) and IMSI (Intra Cyto-plasmic Morphologically Selected Sperm Injection)

Q: That sounds very technical. Could you please explain each of them in laymen terms?

A: Sure. It all begins when a couple consults a fertility doctor with failure of conception, after 6 months of unprotected intercourse. Usually and firstly the follicles in the ovaries will be monitored and HCG hormone will be administered to trigger egg release and the couple will be advised to have normal intercourse. If this does not give any results after few months, then the couple will be directed to IUI treatment. IUI (Pool Sampling) is when all live sperms in the sperm sample are inseminated to the womb. This is much like natural intercourse, where 80 to 100 thousand sperms gather around one egg and one sperm enters the egg; only difference being the sperms are supported to enter the uterus. However everything depends on the sperm count. If the sperm count in the sample is marginally low, IUI is better than normal intercourse. But if the sperm count is very low, naturally IUI will fail.

Lanka Hospital has also introduced two cutting-edge tests used internationally in management and treatment of IUI. Reactive Oxygen Species (ROS) shows the abnormalities at the molecular level of the sperms when a patient fails in natural conception or fails one or two cycles of IUI even with an acceptable sperm count or high count. The second test, Sperm DNA Fragmentation Analysis identifies whether there is any DNA damage to be found among the sperms and if there is a significant damage, what percentage of sperm has fragmentation, which might be the obstruction for conception.

When IUIs fail a few cycles, the couple opts for IVF treatment. By the time they opt for IVF, they would have spent a lot of money and a lot of time trying to conceive through many failed cycles of IUI, which would have left the female partner with high hormone levels. This is why it is important to test the male partner before starting any sub-fertility treatment.

If the male tests at the outset suggest that the sperm count is very low, the patients can directly opt for IVF. In Vitro Fertilization (IVF) is an Assisted Reproductive Technique (ART) in which the egg and the sperm are united in the laboratory (In vitro).There are 2 methods in IVF called Standard IVF and ICSI (Intra Cyto-plasmic Sperm Injection).Following the extraction of mature eggs from the ovaries, In standard IVF, 2 to 3 eggs are inseminated with 80,000 to 100,000 sperms and will be kept in an incubator. Here, the sperm has to penetrate itself in the natural way. In ICSI, or (Intra Cyto-plasmic Sperm Injection) where sperms are directly injected to mature eggs, the sperm’s entering of the egg can be confirmed in a lab setting.

IMSI is a variation of ICSI, whereas ICSI is the fusing of an egg with a morphologically normal selected sperm in a lab environment, IMSI is when the sperms are thoroughly selected based on its morphological condition (giving special attention to the formation of sperm head in detail) and fused with an egg. This is a proven method for a couple that miscarries the fetus constantly, as miscarriages mostly occur due to morphologically abnormal sperms.

Q: What are the odds of a couple failing to conceive even after all these tests, investigations and treatments?

A: We have a solution even if a male comes to us with a zero sperm count; the option of a Testicular Sperm Aspiration (TESA). If that fails, he can select a sample from the sperm bank, just like the female can opt to go for donor eggs. And the eco-system of Lanka Hospitals fertility treatments are so comprehensive with Physicians, Urologists, Geneticists, Endocrinologists working in tandem with the Fertility Centre, that the chances of non- conception is extremely low. However, each individual couple has its unique sub-fertility problems and we are able to identify them and treat them at Lanka Hospitals.

Q: What future plans do you have for the Fertility Centre of Lanka Hospitals?

A:We will be introducing an advanced fertility treatment called PGD (Pre-implantation Genetic Diagnosis) where the embryo can be checked for genetic disorders such as Down’s Syndrome, Haemophilia, Thalassemia and x- linked diseases, before being inseminated to the womb, giving the chance of deciding against the implantation of such embryos. We will also be announcing the 1000th IVF baby delivery of Lanka Hospitals Fertility Centre, in the near future.

Dr. Miuru Jayaweera

Dr. Miuru is an executive director at Colombo Creative.

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