Study of evaluation of causes of male infertility at a tertiary care hospital

Abstract

Introduction: Worldwide 580 million males experience infertility at some point of time in their life; of these, 372 million reside in low- and middle-income countries. Male subfertility is one of the most rapidly growing fields in medicine, with dramatic advances and treatment. If a male infertility factor is present, it is almost always defined by the finding of an abnormal semen analysis, although other male factors may play a role even when the semen analysis is normal. Aims: To classify the causes of male infertility at pre-testicular, testicular, and post-testicular levels. Materials and methods: This study was conducted at the Department of Obstetrics and Gynecology in collaboration with the Department of Radio Diagnosis, Institute of Postgraduate Medical Education and Research, Kolkata. Results: Pre-testicular cause was seen in 7% of patients. Erectile dysfunction is the commonest. In testicular causes, varicocele is the most common (29.6%), followed by idiopathic (25.9%) and trauma in 14.8%, and other causes, such as torsion, infective orchitis, and cryptorchism show a common incidence of 7.4%. In post-testicular, varity in 51.8% is due to ejaculatory duct obstruction and accessory gland dysfunction, and acquired hernia surgeries have a common incidence of 14.81%. The least common cause is epididymal asthenozoospermia. Conclusion: In male infertility evaluation history and clinical examination, semen analysis is the common tool for all groups of patients. Pre-testicular male infertile is mainly due to consequences of primary or secondary dysfunction of endocrine or exocrine glands influencing the male reproductive axis. Testicular group of male infertility are due to varity of genetic, congenital, and acquired insults to the proper testicular function; post-testicular cause of infertility is due to pathology in the pathway of sperm passage; this is influenced by congenital and acquired defects and diseases respectively. The idiopathic group of patients needs further evaluation by use of advanced seminal tests like immunological tests, semen culture, special staining of the spermatozoa, sperm DNA integrity tests, appropriate genetic evaluation and. Evaluation of ultrastructural abnormalities of spermatozoa, for detection of defects in outer dense fibers, microtubules, mitochondria, connecting piece, and acrosome.