In this age, the concept that infertility is somehow associated with only a woman’s inability to conceive has become outmoded. It is now widely understood that 30-40% of infertility cases may be due to problems with male counterparts. This is owing to either ineffective sperm delivery as seen in retrograde ejaculation, altered testosterone levels, or abnormal sperm count that can be associated with a condition known as varicocele. Regretfully, there are cases which can’t be helped; however, on the brighter side, all hope is not gone with the availability of multiple infertility treatment options in the market. Perhaps, if you suspect being the victim of varicocele, it is best suited to seek immediate medical attention than to wait until the condition gets worse to the point that it can’t is untreatable.
Explaining Varicocele
The reasons associated with male infertility correspond to their unique reproductive anatomy. In men, the scrotum is a skin-covered sac that holds the testicles along with arteries and veins that deliver blood to the reproductive system. Varicocele is a clinical condition that causes the enlargement and dilatation of the scrotal veins. These veins form a vascular network known as pampiniform plexus in the spermatic cord, which ultimately connects to the vessels in the abdominal cavity and takes blood back to the heart. A varicocele is a varicose vein of the testicle and scrotum that is very similar to varicose veins that occur in the leg. It results in low sperm count and decreased quality, which is usually the main culprit behind infertility issues. It is deemed as the most common yet correctable cause of male infertility which has been associated with deleterious effects on spermatogenesis, sperm quality, testicular atrophy, reproductive hormones and pregnancy outcomes.
Varicocele raises the temperature of the testicles, which has mainly two effects. First, it affects the development and quality of sperm and second, it leads to a decrease in the production of testosterone, which is involved in the production of sperm. Moreover, the increased temperature is said to lead to a rise in reactive oxygen species (ROS), which damages the sperm DNA.
Symptoms Associated with Varicocele
It’s scary to be in oblivion, when you don’t know what is wrong with you while nothing is going your way. Following are the few symptoms associated with varicocele.
Pain: Where many patients do not find any scrotal discomfort. Some go through mild discomfort or severe pain when standing or sitting for prolonged periods due to the pressure that builds up in the affected veins, which is relieved when the affected person lies on its back.
Infertility Issues: Nearly 30% of couples that are facing fertility issues are diagnosed with presence of varicocele in the male counterpart. Infertility has been said to be associated with raised temperature in the scrotum, which affects sperm production.
Testicular Atrophy: Testicular shrinking is another giveaway of varicocele in the affected individuals.
Diagnosing Varicocele
Varicocele diagnosis is traditionally made upon physical examination, which is typically performed in the laying and standing position, wherein the scrotum is examined for visible swelling during rest and straining conditions. Along with physical examination, scrotal ultrasound, venography, and color doppler ultrasonography are also used for its diagnosis.
It is graded ranging from grade 0-3 depending on the clinical findings on palpitations and testicular size. Where grade 3 varicocele is easily identified through physical examination however, lower grade varicoceles are difficult to pinpoint, particularly in case of certain clinical comorbidities.
Varicocele Treatment
Below are listed some available options patients suffering from varicocele can opt;
Surgical Procedures: There are three types of surgical approaches that are typically used for its treatment, namely, laparoscopic surgery, open surgery and microsurgery. All of these options involve hospitalization, incisions, extended recovery time, scarring and recurrence potential.
Healthy Diet and Supplements: It’s been observed that foods that are rich in fiber and antioxidants are exceptionally good for varicocele patients in relieving the symptoms. Furthermore, supplements might prove to be beneficial as well since our daily diet lacks all the necessary nutrients therefore, taking these will allow the consumption of the nutrients that we are missing out on in appropriate amounts which will have their long-term effects.
Varicocele Embolization: It is a minimally invasive 3-D precision guided treatment first time introduced by Dr Imtiaz Ahmad in 2019 in Pakistan. Dr Imtiaz Ahmad is an American trained and highly qualified Endovascular Surgeon and interventional Radiologist.This procedure is performed using real-time fluorescent imaging to guide catheters inside the body through the Jugular vein and sometimes femoral vein. Using either mild IV sedation or local anesthesia, patients remain relaxed and experience minimal pain during the procedure.No surgical incisions are formed with no risk of scars. The blood flow to the affected vein is stopped by injecting FDA approved medications through the catheter, which embolizes the abnormal veins with defective valves and thus reduces the pain, pressure and high temperature in the groin and specifically along the testis.Through embolizing the vein, the blood flow is redirected to healthy vessels in the vicinity.
Varicocele Embolization has been first introduced as a 3-D precision guided endovascular treatment in two of the major cities of Pakistan; Karachi and Lahore. The embolization procedure is carried out using FDA approved medications by Dr. Imtiaz Ahmad, who is a world renowned interventional radiologist and endovascular surgical specialist. As a part of post-treatment practice, the patient can expect a follow-up for up to 6 months. There are numerous success stories of patients that underwent the procedure performed by Dr. Imtiaz Ahmed, whose lives are restored to a hassle-free state that they have been looking for a very long period of time and couples are able to have successful pregnancies and children.
When couples decide that it’s time to start a family, often at times, fertility can be a serious impediment for them and the process does not seem as easy as they had initially hoped. What’s more daunting is that it comes with undeniable emotional and psychological ramifications. Therefore, if you think you are suffering from fertility problems, the initial course of action should be to consult your doctor at the earliest, who will likely take your medical history, perform a complete physical check-up and recommend several fertility tests for men to find out what could be the underlying cause of your infertility, which usually is correlated with low-quality sperm production that interferes with conception.
When it comes to fertility, it’s a 50-50 deal: half egg and half sperm. It isn’t a blame game, so it shouldn’t come as a surprise if the complication in getting pregnant is associated with men. If you are stuck in this dilemma, then it’s about time that you empower yourself with the knowledge of alternative options and treatments that you need to get for the outcome you want. In spite of its prevalence, male infertility is often ignored in conversations. In our society, it’s the lack of awareness surrounding male infertility along with a heavy stigma surrounding the topic, that keeps men reluctant from openly talking about their fertility struggles. This drives the situation to the point where couples miss out on having the opportunity of being able to conceive.
Explaining Male Factor Infertility
Male factor infertility is clinically defined as the presence of abnormal semen parameters in the male partner of a couple who is unable to conceive after one year of unprotected intercourse. Therefore, World Health Organization (WHO) male factor infertility is the presence of abnormalities seen in semen analysis.
There is a general division that allows your expert urologist to appropriately workup the underlying cause of infertility. This helps your doctor in choosing a specific course of action for treatment that suits you best. Male factor infertility is in essence associated with suboptimal sperm parameters that can either exist alone or in combination which include deficiencies in sperm formation that result in lower sperm concentration, poor sperm motility, abnormal morphology along with suboptimal delivery or transportation.
Researchers have noticed that the rates of infertility in less industrialized areas are markedly higher that have been associated with the prevalent infectious diseases in those specific regions, which then contribute to a greater proportion of infertility.
Symptoms Associated with Male Infertility
Often there won’t be a particular symptom of for it, apart from the obvious obstructions in trying to get pregnant. Your medical expert will perform a thorough medical and urologic history. That will include your timing of puberty, the duration of infertility, any urologic disorders, spinal cord injury, medical illness, or surgical procedures for the proper diagnosis.
It’s Underlying Causes
Some of the underlying causes of male infertility include:
Disorders relating to sperm production
Structural abnormalities in sperms
Any prior surgical procedures such as vasectomy and hernia repairs
Groin or spinal cord injury
Varicocele
Immunologic disorders
Hormonal disturbances
Environmental factors
Diagnostic Tests for Male Infertility
Your overall sperm quality provides a window to your health. It’s highly impacted by your lifestyle choices such as smoking and alcohol consumption which further deteriorates the condition however, that can be improved by adopting good diet, exercise, and sleep pattern.
To diagnose the culprit behind male infertility, your urologist or male infertility expert will recommend fertility tests that asses the semen which will measure three main factors including your sperm concentration, its morphology and motility. While more sperm count isn’t necessarily better, however, less can be problematic. Similarly, sperm must be of a certain shape to be able to penetrate the egg to fertilize it. Similarly, the sperm’s ability to move is also of great importance during the process of conception.
In many cases, your genetic background can be a factor behind your fertility issues. If your semen analyses show fewer than five million sperm per mL in your semen, DNA testing is recommended, such as karyotyping and Y-chromosome analysis.
Y-Chromosome Microdeletions (YCMD)
Men with very low sperm counts are usually recommended to get tested for Y-chromosome microdeletion fertility test. These may be transmitted to your offspring, which may result in fertility problems in your male progeny.
Y-chromosome is essentially related to male fertility and unfortunately there are cases where portions of the Y-chromosome are missing or simply put deleted. It’s still possible for the patient to produce few healthy sperms if these mutations do not affect your fertility related regions in the chromosome. However, if the portions of your chromosome that are critical in the development of healthy sperm are deleted, then it is a rather bad news and may require extreme medical interventions.
DNA Fragmentation And Male Infertility
Sperm DNA fragmentation is a physical break in either one or both strands of DNA within the sperm. Many studies till date have shown that sperm DNA damage is common in infertile men which may be the contributing factor towards poor reproductive outcomes. It’s been found that despite having normal semen analysis results, a large proportion of men dealing with infertility issues have increased DNA fragmentation. Therefore, fertility tests assessing DNA integrity is yet another method used to assess your fertility potential.
There are many different types of tests for sperm DNA fragmentation, which provide an estimate of the degree of DNA damage present in a semen sample. Most used DNA fragmentation tests include sperm chromatin structure assay (SCSA), deoxynucleotidyl transferase-mediated dUTP nick end labeling assay (TUNEL), the single-cell gel electrophoresis assay (COMET) and sperm chromatin dispersion test (SCD).
Karyotype
Karyotyping is the analysis of all chromosomes of the said subject to see if there are any chromosomal abnormalities, such as extra or missing chromosomes.
Treatment Options for Male Factor Infertility
Depending on the results of your semen analysis, your reproductive urologist will refer you to different treatment options. Some of the treatment options are categorized below:
Medications – a regimen is prescribed to control hormonal imbalances and treat any urogenital infection.
Non-invasive varicocele treatment to correct enlarged incompetent veins around testes.
Intrauterine insemination (IUI) – In this procedure, sperm is placed inside the uterus thus, bypassing the need for sperm transportation and delivery.
In-vitro fertilization (IVF) – In this procedure, fertilization of an egg and sperm is performed in a lab test-tube.
Amongst the most common causes of infertility are varicocele, which is characterized by dilated or enlarged blood vessels around the testicles. It is the result of abnormal closure of the vessels valves which leads to pooling of blood around the testicle, due to which the temperature inside the testicle rises and thus compromises the sperm production.
The non-surgical treatment for varicocele is a complex and challenging procedure which requires high expertise in the said field. So far, the best treatment for varicocele available is the minimally invasive endovascular treatment. Varicocele treatment in Pakistan was introduced by Dr Imtiaz Ahmed, who is an endovascular surgical specialist and an interventional radiologist who treats men suffering from infertility issues that may have little hope left. The technique uses fluoroscopic guidance which helps the catheter to reach the selective abnormal veins draining blood from the testis while using specialized FDA approved devices and medications for the treatment of abnormally enlarged veins(Varicocele)around the testis. The entire treatment is done in single session and patient is discharged on the same day in 1-2 hours after procedure.
