BackMale fertility takes a hit
Rising levels of pollution, pesticide use and zinc deficiency are some of the reasons for falling sperm counts
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A Mumbai-based couple couldn’t conceive for many years. Finally, the diagnosis came: The male partner didn’t have the tube that transports sperm from the testis to the urethra. The news was hard for him to digest.
“In our culture the entire onus of reproduction is pushed on to the female, so it becomes difficult for the couples and their families to accept a diagnosis of male infertility," says Jaydeep Tank, fertility expert, programme director and board member, Birla IVF Fertility Clinic, Mumbai. “These cases need to be tackled with empathy and both the spouses should be counselled to make them understand that viable medical intervention is an option," he says.
The husband in the case mentioned finally came around and medical intervention (Intra-Cytoplasmic Sperm Injection) helped the couple become parents of
a daughter.
Sonia Malik, an IVF expert and director, Southend Fertility and IVF Centre, Holy Angels Hospital, New Delhi, says: “The most common causes of male infertility include azoospermia (when no sperm cells are produced) and oligospermia (when few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. And all these sperm situations are on an increase."
In a bid to understand the reasons for the dip in fertility, she began studying the causes of male infertility and even did a 10-year comparative sperm-data analysis starting in 2000 (without a grant; the study is yet to be published). She studied 400 patients who came to the clinic and
observed that there was a huge decline in both male sperm count and motility and also a drastic change for the worse in the morphology (structure and form) of the sperms in this time span.
Apparently the sperm count in males over the years has gone down so drastically globallythat for the first time in medical history, the World Health Organization (WHO) in 2010 brought down the standard from 40 million per ml to 20 million per ml, says Archana Dhawan Bajaj, consultant obstetrician, gynaecologist, fertility and IVF expert at The Nurture clinic, New Delhi. “This trend of falling sperm count has been seen globally and now up to 50% of cases of infertility, I would say, are due to male causes," agrees Hrishikesh Pai, gynaecologist and infertility expert, Lilavati Hospital and
Research Centre, Mumbai.
Behind the scenes
Increasing levels of pollution are one of the prime causes of the decline in sperm count. “The rapid expansion of the chemicals industry in the country," says Dr Malik, “has resulted in the release of a plethora of xenobiotics (molecules foreign to biological systems) into the environment. Xenobiotics and other environmental factors such as radiation can lead to male infertility. The nitrogen dioxide and sulphur dioxide (levels of which are increasing because of vehicle emissions, industrial waste, pesticides, etc.) present in the environment affect fertility. These decrease sperm motility and increase the DNA damage of the sperm," adds Dr Dhawan Bajaj.
Pesticides too can cause a fall in fertility levels. “Crop sprays (like HPTE) can stop testosterone production for more than 17 hours after exposure," says Dr Malik. “I would advise everyone to eat food only after washing and cleaning well. Or better still, switch to organic," adds Dr Pai.
Zinc deficiency has a role to play too. Zinc (a micronutrient abundantly present in meat and seafood) is essential for the functioning of more than 80 enzymes involved in DNA multiplication and protein synthesis. So its deficiency leads to decreased testosterone levels and sperm count. “Zinc levels are generally found to be lower in infertile men with diminished sperm count," says Dr Malik. “Often supplementation of zinc (in those who are deficient) helps improve sperm counts and boosts testosterone levels," Dr Pai adds.
What’s the solution?
The long-term solutions are an improvement in environment and better lifestyles. “Pollution is definitely not in our control but changing our lifestyle (no smoking, less alcohol, more exercise and reining in stress) is the way to go," suggests Dr Pai. Medical aid can provide relief too. The three most effective interventions, according to the experts, are:
• “IVF (In-vitro fertilization), where the success rate is as high as 40-50%, is a good option. In IVF, an egg is surgically removed from a woman’s ovaries and fertilized with male sperm in a laboratory. The fertilized egg (now called an embryo) is again returned to the woman’s womb to nurture and develop," explains Dr Pai. The procedure costs approximately ₹ 1.5 lakh.
• But Dr Tank believes the real breakthrough came around 20 years back, when the first child was born from a treatment called ICSI (Intra-Cytoplasmic Sperm Injection), developed by Gianpiero Palermo in 1991 in Brussels. This treatment enabled embryologists to insert the sperm directly inside the egg. Till then, what had been possible was conventional IVF, which had its limitations as the success rate when sperm count was low was not good. “ICSI revolutionized the treatment available for low sperm count and even men who had no sperm in the semen can use this treatment for it requires collecting the sperm directly from the testis," he says. It costs approximately ₹ 1.5-2 lakh.
• Finally there is Intracytoplasmic Morphologically Selected Sperm Injection, or Imsi, which is recommended for couples who have had repeated ICSI/IVF failures or men whose samples show low counts with abnormal sperms. “In instances when male sperms are either infertile or of poor quality, this technology makes the procedure of identifying quality sperm more precise. In this procedure, sperms are magnified to 7,200 times, which gives us the option to choose the good sperms from the bad ones," explains Dr Dhawan Bajaj. Imsi can cost up to ₹ 2-2.25 lakh approximately.
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