Selected news stories from the international press relating to Asian (In)Fertilities:
Combating infertility problems - Times of India
(31 October 2009)
Rajeev and Maya Malhotra had been married for just about three years. But Maya's inability to conceive had already started taking a toll on their relationship.
However, a visit to a fertility expert came as a shocker for those pointing fingers at Maya for her inability to conceive - Rajeev's semen analysis test showed that he suffered from oligospermia (low sperm count). He was advised to go in for either Assisted Reproductive Technology (ART) or Intra Cytoplasmic Sperm Injection (ICSI).
A fall in the sperm count of men in their reproductive years is now a serious global problem. And the crisis is equally acute in India. According to doctors, the sperm count of a normal adult male in India has plunged to around 20 million per ml, one-third of what it was three decades ago. While Rajeev is a typical case of low sperm count, several others are suffering from azoospermia - no sperm at all in the semen sample, despite a normal and healthy libido and seemingly normal semen.
Currently, infertility is affecting 20 per cent of couples attempting pregnancy and, in over 60 per cent of the cases, it's due to low sperm count in men. According to Dr Rima Dada, associate professor of anatomy at AIIMS, an infertile man is one whose wife is not able to conceive after one year of regular unprotected intercourse . "Male infertility may be caused due to problems associated with sperm production, sperm transport and sperm motility (ability to move). In the past decade, there has been a marked decline in male reproductive health with increase in the population of sub-fertile males. Due to this, now the accepted definition of lower limit of normal semen quality has dropped from 60 to 20 million per ml," she says, adding, "This proves that environmental and lifestyle causes are adding to this rapid decline. An increasing number of couples find it difficult to conceive and become victims of the associated social stigma."
Dr Hrishikesh Pai, infertility specialist from Lilavati Hospital, Mumbai, adds, "In males, the normal sperm count is more than 60 million and motility is over 50 per cent. However, a male with sperm count of more than 20 million is also considered capable of producing children provided motility is more than 50 per cent."
The possible reasons for such a dip could be stress, both mental and physical. A recent finding by an AIIMS team, which included Dr N P Gupta (chief of urology) and Dr Dada, confirmed that it had affected about 25 per cent of the infertile men examined . "The excess free radical levels produced during oxidative stress can be reduced by intake of antioxidants, like fruits and vegetables. Exercise and meditation also help in improving sperm count," says Dr Dada.
The other factors that reduce sperm count are wearing tight underwear or trousers, bathing in very hot water, sitting for long hours, pesticide exposure and being overweight (fat layers sag on the testicles). Laptops too affect fertility, because they are frequently positioned close to the scrotum. The user sits with his thighs close together, and this traps the scrotum between the thighs.
Smoking is a risk factor, as it impairs sperm count and motility, reduces sperm lifespan and may also cause genetic changes that affect the offspring. Similarly, alcohol lowers the production of sperm and of the male hormone testosterone. Deficiencies of certain nutrients, such as vitamin C, selenium, zinc and folate may also be risk factors. A lot of bicycling too has been linked to impotence in men as pressure from the bike seat may damage blood vessels and nerves.
Dr Rajeev Sood, fertility expert at Max Hospital, says, "Obesity, consuming excessive coffee, fast foods with soya, wearing tight clothes, keeping cell phones in trouser pockets can raise the temperature around the scrotum, causing a reduction in sperm production."
Talking about modern techniques that are helping men with low sperm count achieve parenthood, Dr Sohani Verma, IVF in-charge at Indraprastha Apollo Hospitals, says that with modern ART using intra-uterine insemination , in vitro fertilisation and ICSI, couples with male infertility can be helped. "Even when there is no sperm in the semen sample, these can be retrieved from the testes using testicular sperm aspiration or testicular sperm extraction techniques, and thus pregnancy can be achieved. However, the success rate in my patients is about 40-50 per cent per treatment cycle. At times, donor sperm from a semen bank may be the only option for infertile couples."
How you can increase your sperm count
- Give up smoking and alcohol, which affect liver function and cause a dramatic rise in oestrogen levels
- Exercise regularly
- Eat nutritious food, which is low in fat and high in protein, vegetables and whole grains
- Reduce caffeine intake
- Wear loose undergarments. Do not store your cellphone in the trouser pocket, or place your laptop on your lap. Protect testicles from too much heat
- Avoid frequent hot baths and sauna sessions
- Lose any excess weight, as it tends to cause testosterone/ oestrogen imbalances
- Reduce stress levels by learning relaxation techniques like yoga and meditation
- Make love in early morning or afternoon. Sperm levels are often highest in the mornings
Who is an infertile man?
- An infertile man is one whose wife is not able to conceive after one year of regular and unprotected intercourse
- Men with sperm count less than 20 million per ml or sperm motility less than 50% are considered infertile
- 90% of male infertility cases are due to low sperm count, poor sperm quality or both
- The sperm count of a normal adult male in India, which used to be 60 million per ml around 30 years ago, has plunged to a third of that count - to around 20 million per ml
- A sperm count of less than 20 million per ml is considered low
- Scientists say that sperm counts have been falling at an alarming rate of 2% per annum for the past 20 years, globally
- Infertility affects about 1 in every 5 couples in India attempting pregnancy, with the man responsible in approximately half the cases