Male Infertility - An Analysis in a Low Resource Setting

Abstract

Purpose: The prevalence of male subfertility is increasing among couples seeking fecundity in recent years. A prospective study was carried out in a gynaecological outpatient, to study the benefit of a low cost algorithm for determining the etiology of infertility in adult males with suboptimal semen parameters. Materials and Methods: Thirty one males, who had a sperm concentration less than 15 million/ml were considered in the study. The cost of diagnosis was kept low; not exceeding 150 US dollars. A similar algorithm of investigation was followed for all patients and medical treatment provided as per treatment guidelines. Results: A confirmed etiology could be determined in 7 patients, while a probable diagnosis was suggested in 21 males. Endocrino-metabolic causes were the most important etiological factors in our Indian population. Lifestyle diseases like obesity, insulin resistance were prominently found in the suspected acquired hypogonadotropic hypogonadism group. Medical treatment was provided to 24 subfertile males, and 64% showed good improvement in seminal count, after 3 months of therapy. Only selected patients were referred to higher teritiary centres, for specific interventions like sperm retrieval techniques, intracytoplasmic sperm injection of the female partner. Conclusion: This study proves that male subfertility can be managed in a low resource centre, with the help of a simple algorithm, with ease and proficiency, thereby reducing economic burden on these couples. Also, this analysis has helped us to ascertain the relative propensity of etiological factors among adult males with infertility ,in North India in the present time.