Ann. Pak. Inst. Med. Sci. 2010; 6(1): 7-10

Objective: To determine the frequencies of different etiological factors responsible for male infertility in our setup.
Study Design: Case Series Study
Place and Duration: This study was conducted at Lady Reading Hospital Peshawar, Pakistan, from 1st January 2002 to 31st December 2006.
Materials and Methods: All male patients attending the infertility clinic were included in this study. After taking an informed consent and history, clinical examination and related investigation were carried out and a male factor responsible for infertility were confirmed and a possible etiology was tried to be sorted out. All the above information was collected and entered into a proforma. The data were analyzed in SPSS, version 10.0, Frequencies and percentages were calculated.
Results: Total number of patients was 676, in which 166 (24.55%) were normospermic, 316 (46.74%) were oligo and/or asthenospermic and 194 (28.69%) patients were azoospermic. 240 (35.50 %) patients had a past history of sexually transmitted infection (STI) and 72 (10.65%) had mumps in childhood while 98 (14.50%) patients underwent inguinal/scrotal surgery or sustained scrotal trauma in the past. 24 (3.55%) patients were having varicocele on left side on clinical examination. 340 (50.30%) patients were having pus cells (>1*106/mL) in their semen, out of which 08 (2.35%), 04 (1.17%), 02 (0.59%) and 02 (0.59%) were having growths of N. gonorrhoeae, E.coli, Proteus and Provedencia respectively on semen culture. Out of 194 azoospermic patients, 108 (55.67%) were labeled as having testicular failure on the basis of clinical/radiological examination, semen analysis, hormonal assays or testicular biopsy. Sexual dysfunction in the form of decreased libido or premature ejaculation was found in 234 (34.62%) patients. 616 (91.12%) patients married once, 54 (7.99%) married twice and 6 (0.89%) patients married thrice.
Conclusion: Male factor contributes significantly towards infertility and several treatable causes can be sorted out easily. Thus steps should be taken to create an environment of awareness regarding the issue and male partner should be investigated first thereby reducing the negative social impacts.
Keywords: Male infertility, semen analysis, genital infections, testicular failure.

Introduction

Infertility is defined as the inability to conceive after one year of unprotected sexual intercourse.¹ It affects about 15% of couples and a male factor is responsible in about 50% of cases.² It has got social implications in certain societies. A diagnosis of male factor infertility is responsible for lower sexual and personal quality of life.³ Moreover, an age above 30 years; 3-6 years of infertility duration and male factor infertility are risk factors for marital dissatisfaction.⁴ There are several recognizable causes for male infertility such as varicocele, chryptorchidism, infections, obstructive lesions, cystic fibrosis, trauma, tumours and oxidative stress.⁵ All these are responsible for defective spermatogenesis through cytokine production thereby causing infertility.⁶ Semen analysis is the first step to investigate male infertility.⁷ It can label a patient as normospermic, oligospermic, asthenospermic, teratospermic, leucocytospermic and azoospermic or a combination of these. Patients with varicocele have significant oligoasthenospermia and varicocelectomy improves sperm volume, density, motility and vitality.^{8, 9} Testicular inflammation leads to decreased testicular volume and oligospermia.¹⁰ Testicular damage is also associated with exposure to heat, noise and physical exertion causing terato/oligoasthenospermia.¹¹ Prolonged automobile driving and cigarette smoking are responsible for significant teratoasthenospermia.¹² Patients with history of sexually transmitted infections (STI) have significant leucocytospermia. Early and adequate treatment of STI will prevent late sequalae.¹³ Azoospermia can result from duct obstruction or hypospermatogenesis, absent spermatogenesis, maturation arrest, Sertoli cell only syndrome or Leydig cell hyperplasia.¹⁴ These can be confirmed by testicular FNAC or biopsy. Before embarking upon such invasive investigation, gonadal hormonal levels i.e. testosterone, LH, FSH and prolactin are done. The level of testicular damage can be measured by blood levels of gonadal hormones especially FSH.15 In addition to the causes already mentioned; there are cases of Idiopathic infertility in which the pathophysiology is still unknown.2
This study was conducted to evaluate the spectrum of the disease male leading to infertility in our local community.