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 gynecological outpatient,  to determine the benefit of a low-cost algorithm for the diagnosis of adult males with suboptimal semen parameters. Materials and Methods Twenty-nine males, who had a sperm concentration of 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 the investigation was followed for all patients and medical treatment was provided as per treatment guidelines. Results A confirmed etiology could be determined in 9 patients, while a probable diagnosis was suggested in 17 males.  Endocrino-metabolic causes were the most important etiological factors in our Indian population. Lifestyle diseases like obesity, and insulin resistance were prominently found in the suspected acquired hypogonadotropic hypogonadism group..Medical treatment was provided to 24 males, and 64% showed good improvement in the seminal count, after 3 months of therapy. Only selected patients were referred to higher tertiary centers, for specific interventions like sperm retrieval techniques, and intracytoplasmic sperm injection of the female partner. Conclusion This study proves that male subfertility can be managed in a low-resource semiurban center, with the help of a simple algorithm with ease and proficiency, hence reducing the 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 at the present time.