Study on causes of infertility
among males attending infertility clinic at a rural teaching hospital
in Andhra Pradesh
K. Pushpalatha 1, R
Sudhakar 2, G Raja Pramila 3
1Dr. K. Pushpalatha, Associate Professor, Maheshwara Medical College,
Chitkul (V), Near Isnapur X Roads, Patancheru, Medak District,
Telangana 502307, 2Dr R Sudhakar, Associate
Professor Gitam Institute of Medical Sciences and
Research, Vizag, 3Dr G Raja Pramila, Professor, Gitam Medical College
Rd, Rushikonda, Visakhapatnam, Andhra Pradesh, India
Address for
Correspondence: Dr. K. Pushpalatha, Associate Professor,
Maheshwara Medical College, Sangareddy. Email id: resdoc555@gmail.com
Abstract
Introduction:
The incidence of infertility is increasing in developed and developing
counties due to various causes, out of these many are preventable. The
paper outlines study conducted to find the impact of various causes in
male. Methods:
All patients who attended the infertility clinics of GEMS Medical
College, Srikakulam, between March 2014 to February 2015 were included
in the study. Results:
Infertility was high among men aged 20-25 and 30-40 years with 62.07%
and 62.96%. Most common abnormality of infertility by microscopic study
was found to be Pyospermia (38.46%), followed by Oligozoospermia
(16.92%) and lowest abnormality is Hematospermia (3.08%). Conclusion:
Infertility is high in 20-25 and 30-40 age group. Pyospermia was the
most common microscopic abnormality; Preventable causes (87%) are
commonest cause for infertility. Abnormality is found to be more than
50% among the patients.
Key words: Male,
Infertility, Pyospermia, Microscopic study
Manuscript received: 20th
November 2016, Reviewed:
30th November 2016
Author Corrected:
08th December 2016,
Accepted for Publication: 15th December 2016
Introduction
72.4 million couples globally experience fertility problems [1]. As per
the WHO estimates 60–80 million couples worldwide currently
suffer from infertility [2]. As per the WHO, the overall prevalence of
primary infertility ranges between 3.9% and 16.8% [2]. Also, the
estimates of infertility vary widely among Indian states from 3.7% in
Uttar Pradesh, Himachal Pradesh, and Maharashtra, to 5% in Andhra
Pradesh, and 15% in Kashmir [3-5].
In the developed countries and communities the birth rate is rapidly
decreasing over years [6]. The incidence of infertility is increasing
in developed and developing counties due to various causes, out of
these many are preventable [7-9]. Now this phenomena has
become quite common in India also. India’s economic
boom has started in 90s and resulted in change in lifestyle and
behavioral aspects. More than 90% of male infertility cases are due to
low sperm counts, poor sperm quality, or both. Male infertility refers
to a male's inability to result pregnancy in a fertile female.
“Male factor” infertility is seen as an alteration
in sperm concentration and/or motility and/or morphology in at least
one sample of two sperm analyzes collected 1 and 4 weeks apart [10].
Infertility and sub-fertility can be caused by various factors such as
chromosomal and genetic disorders, physical and mental stress, obesity,
malnutrition, smoking, drug abuse, cryptorchidism, Sexually Transmitted
Diseases (STDs), contraceptive procedures, accessory gland infections,
germ cell malignancies, and testicular cell calcification, disorders of
ejaculation, varicocele, endocrine disruption and autoimmunity
[11-13]. Sperm abnormalities can be caused by wide range of
factors like congenital birth defects, disease, chemical exposure and
life style habits. These abnormalities either affect sperm count,
movement or shape.
Categorization of Causes
of infertility: The causes of the infertility are grouped
as follows for the study. Physical Aspects: Lack of active exercises,
Behavioral Patterns
Unhealthy Habits: Smoking and usage of recreational drugs. Over
exercising
Food habits: Eating
junk food frequently, excessive or frequent consumption of alcohol,
which lead to obesity, as they impair hormonal levels adversely and
affect the fertility.
Working Environment: Exposure to hazardous conditions such as working
in pesticide factories, exposure to microwaves and noisy factors
[14-16] also affect fertility.
Infections: prostatitis (inflammation in the prostate gland),
orchitis (in the testicle), semino-vesculitis (in the glands that
produce semen), or urethritis (in the urethra),
Unknown reasons:
Genetic disorders, Cystic fibrosis, polycystic kidney disease.
Microscopic abnormalities- The abnormalities of infertility that are
found in microscopic study can be grouped as follows.
Pyospermia: Pus cells in semen
Oligozoosmermia: Reduced sperm count
Hematosmermia: RBCs in semen
Oligoasthenozoosmermia: Reduced count and motility
Asthenozoosmermia: Reduced motility
Necrosmermia: Dead sperms in semen
Azoospermia: Absence of spermatozoa
Teratospermia: Abnormal forms
Methods
All patients who attended the infertility clinics of GEMS Medical
College, Srikakulam, between March 2014 to February 2015 were included
in the study. Approval for the study was obtained from the research and
ethical committee of the Institute. An informed consent was obtained
from the patients willing to participate in the study. Patients data
included history, age, number of years of marriage, occupation,
personal lifestyle, any known diseases, previous surgery, and primary
or secondary infertility were available and recorded. Laboratory tests
performed included complete blood picture, follicle-stimulation hormone
(FSH), leutinizing hormone (LH), and prolactin level. The details of
the husband’s semen analysis, volume, count, motility, and
morphology, were entered. The semen parameters were compared to the
normal reference values as described by the World Health Organization.
The data were entered into a database and analyzed using a t-test to
compare means between the different levels of number and morphology of
the semen samples. The data were analyzed using SPSS version 14.
Such information is matched with types of infertility mentioned above
for finding the common pattern. A sterilized container for sample
collection of semen, clean glass slide, Papanicolaou stain and
microscope are used for the study.
Results
113 male patients aged 18 -55 have visited the lab for infertility
test. The patients were requested to submit the semen in a clean
container. After the collection, a slide was prepared for the
microscopic examination of the semen. Out of 113, 65 (57.2%) men had
infertility.
Infertility was high among men aged 20-25 and 30-40 years with 62.07%
and 62.96%. Lowest is observed in men below 20 years. (Table1)
Most common abnormality of infertility by microscopic study was found
to be Pyospermia with 38.46%, followed by Oligozoosmermia (16.92%) and
lowest abnormality is Hematospermia with 3.08%. (Table 3)
Later either telephonic or face to face interviews were conducted to
find the reasons behind the abnormality. Abnormality was high among the
people, who had Infections (17.58%), unknown reasons (13.94%), lack of
physical activity 12.73% and unhealthy habits 12.73%. The table 4,
shows controllable reasons amount to > 80%, a primary cause of
infertility.
Table-1: Normal and
Abnormal cases
|
Number of patients
|
Normal
|
abnormal
|
|
113
|
48
|
65
|
|
% of cases
|
42.48%
|
57.52%
|
Table-2: Age-wise
distribution of cases
|
Age wise distributions
|
No of patients
|
Abnormal Cases
|
Abnormal Percentage
|
|
Below
20
|
3
|
1
|
33.33%
|
|
20
to 25
|
29
|
18
|
62.07%
|
|
25
to 30
|
51
|
28
|
54.90%
|
|
30
to 40
|
27
|
17
|
62.96%
|
|
Above
40
|
3
|
1
|
33.33%
|
Table-3: Age-wise
Microscopic abnormalities
|
Age wise distributions |
Pyospermia |
Oligo
zoosmermia |
Hematos
mermia |
Oligoastheno
zoosmermia |
Astheno
zoosmermia |
Necros
mermia |
Azoos
permia |
Teratospermia |
| Below 20 |
1 |
|
|
|
|
|
|
|
| 20 to 25 |
9 |
|
|
|
|
|
|
|
| 25 to 30 |
9 |
|
|
|
|
|
|
|
| 30 to 40 |
6 |
|
|
|
|
|
|
|
| Above 40 |
0 |
|
|
|
|
|
|
|
| total |
25 |
|
|
|
|
|
|
|
| % |
38.46% |
16.92% |
3.08% |
13.85% |
7.69% |
3.08% |
9.23% |
7.69% |
Table-4: Frequency of
causes of infertility
| Reasons |
Pyosper
mia |
Oligozoos
mermia |
Hematos
mermia |
Oligoastheno
zoosmermia |
Astheno
zoosmermia |
Necros
mermia |
Azoos
permia |
Terato
spermia |
Total Patterns |
Percentage of patterns |
| No
of patients |
25 |
11 |
2 |
9 |
5 |
2 |
6 |
5 |
65 |
12.73% |
| Physical
Aspects |
5 |
6 |
0 |
4 |
3 |
1 |
2 |
0 |
21 |
10.91% |
| Behavioral
Pattern |
5 |
6 |
0 |
0 |
2 |
1 |
2 |
2 |
18 |
|
| Unhealthy
Hobbits |
10 |
5 |
0 |
0 |
2 |
0 |
3 |
1 |
21 |
12.73% |
Discussion
Reproduction is essential for the continuation of the genome of
individuals and species including human. The desire of survival and
continuation of the genome is strong enough that the human individuals
fail to reproduce have poor social, mental and physical health. For the
remedies of the condition, estimation of prevalence and factors are
pre-requisite.
The overall incidence of infertility over the last two decades varied
between 8.97% to 14.63%. Incidence of primary infertility had a higher
incidence as compared to secondary infertility. Over the years it was
proved that the incidence of infertility varied between 10-20% [17-20].
In a Cohort study conducted in Iraq, Razzak and Wall reported incidence
of primary infertility as 77.20% and secondary infertility as 22.80%
and Sinha et al of 65.83% and 34.17% respectively [21]. Our
observations were compared to them of 57.2% primary infertility and 22%
secondary infertility. When semen analysis reports of 113 cases were
analysed it was evident that the most affected age group was 25-40
years. This was similar to study conducted by H.A. A.L Turki et al 2015
[22].
Most common abnormality of infertility by microscopic study was found
to be Pyospermia with 38.46%, followed by Oligozoosmermia with
16.92%. The prevalence of pyospermia was more among men in
the age group 25- 30 years was 36% and 24% among 35-40yrs age group.
Abnormality was high among the people who have Infections with 17.58%,
unknown reasons with 13.94%, lack of physical activity 12.73% and
unhealthy habits 12.73%.
Durphy et al, (1991) suggested that chronic alcoholism can cause
testicular atrophy leading to oligospermia or azoospermia and also
cause ejaculatory dysfunction. In the present study the relationship
between alcohol consumption and abnormalities of semen was evident and
supports the findings of the above authors [23-26]. In the
present study the significant relationship of alcoholism and cigarette
smoking to abnormalities of semen was appreciated, but still this can
be under reporting of the smoking habits because as this can be other
way round as the patients are generally not comfortable about giving
history of any addiction even though present. With the advancing age a
decline in testosterone and increase in gonadotrophins are associated
with a decrease in sperm production and number of normal sperm [26].
Conclusions
• Infertility is high in 20-25 and 30-40 age groups.
Pyospermia is found be higher in percentage. Preventable causes (87%)
are commonest cause for infertility. Abnormality is found to be more
than 50% among the patients.
• Optimal of age of marriage, refraining from
addictions, timely medical assistance can help the couples to have
successful pregnancy.
• Due to diverse environmental, nutritional and
socioeconomic factors and climate conditions, it is important to assess
the semen quality in different parts of the country.
Funding:
Nil, Conflict of
interest: None initiated.
Permission from IRB:
Yes
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How to cite this article?
K. Pushpalatha, R Sudhakar, G Raja Pramila. Study on causes of
infertility among males attending infertility clinic at a rural
teaching hospital in Andhra Pradesh. Trop J Path Micro
2016;2(3):201-205.doi: 10.17511/jopm.2016.i3.20.