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Department of Andrology

Asian Institute of Nephrology and Urology (AINU) has a well-equipped Department for Andrology which is fully committed to men’s health. The department has an expert team of andrologists which specializes in treating men’s reproductive disorders particularly Male Infertility and Impotence (Erectile Dysfunction).

Male Infertility

Infertility is the condition in which a person is not able to contribute his/her part in the conception of a child. The role of a male is to deliver a healthy sperm to his female counterpart. So, if a male becomes unable to do so he is considered infertile. This can result due to number of reasons like reduced or no sperm production, low quality of sperms, impotence, hormonal imbalance, ejaculation problems, etc. Though the condition is not lethal but is highly frustrating, stressful, and causes a psychological trauma in some. So it is important that if a couple is not able to conceive a child even after regular unprotected sex, they must consult an andrologist for the treatment or solution of the problem.

Male fertility is quite a complex process and there could be a number of causes which can lead to male infertility. Some of the most common reasons behind male infertility are described below.

  1. Varicocele – Enlargement of veins in the scrotum can lead to infertility.
  2. Reproductive tract infections- Reproductive tract infections like inflammation in the testes or epididymis or sexually transmitted infections like gonorrhoea and HIV can lead to infertility.
  3. Ejaculation issues- A person may be capable of producing healthy sperm but there could be aberration in the process of ejaculation such as Retrograde Ejaculation, a condition in which the semen (fluid transporting sperm) flows backward to the urinary bladder instead of going out during orgasm.
  4. Autoimmune disorder: The immune system of the body which otherwise fight against foreign particles or invaders (pathogens), can misrecognize sperms as foreign particle thus produces antibodies to attack sperms.
  5. Cancer or tumors- Presence of tumors or cancer affects the male reproductive system which can lead to infertility. Sometimes, the chemotherapy or radiotherapy which is opted for the treatment of cancer can also lead to fertility issues.
  6. Hormonal imbalance- Hormonal system including hypothalamus, pituitary, thyroid and the adrenal glands plays a very crucial role in the reproductive system. Even a minor slip-up can lead to significant issues in the reproductive process which may lead to infertility.
  7. Obstruction in the sperm transport system: Before ejaculation, the sperms have to travel a long track passing through a number of tubes. Obstruction in this path can thus results in infertility.
  8. Genetic aberrations: Genetic defects like klinfelter’s syndrome, cystic fibrosis, or kartagener’s syndrome can also be responsible for male infertility.
  9. Impotence: Impotence or erectile dysfunction, a condition in which the penile erection is not firm enough for penetration, results in the inability to transfer sperm to the partner thus causing infertility.
  10. Surgeries or medications: Prior surgeries or consumption of certain medications can also affect male fertility.
  11. Developmental errors: Developmental errors in the male reproductive system like undescended scrotum, can lead to infertility.
  12. Environmental causes: Certain environmental factors like occupational or acute exposure to certain substances (like benzene, xylene, or heavy metals) or harmful radiation (x-rays) may lead to male infertility.
  13. Overheating of the scrotum and prolonged sitting while wearing tight clothing are also suspected to result in reduced male fertility.
  14. Obesity- obesity and excessive weight gain can impair fertility in several ways.
  15. Lifestyle: Unhealthy lifestyle including illicit drug use, smoking, excessive alcohol intake, improper diet and emotional, physical or mental stress are also associated with male infertility.

As the human reproductive is quite complicated, diagnosis of the exact cause of infertility might need a number of diagnostic tests. It is likely that the doctor will ask the patient to take his partner along. The diagnostic process will involve one or combination of the following tests:

  1. Medical History: The doctor will first ask the patient several questions about his condition, medical history, sexual habits and related information to get an estimate about the cause and severity of the issue.
  2. Physical Examination: The doctor will then physically examine the patient to verify if there are any physical abnormalities involved.
  3. Semen analysis: The doctor will prescribe the patient to go for semen analysis. This test involves collection of semen sample into a special container by masturbation and ejaculation or in special condom during intercourse. The sample is then analyzed in a laboratory for sperm count, quality, motility, or morphology and also to check for any infection. The test is usually repeated multiple times to ensure accurate results.
  4. Ultrasound: The doctor may ask the patient to go for scrotal or transrectal ultrasound. Scrotal ultrasound helps in identifying any signs of abnormality in the testis and supporting structures. For example, the scrotal ultrasound is suggested to diagnose conditions like varicocele. Transrectal ultrasound is recommended when the doctor wants to check patient’s prostate or to look for any blockage in the tubes that carry sperms.
  5. Hormone Analysis– The doctor may ask the patient for hormonal analysis including analysis of thyroid hormones and reproductive hormones (androgens)
  6. Post ejaculation Urinalysis- If the doctor suspects retrograde ejaculation, he/she may ask the patient to collect urine sample right after ejaculation. The urine sample is then analyzed for the presence of semen and sperm.
  7. Testicular Biopsy: In this test, the doctor collects a sample of tissue from testes with the help of a needle. The sample is then analyzed to check if there is problem in the production of sperms or if there is any other cause for infertility like obstruction in the transportation.
  8. Specialized sperm-function tests: A number of other specialized tests like tests for checking how well the sperm survive after ejaculation, or how well it can penetrate the ovum.
  9. Genetic cause- the test involves chromosomal analysis to check if there is any abnormality in the genetic makeup of the patient which can cause infertility.

After performing the diagnostic tests, the doctor will recommend the best treatment plan to the patient, some of the treatment method which can be prescribed by the doctor includes:

  1. Treatment of infections: If the patient has been diagnosed with reproductive tract infection, the treatment approach will focus on treating infections using various antibiotic medications. This may restore the infertility in some cases where the cause of infertility is infection.
  2. Surgery– If the patient is diagnosed with conditions like varicocele or tumors, the doctor may surgically treat the condition.
  3. Impotence treatment- Certain medications along with psychological counselling will be beneficial if sexual intercourse problems like impotence are responsible for infertility.
  4. Hormone Replacement Therapy- The doctor may recommend hormone replacement therapy or medications to treat the patients with hormonal imbalance.

Assisted Reproductive Technology: Assisted Reproductive Technology like in-vitro fertilization or artificial insemination is recommended if the patient’s fertility cannot be directly recovered.

Erectile Dysfunction

Erectile dysfunction, usually known as Impotence is a reproductive disorder in which a male suffers from the inability to develop or sustain a penile erection, firm enough for penetration during sexual intercourse. It is a very common disorder affecting millions of men globally. Facing such inability at some point is normal but, one should take it seriously if it continues for more than a few weeks.

Sexual arousal is a highly complex process. It involves collaborative functioning of the brain, hormones, nerves, muscles, blood vessels, and emotions which make it difficult to diagnose the exact underlying cause in some cases.  Thus, both physical and psychological causes can be responsible for the incidence of erectile dysfunction.
Physical and Medical causes for impotence:

  1. Heart disease (Cardiovascular diseases) – Heart disease is a range of health conditions which are related to heart. Some of them are coronary artery disease; arrhythmias (heart rhythm problems); congenital heart defects (heart defects a person is born with), atherosclerosis (clogged blood vessels) and other related disorders.
  2. Diabetes– Medical condition in which blood glucose levels are too high which starts affecting other functions of the body.
  3. Metabolic syndrome – Metabolic syndrome is a term used for a group of disorders which involve high blood pressure, high insulin levels, high cholesterol and accumulation of fat around the waist. The condition possesses a high risk for the incidence of more alarming conditions like heart stroke, diabetes, impotence and infertility.
  4. Neural disorders: Brain disorders like Parkinson’s disease or multiple sclerosis can also lead to impotence.
  5. Peyronie’s disease — Development of a scar tissue inside the penis
  6. Smoking, excessive alcohol intake or use of other drugs
  7. Sleep disorders
  8. The impotence can occur as a result of prostate enlargement or treatments for prostate cancer
  9. Shock, injuries or surgeries that affect the pelvic area or spinal cord
  10. Side effect of certain prescription medications

Psychological causes for impotence:
Brain is the major player in the process of sexual arousal. It initiates series of physical events which generates sexual excitement and hence causes penile erection. Since this entire process is composed of a network of complex events, there is a possibility of number of flaws in the system which can lead to impotence. Some of the major psychological reasons behind Impotence are:

  1. Mental health conditions like depression or anxiety
  2. Stress in life
  3. Emotional stress and relationship problems

Though it is embarrassing for some patients, it is necessary to consult an andrologist (a doctor who is specialized in treating male infertility and related disorders) as impotence can be an indication of some more serious disease. So, one should consult an andrologist if he is facing a problem in getting or sustaining erection during sexual activity or has a reduced desire for sex.

The doctor will first ask some questions to the patient to have an idea of patient’s condition. Then he or she will ask the patient to go for one or combination of the following tests.

  1. Physical Examination– The doctor will carefully examine patient’s penis and testicles to see if there is any physical reason behind the condition
  2. Blood tests– The doctor may ask for blood tests if he/she suspects conditions like heart disease, diabetes or hormonal imbalance
  3. Ultrasonography– The doctor may ask the patient for an ultrasound which could usually be done after an injection of medications in the penis which causes erection.
  4. Urinalysis– The patient could also be asked for urine analysis like blood analysis if the doctor suspects any other underlying health cause
  5. Overnight Erection Test- Overnight erection test is test done to check if the patient gets erection in sleep or not. In this test a device is used which is wrapped around the penis to monitor penis erections, before the patient go to bed. Most men have erections when they are asleep but do not remember it. The result of this test indicates if the person has a physical or psychological cause for impotence.
  6. Psychological Exam– The patient will be referred to psychologist if a psychological reason behind the condition is suspected. The psychologist will ask several questions to the patient for analyzing his mental and emotional condition.

The doctor will plan the treatment approach depending upon the diagnosis.  If the patient has any underlying health issue, he would be prescribed treatment for the underlying cause. The doctor may recommend

  1. Medications like Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra, Staxyn), or Avanafil (Stendra)
  2. Self- Injections which contains a mixture of medications to be injected directly into penis before sexual activity
  3. Alprostadil urethral suppository- A vasodilator suppository known as Alprostadil which has to be placed inside the penile urethra 10 minutes before the intercourse
  4. Hormone Replacement therapy- If a person is diagnosed with hormonal disturbance he may be suggested testosterone replacement therapy
  5. Vacuum erection device– Vacuum erection device commonly known as penile pump is a device which has a long hollow tube, attached with a battery pump, which is placed around the penis to suck the air out resulting in penile erection. Then a tension ring is wrapped at the base of the penis to hold the erection after which the pump is removed.
  6. Penile implants: Inflatable or semi rigid rods are implanted into both sides of penis surgically, which allows the patient to control his erection.
  7. Blood vessel surgery: If the reason behind the condition is obstruction in the blood vessel, a surgery to bypass the blood flow could be done.
  8. Counselling: A psychologist will provide mental support to the patient through counselling.
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