Epidemiological Study of Male Infertility

Transcription

1 174 Original Study Epidemiological Study of Male Infertility S. Samal, Ex. Prof & Head, K. Dhadwe, Ex-Registrar, U. Gupta, Ex-Consultant, N. K. Gupta, Ex-Consultant Department of Obstetrics & Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra. Abstract Advanced male age has been associated with signicant reductions in pregnancy rates, increased time-to-pregnancy and increased subfecundity.the present study was aimed at analyzing the male factor causing infertility and epidemiological factors in the rural institute situated in the eastern part of Maharashtra. Aims and Objectives: Study the profile of male infertility in this rural area over a period of 20 years and correlate the various factors responsible for male infertility. Materials and Methods: The present study comprised of retrospective as well as prospective analysis of infertility cases over a period of 20 years. Analysis of the records was done for male factors thoroughly in relation to age, duration and type of infertility, age at marriage, addiction. Statistical Evaluation: Statistical analysis was done in EPI-6 software. Chi square test and variance analysis was used for analyzing the data. Observations:The incidence of primary infertility (62.00%) was higher as compared to secondary infertility (38.00%) in all the five blocks.the semen analysis reports revealed that the most affected age group was years. The abnormalities of semen were 35.49%, 86.49% and 53.75% in smokers, alcoholics and in cases having more than one addictions respectively. Cases with no addictions were having the maximum of (82.96%) normozoospermic males. Conclusions:The relationship between smoking and alcoholism was evident. Both of these addictions were found to impair the reproductive functions in male. Keywords male infertility, addictions, age, epidemiological factors Introduction Female partner was generally blamed for infertility but, the Greeks were aware of male infertility. Various causes are attributed for infertility and it is proved that infertility is due to many factors, in both male and female. The age related decline in fecundity for men is more controversial. Male fertility peaks at about 35 years of age and declines sharply after 45 years of age. However, men have reportedly fathered children into there 80s 1. A paternal age more than 40 is associated with a 20% greater chance of birth defects in offspring 2. The changes in the male with aging are moderate, but significant, although the capacity to fertilize is maintained 3. Advanced male age has been associated with signicant reductions in pregnancy rates, increased time-to-pregnancy and increased subfecundity 4. Address for correspondence: Dr Uma Gupta, C/o 3/221, Vikas Khand 3, Gomtinagar, Lucknow umankgupta@yahoo.com

2 175 The present study was aimed at analyzing the male factor causing infertility and epidemiological factors in the rural institute situated in the eastern part of Maharashtra. Aims and Objectives Study the profile of male infertility in this rural area over a period of 20 years and correlate the various factors responsible for male infertility. Materials and Methods The present study comprised of retrospective as well as prospective analysis of infertility cases over a period of 20 years (Aug 1990 to July 2005) in the Department of Obstetrics and Gynaecology and Medical Records Department (MRD) of Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra. There were total of 3000 cases of which 2400 were retrospective and 600 were prospective cases. For retrospective study the case records of women were collected from MRD section through proper official procedure. For prospective analysis data was collected when infertility cases were admitted for investigations. The clinical data was entered in a pre-tested proforma. Analysis of the records was done for male factors thoroughly in relation to age, duration and type of infertility, age at marriage, addiction. The records of medical and surgical history, if any, were analysed. In a study of prospective cases along with above data additional enquiry on occupational details, psycho-social problems was also enquired in the pre-designed proforma. Male partners of these cases were subjected for investigations like blood group, VDRL and semen analysis. The results of the retrospective and prospective studies were analyzed. Statistical Evaluation Statistical analysis was done in EPI-6 software. Chi square test and variance analysis was used for analyzing the data. Observations A total of 3000 cases of infertility were studied, which included 2400 retrospective and 600 prospective cases. For the purpose of analysis and better interpretation the study period was divided into five blocks of 5 consecutive years each Block A to Block E. There were 1860 (62.00%) cases of primary infertility and 1140 (38.00%) cases of secondary infertility. The year wise distribution of primary infertility varied between 92 (49.73%) 73 (71.57%) and that of secondary infertility varied between 29 (29.12%) 70 (42.68%) over the two decades. During these 20 years period the total gynaecological admissions were of which admissions of infertility were 3000 (11.69%). The duration of infertility was 1 to 4 years in 987 (32.90%) of primary infertility and 209 (6.97%) secondary infertility and was more than 12 years in 74 (2.47%) cases of primary infertility and 58 (1.93%) in secondary infertility (Table 1). Farm workers or labourers constituted 1950(65.00%) cases, 870 (29.00%) were factory workers (mainly working in Coalmines) and 180 (6.00%) were involved in sedentary job. Observations of education of husband and duration of infertility showed that with infertility of 1-4 years, 626 men (52.34%) were having primary education; in 5-8 years, 506 (39.94%), in 9-12 years 242 (59.75%) and in >12 years 45 (34.09%), were the maximum number of cases having secondary/ higher secondary education, primary education and graduation respectively (Table 2). Distribution of cases according to type of infertility and semen analysis reports; of 2904 (96.80%) semen analysis reports which were available during the study, of them 1860 (64.05%) were of primary infertility and 1044 (35.95%) cases were of secondary infertility. Distribution of cases according to semen analysis reports and type of infertility showed that in cases of primary infertility, 1005 (54.03%), 617 (33.17%), 184 (9.89%), 34 (1.83%) and 20 (1.08%) were normozoospermic, oligospermic, azoospermic, asthenozoospermic & teratoasthenozoospermic, respectively. In cases of secondary infertility, 795 (76.15%), 229 (21.93%), 12 (1.15%), 8 (0.77%) were normozoospermic, oligospermic, azoospermic and asthenozoospermic respectively. Teratoasthenozoospermia was not found in secondary infertility during the study (Table 3).

3 176 Correlation of addictions in husband and semen analysis reports; of 2904 cases 587 (20.21%) had no addiction, tobacco chewers 58 (1.99%), smokers 1767 (60.85%), alcoholic 185 (6.37%) and multiple addictions in 307 (10.57%) cases. In cases with no addiction maximum of 487 (82.96%) were normozoospermic. While in tobacco chewers of 46 (79.31) were oligospermic, in smokers of 1140 (64.51%) were normozoospermic followed by 526 (29.77%)who were oligospermic. In alcoholics maximum of 96 (51.89%) were oligospermic. In cases with more than one addiction 142(46.25%) were normozoospermic followed by 80 (26.05%) who were oligospermic (Table 4).

4 177 Distribution of cases according to age of husband, type of infertility and semen analysis reports: The semen analysis reports indicated, normozoospermia in 1800 (61.98%), oligospermia in 846 (29.13%), azoospermia in 196 (6.75%), asthenozoospermia in 42 (1.45%) and teratoasthenozoospermia in 20 (0.69%) cases. Maximum of 240 (28.36%) and 260 (30.73%) had Oligospermia in age group of yrs, in primary and secondary infertility cases respectively. Azoospermia was found maximum 66 (33.67%) in age group yrs and 31 (15.82%) in age group 31-35yrs in primary infertility and secondary infertility group, respectively (Table 5).

5 178 Discussion 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% (5-8) incidence of 11.69% in our study is compatible to other authors. In a Cohort study conducted in Iraq, Razzak and Wall 9 reported incidence of primary infertility as 77.20% and secondary infertility as 22.80% and Sinha et al 10 of 65.83% and 34.17% respectively. Our observations were compared to them of 62% primary infertility and 38% secondary infertility. Overall higher incidence of primary infertility might be due to increased anxiety. Infertility, age of husband and semen analysis: When semen analysis reports of 2904 cases were analysed it was evident that the most affected age group was years. The finding of maximum of 28.36% (240) and 30.73% (260) oligospermic male in age group years in primary and secondary infertility respectively supports the above statement also the highest of 33.67% (66) cases had azoospermia in primary infertility between the age group of years and that of 15.82% (31) between age group of years in secondary infertility. The highest of asthenozoospermia in primary infertility group was present in 38.10% (16) between age group of years while teratozoospermia was also highest in the same age group being 40% (8) (Table 5). Analysis of these cases with addiction showed that in no addiction group 82.96% were normozoospermia while 17.04% had abnormal semen analysis reports (p <0.000) which was highly significant. It was found that addictions like smoking, alcohol and the combinations of these had a detrimental effect on spermatogenesis. It was shown that there were 20.21% cases with no addiction and 79.79% were having some or other addiction. The abnormality of the semen analysis

6 179 report was found in 35.49%, 86.49% and 53.75% in smokers, alcoholics and in combinations of these addictions respectively. Alcoholics have statistically significant abnormal semen analysis report while in smokers the abnormality of semen compared to normozoospermia was statistically significant (p < 0.001). Excessive alcohol consumption has been associated with poor reproductive functions. Jensen et al, (1988), and there is some evidence that complete cessation of alcohol consumption is associated with improved fertility. 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 As it is evident from the literature, infertility has been shown to be elevated by smoking. Greenlee et al 15 reported that smoking and passive smoking are the risk factors for female infertility and stated that the metabolites of cigarette smoking are toxic to oocytes, sperm and embryos. Durphy et al 12 studied the relation between male cigarettes smoking and decreased chances of conception in 330 couples and found that fertility outcome is apparently unrelated to the number of cigarettes smoked by the male partner. Other studies also reported the substantial harmful effect of cigarettes smoke on fecundity and reproduction not being appreciated. Hull et al 16 reported smoking having no effect on male fertility. 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. Epidemiologic studies in US & Israel showed that among 485 men who were occupationally exposed to dibromochloropropane (a pesticide), affected spermatogenesis causing azoospermia in 12.8% and oligospermia in 22.1% 17. Employment in agriculture increases the risk of specific morphological abnormalities in sperm, including the decreased sperm count per ejaculate and declined percentage of viable sperms. But there is no effect on sexual hormones 18. Cigarette smoking impairs fertility and both partners should be encouraged to stop smoking, particularly while trying to conceive. Alcohol consumption & Infertility Excessive alcohol consumption has been associated with poor reproductive function. Ejaculatory dysfunction can also result from chronic alcoholism 19,20. There is some evidence that complete cessation of alcohol consumption is associated with improved fertility 11. Chronic alcoholism even in men can cause testicular atrophy with decreased spermatogenesis or azoospermia secondary to endocrinological consequences of hepatic compromise. Alcohol has profound effects on leydig cell function by reducing testosterone synthesis and its metabolite, acetaldehyde, causing membrane damage and the formation of leydig cell autoantibodies. Excessive intake of alcohol also disturbs hypothalamopituitary function, further worsening testicular and sexual function. Impotence is a well-known effect of alcoholism, as are the signs of hyperestrogenism which is probably secondary to disturbances of the metabolism of testosterone and estrogens in the cirrhotic liver 19,20. 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 14. Optimal of age of marriage, refraining from addictions, timely medical assistance can help the couples to have successful pregnancy. References 1. Chandra A., Mosher W.D. The demography of infertility and use of medical care for infertility. Infert Reprod Med Clin North Am. 5: , Lian Z., Zack M.M., Erickson J.D. Paternal age and the occurrence of birth defects. Am J Hum Genet. 39: , Gallardo E., Simon C., Levy M., Guanes P.P., Remohi J., Pellicer A. Effect of age on sperm fertility potential: oocyte donation as a model. Fertil Steril. 66: , Kidd S. A., Eskenazi B. and Wyrobek A. J. Effects of male age on semen quality and fertility: a review of

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