Dr. Nicolás Garrido, director of the andrology lab of the IVI Valencia, talks about the quality of sperm and its influence in male fertility problems. In the interview, he solves the doubts about the possible treatments.
 

1. Regarding male infertility, which options of treatments can men perform before undergoing some of the assisted reproduction techniques?

There aren’t many possibilities. In most of the cases of low sperm quality there’s no pharmacological treatment that can be applied and will have a beneficial impact on the sperm quality.

In some cases, some antioxidant treatments are applied in which some vitamin supplement is provided. However, this doesn’t count on a scientific base and it’s done just to see if it works. There are no studies that prove that this is going to improve sperm quality.

Only in some specific circumstances, in the case that the man suffers from hypogonadotropic hypogonadism, in which there’s a lack of hormones, a hormonal supplement will work out and allow this man to have a normal sperm parameters, but only in these cases. It’s not very common.

2. Which of the assisted reproductive techniques is the most effective for this kind of patients?

It will depend on the severity of the problem. The analysis of the sperm is based on the count of motile spermatozoa in the ejaculated sample. Assisted reproductive techniques require a minimal sperm quality. For example, artificial insemination will need at least 2 million spermatozoa with good motility, so that they can be inseminated. That’s what guarantees good gestational rates. If the man can’t provide samples with this quantity of spermatozoa, an in vitro fertilisation treatment should be carried out. An oocyte of the woman and a sperm sample, which can be below the parameters we were talking about, are required for IVF.

What’s more, we could even talk of another case in which the man has a severe pathology and only has some the thousands or hundreds of spermatozoa. It’s the situation in which the sperm is considered the worst. Even in these cases, something could be carried out: a micromanipulation. It’s an assisted reproduction technique in which a spermatozoa is captured in the laboratory and injected into the oocyte. This technique would solve the most severe cases of male infertility.

Another option would be to look for spermatozoa testicle tissue, as long as none have been found in the ejaculated sample. There’s still the likelihood that spermatozoa are found in it even when no spermatozoa have been found in the ejaculated sample. In these cases, a simple surgical intervention would be performed, in which testicle tissue would be extracted in search for spermatozoa.

3. There are some studies in which bad sperm quality, or problems related with the fragmentation of the DNA, or oxidative stress, were linked to miscarriages in women. To which extent can this relationship be established?

Up to now, there’s not much information about this. The great majoritiy of repeated abortions don’t seem to be that related to miscarriages.There’s very little information about the subject.

We (IVI) have a study about repeated abortions that has been published. These are the cases in which there’s an abortion three or more times in a couple without an apparent reason. In these cases, we’ve studied the fragmentation of the DNA and the oxidative stress situation of the spermatozoa, but we couldn’t find any relationship between these factors and the repeated miscarriages. There’s not much information, but based on the data we have, there doesn’t seem to be any direct link.

Nevertheless, it’s still being studied. We must not forget that men and women share the responsibility in gestation to 50%. The woman contributes with the egg, and the man with the spermatozoa.

4. In the case of men that are HIV or hepatitis C virus carriers, what is the likelihood of being parents without transmitting the disease to their children?

There are a lot of options. In Spain, ever since 20 years ago, there’s the possibility of working on the sperm samples of men that have this kind of illnesses to eliminate those parts of the sperm that are carriers of the virus, and keep the healthy spermatozoa. What’s more, there are techniques with a high security level to check, that after carrying out this selection in the laboratory, there’s an absence of viral particles.

The seminal lavage technique, to extract the spermatozoa that will subsequently be used for the assisted reproduction techniques, with the aim of having children and not transmitting the disease, neither to the woman nor the baby, is something common and available in several centres. We’ve been performing it for 11 years and about thousand couples have gone through this treatment. According to our experience, and to the international experience published in magazines, the chance of transmitting the disease is practically zero.

5. Which factors may affect the seminal quality of a man?

Several studies have been performed, but the information is biased. It’s really difficult to value the influence of one single factor in one man. For example, if we were talking about lab animals, they are less exposed to several things, they have a controlled diet, controlled hours of light, controlled conditions and you can expose them to alcohol, drugs, tobacco etc. On the contrary, it’s hard to control to which factors that can affect himself a man is exposing himself.

An organism can carry on with its normal life even if its reproductive function doesn’t work, that’s why if there’s an imbalance in the organism, the first thing affected is the reproductive function. Every factor that will contribute to create a better health state will help improve the seminal quality. Having healthy habits and avoiding the exposition to toxics (environmental, in the work life etc.) will help improve the seminal quality. However, this is hard to check.

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