The male is not immune to infertility

The fact that fertility decreases with age is known, but the myth prevails that the male is immune to this. In women aged over 35, the ovarian reserve, which is the capacity of the ovary to produce eggs, decreases – it is 50 per cent at 37 years, 10 per cent at age 40 and 5 per cent at 42. 

In men, decreasing fertility is usually associated with those aged over 47 years, which is compounded by factors, such as smoking, alcohol, stress, diabetes, hypertension and the medication used to treat these conditions. In men, the impact of age is seen by doing a computerized semen analysis and a DNA fragmentation index. 

There are couples with excellent embryos, but they have repeated IVF failures. They show structurally abnormal sperm and also high DNA fragmentation index. Analysing the cause of a high DNA fragmentation index may reveal a varicocele, which can be corrected by a laparoscopic varicocelectomy. 

Correction of the problem is by giving vitamins, minerals, trace elements and coenzymes for a month or two. Lifestyle modifications, like cutting down on smoking or alcohol, consuming fresh fruits and vegetables and bringing down sugar levels, also helps. 

Reassessment of DNA fragmentation levels after a couple of months can be done and when they are down to normal, ICSI can be done. Use of Intracytoplasmic Morphologically Selected Sperm Injection (IMSI), where sperm is viewed at 7000 magnifications and the best sperm is selected, also helps. 

Newer strategies today have helped in improving pregnancy rates to a great extent, with the impact of an older age being minimized to a great extent. However timely intervention is still the first level of management and for women age 35 and age 45 for men would be the apt age to make a decision regarding use of ART. 

New technique: To improve the quality of the embryo, Prashanth Fertility Research Centre has introduced a new technique called cytoplasmic transfer is available where the energy levels of the egg are improved by transferring the cytoplasm with the mitochondria, which is the energy apparatus in the cell. 

Here, the nucleus is not disturbed; thus, the baby is genetically related to the mother, which again, is what all women want. Only when there are no eggs is a donor required as a fewer number of eggs are expected and the dose of medication needed will also be low.