Table Of ContentRajender Singh · Kiran Singh Editors
Male Infertility:
Understanding,
Causes and
Treatment
Male Infertility: Understanding, Causes
and Treatment
Rajender Singh • Kiran Singh
Editors
Male Infertility:
Understanding, Causes
and Treatment
Editors
Rajender Singh Kiran Singh
Endocrinology Division Department of Molecular and Human
Central Drug Research Institute Genetics
Lucknow, Uttar Pradesh Institute of Science, Banaras Hindu
India University
Varanasi, Uttar Pradesh
India
ISBN 978-981-10-4016-0 ISBN 978-981-10-4017-7 (eBook)
DOI 10.1007/978-981-10-4017-7
Library of Congress Control Number: 2017943463
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Preface
Male infertility presents a spectrum of phenotypes often with a complex etiology.
About 15% of couples worldwide suffer from infertility, and male factors contribute
to roughly one third, female factors contribute to another one third, and the remain-
ing are due to combined male and female factors. In-depth physical and physiologi-
cal examinations reveal exact etiology in only a few cases, resulting in the
classification of the remaining as idiopathic. Due to complex and partially under-
stood etiology, the treatment of male infertility is not straightforward. In the cases
with a defined etiology, specific treatments offer hope, but in the cases with idio-
pathic infertility, empirical and generalized treatments are advised often. This puts
impetus on a thorough understanding of the process of spermatogenesis and fertility
to craft new avenues for infertility treatment.
This book aims at providing a comprehensive coverage of male infertility. It is
divided in three sections; the first section introduces the reader to spermatogenesis
and male fertility to provide a reasonable understanding of spermatogenic failure
and male infertility. This covers the overview of the male reproductive system, its
genesis, sperm production, maturation, and post-ejaculation changes that are neces-
sary for male fertility. The second section deals with a thorough coverage of the
known and plausible causes of male infertility. The foremost among these are
genetic causes, such as Y deletions and other gene mutations, cytogenetic defects,
and congenital syndromic forms of male infertility. Among environmental and life-
style factors, obesity, oxidative stress, and sexually transmitted infections are dis-
cussed. The latest developments in the genetic, epigenetic, and proteome-related
causes of male infertility have been covered toward the end of this section.
The third section of the book is dedicated to the management of male infertility.
Since the etiology of infertility is complex, a number of different therapeutic or
prophylactic measures are advised depending upon the severity of the disorder and
the depth of investigation. This section entails nutritional, lifestyle, and other pro-
phylactic measures that can be adopted to avoid loss of fertility. Other chapters in
this section emphasize on specific and empirical treatments of male infertility.
Toward the end, fertility preservation options for cancer patients are detailed. Upon
failure of most of the treatments, ARTs are suggested, which have revolutionized
the field of infertility treatment. A detailed description of ARTs is beyond the scope
of this book; however, an overview of these techniques with opportunities and chal-
lenges has been discussed.
v
vi Preface
The book has been composed and designed to serve a broad reader base from
basic scientists and postgraduate students to doctors in reproductive medicine. Most
of the material is composed in a way that even the patients can read and understand
it to benefit their fight against infertility. A thorough understanding of the disease is
the key to successful treatment; therefore, the first section is highly relevant for
clinicians and patients. The second section is largely related to the causes and would
be apt for the researchers and postgraduate students who aim a career in the field of
reproductive medicine. Since the third section largely deals with the therapeutic and
prophylactic measures, it would cater to the patients and layman for adopting mea-
sures (nutritional, lifestyle, and prophylactic) to delay or avoid the development of
infertility and to clinicians for offering counseling to infertility patients.
Uttar Pradesh, India Rajender Singh
Uttar Pradesh, India Kiran Singh
About the Editors
Rajender Singh is a senior scientist at the
Central Drug Research Institute (CDRI),
Lucknow, India. He obtained his doctoral degree
in clinical reproductive genetics from the Centre
for Cellular and Molecular Biology (CCMB),
Hyderabad, India. Dr. Singh is working in the
area of male reproductive biology for the last
more than 10 years. He is a recipient of Young
Scientist Awards from the Council of Scientific
and Industrial Research (CSIR), the Indian
National Science Academy (INSA), the Indian
Science Congress Association (ISCA), and the
Indian Society of Human Genetic (ISHG). He
has also received the Innovative Young Biotechnologist Award (IYBA) from the
Department of Biotechnology, Government of India. Dr. Singh is working on under-
standing and treatment of male infertility. His research interests include genetic and
epigenetic basis of male infertility. He has published more than 100 research articles
and has guided doctoral thesis students.
Kiran Singh is working as an assistant profes-
sor in the Department of Molecular and Human
Genetics, Institute of Science, Banaras Hindu
University, Varanasi, India. She has made signifi-
cant contributions both to the teaching and
research field. She teaches various courses such
as clinical genetics, reproductive genetics, popu-
lation genetics, cytogenetics, etc. to postgraduate
students. Her research interests include reproduc-
tive health, particularly genetics of human male
infertility and miscarriage. She has received hon-
ors and recognition from diverse scientific repro-
ductive societies/institutes as invited speakers in
national and international conferences, seminars, and meetings. Dr. Singh has
supervised many Ph.D., M.D., and M.S. students for their thesis.
vii
Contents
Part I Understanding Spermatogenesis and Male Fertility
1 Overview of the Male Reproductive System . . . . . . . . . . . . . . . . . . . . . . 3
Sujit Kumar Mohanty and Rajender Singh
2 Embryonic Development of the Testis . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Pranav Patni, Sujit Kumar Mohanty, and Rajender Singh
3 H PG Axis: The Central Regulator of Spermatogenesis
and Male Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Vertika Singh, Neeraj Kumar Agrawal, Rajesh Verma, and Kiran Singh
4 S perm Maturation in Epididymis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Gopal Gupta
5 S perm Capacitation: The Obligate Requirement for
Male Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Rohit Kumar Deshmukh and Archana Bharadwaj Siva
6 G enomic Landscape of Human Y Chromosome
and Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Vertika Singh and Kiran Singh
7 S eminal Decline in Semen Quality in Humans Over
the Last 80 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Priyanka Mishra and Rajender Singh
Part II Causes of Male Infertility
8 S yndromic Forms of Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Vertika Singh, Rajender Singh, and Kiran Singh
9 Cystic Fibrosis, CFTR Gene, and Male Infertility . . . . . . . . . . . . . . . . 131
Rahul Gajbhiye and Avinash Gaikwad
10 Oxidative Stress and Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Rima Dada and Shilpa Bisht
11 Obesity, Spermatogenesis, and Male Infertility . . . . . . . . . . . . . . . . . . 167
Joseph R.D. Fernandes and Arnab Banerjee
ix
x Contents
12 Sexually Transmitted Infections and Male Infertility:
Old Enigma, New Insights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Bhavana Kushwaha and Gopal Gupta
13 Cytogenetic Factors in Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . 213
Vertika Singh and Kiran Singh
14 Autosomal Genes in Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Vertika Singh, Sandeep Kumar Bansal, Rajender Singh,
and Kiran Singh
15 Sex Chromosomal Genes in Male Infertility . . . . . . . . . . . . . . . . . . . . 253
Sandeep Kumar Bansal, Vertika Singh, Kiran Singh,
and Rajender Singh
16 M ale Infertility: An Epigenetic Perspective . . . . . . . . . . . . . . . . . . . . . 271
Sweta Mohan, Sharvari Deshpande, and N.H. Balasinor
17 S perm Chromatin Compaction and Male Infertility . . . . . . . . . . . . . 295
Aniket Patankar and Priyanka Parte
18 Proteomics of Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Ashima Sinha and Savita Yadav
Part III Management of Male Infertility
19 Advancing Paternal Age: The Ticking Biological Clock . . . . . . . . . . . 349
Rima Dada and Vidhu Dhawan
20 Food, Nutrition, and Male Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Sudha Bhagwati and Rajender Singh
21 Plant Products in the Management of Male Infertility . . . . . . . . . . . . 381
Sudha Bhagwati and Rajender Singh
22 Lifestyle, Fertility, and Infertility Management . . . . . . . . . . . . . . . . . 401
Rajender Singh
23 Preserving Male Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Rajender Singh
24 Specific and Generalized Treatments of Male Infertility . . . . . . . . . . 449
Sandeep Kumar Bansal and Rajender Singh
25 Oncofertility: Fertility Preservation in Cancer . . . . . . . . . . . . . . . . . . 465
Sameer Trivedi
26 Assisted Reproductive Technologies in Infertility Treatment:
Opportunities and Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
Pawan K. Dubey, Anima Tripathi, and Akhtar Ali
Contributors
Neeraj Kumar Agrawal Department of Endocrinology and Metabolism, Institute
of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Akhtar Ali Centre for Genetic Disorders, Institute of Science, Banaras Hindu
University, Varanasi, Uttar Pradesh, India
N.H. Balasinor Neuroendocrinology, National Institute for Research in Reproductive
Health (ICMR), Parel, Mumbai, India
Arnab Banerjee Department of Biological Sciences, BITS Pilani KK Birla Goa
Campus, Sancoale, Goa, India
Sandeep Kumar Bansal Male Reproductive Biology Laboratory, CSIR-Central
Drug Research Institute, Lucknow, Uttar Pradesh, India
Sudha Bhagwati Male Reproductive Biology Laboratory, CSIR-Central Drug
Research Institute, Lucknow, Uttar Pradesh, India
Shilpa Bisht Laboratory for Molecular Reproduction and Genetics, Department of
Anatomy, AIIMS, New Delhi, India
Rima Dada Laboratory for Molecular Reproduction and Genetics, Department of
Anatomy, AIIMS, New Delhi, India
Rohit Kumar Deshmukh CSIR-Centre for Cellular and Molecular Biology,
Hyderabad, Telangana, India
Sharvari Deshpande Neuroendocrinology, National Institute for Research in
Reproductive Health (ICMR), Parel, Mumbai, India
Vidhu Dhawan Laboratory for Molecular Reproduction and Genetics, Department
of Anatomy, AIIMS, New Delhi, India
Pawan K. Dubey Centre for Genetic Disorders, Institute of Science, Banaras
Hindu University, Varanasi, Uttar Pradesh, India
Joseph R.D. Fernandes Department of Biological Sciences, BITS Pilani KK Birla
Goa Campus, Sancoale, Goa, India
Avinash Gaikwad, M.Sc. Department of Anatomy and Developmental Biology,
Monash University, Clayton, VIC, Australia
xi
