What You May Not Know About Male Infertility

“Overall, one-third of infertility cases are caused by male reproductive issues, one-third by female reproductive issues, and one-third by both male and female reproductive issues or by unknown factors” - National Institute of Child Health and Human Development

Male Fertility 

When we think about difficulties conceiving, there can unfortunately be a tendency to first focus on female infertility, however infertility cases can often be caused by male fertility issues. When you’re trying to conceive, understanding male fertility issues is equally as important. To conceive naturally, a male will need to produce and deliver healthy sperm that can fertilise their partner’s egg.

It may seem obvious, but in order to become a dad, you or your partner will need to have regular sexual intercourse, which is considered to be 2-3 times a week. You should focus on the periods of time around your partner’s ovulation as this is when an egg is released from the ovary.

It’s important to understand that male infertility can be caused by many different things and that sadly, in about 50% of cases, the cause of male infertility cannot be determined.

Male Infertility Risk Factors 

If you’re having trouble conceiving and any of the below apply to you or your partner, you should consider the possibility that you or your partner might be affected by male infertility and seek professional advice, sharing the relevant risk factors:

• Advanced age (from 40+, though this is less of a factor than in women)
• Obesity
• Smoking
• Excessive alcohol use
• Recreational drug use
• Frequent exposure of the tescicles to high temperatures
• Exposure to:
  • Testosterone
  • Radiation such as chemotherapy
  • Medicines such as Sulfasalazine 
  • Toxins such as pesticides, lead, cadmium and mercury

Some of the effects of these are irreversible but others can be tackled in order to give yourselves the best possible chance of conceiving naturally. 

Sperm is produced every day and the full sperm regeneration lifecycle runs between 60-80 days. In under 3 months a man will have regenerated all of their sperm, so if any of the below applies to you and your partner, start making changes to improve the quality of your sperm now: 

• Stop smoking - Smoking is associated with decreases in sperm density, total sperm count and total motile sperm
• Drink in moderation - Excessive alcohol consumption is associated with the same decreases in semen quality. Moderate consumption is not an issue. 
• Do not take recreational drugs - Cannabis, cocaine and anabolic steroids all affect sperm quality 
• Eat a healthy balanced diet combined with regular exercise
• Minimise stress
• Check any medication you are taking to ensure that they are not linked to decreases in sex drive or sperm quality.

Male Fertility Issues 

Most people associate male infertility with a low sperm count, but there are various issues, factors and causes associated with male infertility. 

In addition to the risk factors outlined above, if you have ever experienced any of the issues below and are having difficulties conceiving, then it is worth discussing them with your healthcare provider.

1. Have you or your partner ever had issues with your testicles? This could be any type of testicular problem at birth, one or two undescended testicles, any type of testicle injury, infection (for example, mumps post-puberty), surgery or cancer. This also covers any type of pain, swelling or lumps within the testicles.
2. Have you or your partner ever had difficulties ejaculating or experienced cases of erectile dysfunction?
3. Are you or your partner experiencing reduced sexual desire? This is important because it can point to hormonal imbalances. These changes could also be caused by particular medicines or drugs.

Of course, it is possible that none of the risk factors or issues above apply to you or your partner but that does not mean male infertility should be ruled out. There are various sperm disorders that can significantly affect male fertility. There have also been big recent advances in reproductive medicine - scientists are learning new things about fertility all the time. 

Semen and Sperm Disorders 

Semen is the fluid that is ejaculated during sex. Semen normally contains sperm. Issues with sperm include any reductions in sperm production or any abnormalities in the sperm produced, specifically:

• Low or no sperm - the famous ‘sperm count’  
• Slow moving sperm - sometimes sperm do not move properly and therefore do not have a good chance of reaching and fertilizing an egg
• Abnormally shaped sperm - similar to slow moving sperm, abnormally shaped sperm can have reduced motility and less chances of reaching an egg
• Genetic diseases - Most men with cystic fibrosis are affected by infertility as the tube carrying sperm from the testicles to the penis is blocked or missing. This blockage does not mean that sperm quality is affected, it just cannot be correctly delivered.

Diagnosing Male Infertility 

If you suspect that you or your partner are affected by fertility issues then various tests may be recommended to confirm infertility and attempt to identify the possible cause. For men, this will typically involve a semen analysis, potential blood tests, and in subsequent stages, additional tests involving imaging or biopsy of the testicles.

Semen analysis is straightforward and will normally involve multiple samples on different days. The semen will be checked for sperm count, density, mobility and shape.

Blood tests are focused on detecting any hormonal problems or other markers that could be negatively impacting healthy sperm production and delivery.

If semen analysis detects a low sperm count or no sperm, or defects with the sperm, then additional tests may be considered to try to identify the root cause. This could involve imaging like ultrasounds or a testicular biopsy.

Treating Male Infertility 

If you or your partner are diagnosed with male infertility do not lose hope as there are many different infertility treatments and options available to you. Depending on the cause of your infertility, treatment through medication or surgery may be an option.

Medication

If male infertility is due to hormonal imbalances then medicine could be prescribed to correct your hormone levels. This may be the case if fertility problems are related to the pituitary gland.

Surgery 

Surgery may be considered to address any blockages in the structures that store and transport sperm from the testicles. For example, varicocele, which is a condition where twisted or swollen veins in the scrotum can affect sperm quality, can be treated surgically.

Surgical sperm extraction, which can then be used in the treatments described below, can also be considered if you or your partner have extremely few or no sperm in the semen or some obstruction or defect is preventing sperm from being ejaculated normally. For example, some men are born without vas deferens, the tube that transports sperm from the testicles. Surgical extraction can also be considered when you or your partner have had a vasectomy, a failed vasectomy reversal, or a sexually transmitted infection like chlamydia. There are five different methods of surgical sperm collection: PESA, MESA, TESA, TESE and MicroTESE.

Surgery is normally performed under local anaesthetic and takes a few hours. Collected sperm will be analyzed, frozen and stored.

Assisted Conception 

If the cause of infertility cannot be determined or cannot be reversed, there are still fertility treatments available to help you conceive. Which treatment options are viable for you and your partner and which you should consider first will depend on your specific diagnosis and situation. They involve the collection of sperm, with the best quality sperm chosen to be used in the procedure using assisted reproduction technology.

Artificial Insemination 

This involves selecting the highest quality sperm and injecting them into the cervix or uterus where they have to fertilise the eggs on their own. It is much less invasive than IVF, where eggs are removed from the body.

IVF and GIFT 

In vitro fertilization, or IVF, is normally used when sperm quality is not deemed to be an issue. If there are concerns around sperm quality then a procedure called intracytoplasmic sperm injection (ICSI) may be preferred.

IVF is like artificial insemination except that the sperm is directly mixed with the eggs in a laboratory. If fertilization occurs, then after 2 to 5 days the embryo(s) are transferred to the womb.

Gamete intrafallopian transfer, or GIFT, differs slightly to IVF in that the sperm and eggs are just mixed together and immediately transferred to the fallopian tube. GIFT is closer to natural conception but requires a surgical procedure (an abdominal incision made under general anaesthesia), when IVF does not. That is why IVF is almost alway preferred.

ICSI

Intracytoplasmic sperm injection, or ICSI, works like IVF except that a single sperm is injected into an egg by a specialist to fertilise it. The fertilized egg is then inserted into the uterus. The advantage of this over IVF is that any potential issues the sperm may have getting inside the egg are bypassed as it is directly injected. The CDC has highlighted some studies raising concerns that ICSI could be associated with an increased risk for chromosomal abnormalities, autism, intellectual disabilities, and birth defects compared with conventional IVF.

Alternatives 

Should you or your partner still not be able to conceive then you could consider a sperm donor or adoption. This is not something to approach lightly but if you have been able to accept and come to terms with your infertility and still want to create a family then you should, you’ll be an amazing parent! We know it can be hard to have these conversations, but we are here to be your partner in parenting, all the way.