Male-Factor Infertility: What is it & what can you do about it?
A couple's failure to conceive used to be seen as the woman's issue, but statistics from the National Institute of Health in the USA show that men are implicated in half of all cases. Male infertility results from a problem with how sperm is made: low sperm production or motility, abnormal sperm size and shape (morphology); or how sperm is transported: an obstruction or malformation in the tubing between the testicles and penis. Luckily, there are excellent treatments available and around 50% of men can be successfully treated.
What does male infertility look like?
Most men do not have any symptoms, so will be completely unaware that there is a problem. However, some red flags may include:
- Varicose veins above one or both testicles (varicoceles). The most common cause of male infertility and easily treatable with surgery.
- Undescended testicle(s)
- Past infection in testicles or prostate, mumps, malaria, or certain STDs (gonorrhea, chlamydia)
- Gynecomastia (breast growth), hair loss, low libido, or impotence due to a hormonal imbalance such as low testosterone (hypogonadism) or too much oestrogen
- Dry orgasm (known as retrograde ejaculation) where semen is ejaculated backward into the bladder instead of out of the penis. Causes include prostate surgery.
- Lifestyle factors such as obesity, smoking, excessive alcohol or recreational drug use
- Chronic diseases such as cancer, diabetes, coeliac
- Injury to spine or genitals
- Use of certain medications (anabolic steroids, SSRIs, certain antibiotics and antifungals, chemotherapy, alpha blockers)
- Overexposure to industrial chemicals, heavy metals, radiation
What does fertility testing involve?
If you have been trying to conceive for a year with no success, then you and your partner will need to be assessed to see if there is a problem. Key tests for men include:
- Semen analysis: Most effective, inexpensive and widely used test which checks sperm quantity, quality, motility and morphology
- Scrotal ultrasound: Can show varicocele or other problems in testicles
- Hormone tests: Blood test will indicate whether testosterone and other hormones are at correct levels
- Testicular biopsy: Tiny samples of tissue are removed from the testicles to see whether sperm production is normal or if there is a chromosomal abnormality
- Anti-sperm antibody test: Can detect if the man's immune system is attacking his sperm
- Post-ejaculation urinalysis (PEU): In cases of retrograde ejaculation, it checks for the presence of sperm in a man's urine
- Genetic testing
Sperm retrieval procedures used in assisted reproduction
Intrauterine Insemination (IUI) is typically the first option couples use to try and have a child if they are unable to conceive naturally. IUI involves injecting sperm into the woman’s uterus around the time of ovulation in order to aid fertilization. The objective is to increase the number of sperm that reach the fallopian tubes boosting the chances of fertilization.
It is the closest procedure to naturally conceiving, as it does not require fertility medication. However, the success rates are lower as a result because neither partner can have any predisposing fertility conditions. Generally, IUI has an average success rate of 12 percent per attempt.
In cases where semen analysis shows sperm count is low, sperm is not viable or is absent altogether (azoospermia), or for those who have undergone a vasectomy, then surgical techniques are used to harvest sperm directly from the testicles:
- PESA (Percutaneous Epididymal Sperm Aspiration): Minimally-invasive procedure where sperm is extracted from the epididymis using a very thin needle. Hospitalisation is not required.
- MESA (Microsurgical Epididymal Sperm Aspiration): A tiny incision is made in the scrotum to expose the epididymis and an operating microscope is used to open the tubes so sperm can be harvested. The procedure is carried out under general or spinal anaesthesia.
If no sperm is found using PESA or MESA, then another procedure can be used to retrieve sperm from the testicle:
- TESE (Testicular Sperm Extraction): Similar to MESA, a small incision is made into the testis in order to check for sperm. If necessary, many incisions can be made or the entire testicle can be opened up to check all sperm-producing cells. It is performed under general or spinal anaesthetic.
Harvested sperm (fresh or frozen) can then be used for ICSI (Intracytoplasmic Sperm Injection), a sophisticated technique where a single sperm is injected into the egg. The process can be further finessed by using PICSI (Physiological Intracytoplasmic Sperm Injection), which is a method of selecting the best sperm possible to facilitate fertilisation. It is of particular use to those couples who have experienced the previous failure with ICSI alone. In fact, researchers estimate that half of all couples who combine sperm extraction with assisted reproduction techniques will achieve pregnancy.
What does this all mean?
Understanding male infertility fully will help to ease uncertainties before you embark on your fertility treatment journey. We’ve highlighted some of the major ways to identify the symptoms and conduct advanced testing in order to find a diagnosis. Several advanced sperm retrieval techniques are available to aid in assisted reproduction. Consider discussing treatment options today. Get a quote
Contributing writer: Natasha Robinson