Male Infertility

Male infertility occurs when the male’s sperm is unable to penetrate the female’s egg; there are several reasons that this may happen. Around 80 – 85 percent of couples will conceive naturally within 12 months of trying. If you don’t want to wait 12 months there are at home tests available that will give you an indication if there are problems.  After this time both partners should see their health care provider for fertility evaluation.

Male infertility is responsible for between 30 and 40 percent of couples who are unable to conceive. Causes of male infertility are many and varied, but exciting advances in male infertility means there are a range of innovative therapeutic options available.

Causes Of Male Infertility

For sperm to be able to penetrate the egg it needs to be motile – meaning it should move actively rather than aimlessly. There needs to be sufficient numbers for a pregnancy to take place, and low sperm count is a very common fertility issue among men. On average about 100-750 million sperm are ejaculated during orgasm, but only a few make it to the fallopian tube and reach the egg for fertilisation. The shape of the sperm also influences its quality. Malformed or unusual shaped sperm often are unable to penetrate the egg.

Other problems can be caused by sperm trapped inside the testicles, inflammation of the testicles, sexually transmitted infections, testicles that don’t descend into the scrotum at birth and are damaged by staying in the body, genetic causes (such as Kilinefelter syndrome), cancer drugs, hormonal causes, varicocele (enlarged veins encircles the testicles) and poor quality of sperm after vasectomy reversal.

Other causes of male infertility includes cancer, trauma, hydrocele, malaria, testicular dysgenesis syndrome, idiopathic oligospermia (unexplained sperm deficiencies account for 30 percent of infertility problems in males), tobacco smoking, excessive alcohol consumption, abuse of drugs (both prescription and recreational), emotional stress, obesity and age.

Male Infertility Tests

It is important to detect and treat any correctible problems. In some men, a doctor’s examination may find an underlying medical problem that is causing the infertility.

Diagnostic exams may include:

• Semen analysis – tests the overall appearance, PH and volume of the semen, measures the sperm concentration, motility and vitality, and assesses morphology.
• Sperm Chromatin Integrity test (SCIT) – Assess chromatin integrity and DNA strand breaks, which have been shown to correlate with embryo quality.
• Semen microbiology – It is performed to obtain semen sample. It is cultured for bacterial growth on specialised media. Samples showing significant growth are sent to a laboratory for identification of the bacteria and what antibiotics can kill the bacteria.
• Retrograde semen analysis – It is indicated for men with a low volume and a diminished sperm count in the initial semen analysis.
• Anti-sperm antibodies – The presence of antibodies is evaluated by testing seminal fluid, semen and the serum. There should be an anti-sperm evaluation if in preparation of a vasectomy reversal, sperm motility is diminished, there is an increase of agglutination result or if sperm viability is in question.

It is essential that all necessary testing be done before going down the path of assisted reproduction. Your doctor will analyse the results of any fertility tests and provide an informed opinion and direction on the next steps.

Male Infertility Treatments

Less than a decade ago, treatment for male infertility was limited to assisted insemination or IVF using donor sperm. Today, exciting advances in male infertility have introduced innovative therapeutic options and are offered to couples, to greatly improve their chances of conception.

Some of these options include:

• Assisted insemination can be performed if the sperm count is healthy. Careful washing and preparation of the sperm activates them so they enter into the high energy state needed to fertilise the egg.
• Donor insemination is offered when the male infertility is not able to be corrected. This is where the sperm of another man is used to inseminate the female.
• In vitro fertilisation (IVF) with intracytoplasmic sperm injection (ICSI) is suggested for low sperm count because the sperm and egg are brought together in the small space of a specially designed plastic dish to improve the chance of fertilisation. ICSI is done by injecting a single sperm directly into the body (cytoplasm) of the egg, bypassing most of the barriers to fertilisation.
• Surgical sperm extraction is suggested if the sperm is absent in the semen that is ejaculated, or if the sperm are severely affected by anti-sperm antibodies. The sperm is retrieved directly from the testes or the epididymis.

Prognosis of Male Infertility

More than half the cases of male infertility can be treated. In some cases treatment may help couples to get pregnant through normal intercourse; however, each case is different and it is important to take a doctor’s advice on next steps.