Infertility in men
Male factor infertility | Male fertility problems
Male infertility is becoming an increasing problem in the developed world. For couples with infertility problems, male infertility is a contributing factor in up to 50% of cases. It is the sole cause in about 30% of cases.
Infertility in men can be caused by varying problems including general lifestyle issues, disorders of male (reproductive) organs and genetic disorders.
When it comes to sperm production, men’s testes are like factories. They are then stored in tightly coiled tube called epididymis, which lies on the side of the testis. Sperm are ejaculated in the semen which comes from prostate and seminal vesicles. Testes produce new sperm every 2 to 3 months. This means that a man’s lifestyle in the preceding months has an impact on the quality of the sperm sample.
Modern lifestyle has not helped; as men are now often sitting for long hours at desks, fashion trends towards tight underwear and unhealthy nutrition are all contributing to male infertility problems. However, the good news is that it is widely accepted that men can improve the quality of their sperm by improving general health. Before recommending more invasive treatment, it is always important to try to optimise health to achieve the best sperm quality.
For sperm to be considered as healthy it must have a count of 15 million per millilitre of semen, have a progressive motility rate of 32% (speed of movement) and a morphology (shape of sperm) rate of 4%. Note, this means that a man can have up to 96% abnormal forms, but still have a ‘normal’ sperm sample, as long as the other parameters are met.
The common lifestyle choices that affect the quality of sperm are:
- SmokingExcessive alcohol consumption
- Recreational drugs.
- Increased scrotal temperature
- High stress levels
By cutting out unhealthy aspects of lifestyle, it is possible to improve male fertility and the chances of conception.
There are specific problems that can lead to male infertility. These include issues such as undescended testis, testicular tumours, varicoceles (prominent veins), blockage of the ejaculatory ducts, sexually transmitted diseases, chemotherapy for cancer, some medications and chromosome abnormalities such as Klinefelter syndrome.
One of the most severe forms of male infertility results in azoospermia where no sperm appear in the seminal fluid. This is of two types: obstructive and non-obstructive. In the former, there is obstruction to the passage of sperm due to congenital, surgical (vasectomy) or previous infection. In the second type sperm production in the testis is impaired or damaged. This condition may be amenable to aspiration of sperm from the testis (testicular sperm aspiration-TESA) or extracting the sperm from the testis (testicular sperm extraction-TESE). In men with obstructive azoospermia it is often possible to aspirate the sperm from the epididymis (percutaneous epididymal sperm aspiration- PESA) with a needle.
If it is suspected during fertility treatment that there is a fertilisation problem, it is possible to make use of a procedure called Intra-Cytoplasmic Sperm Injection (ICSI). In the ICSI procedure, an embryologist selects a normal motile sperm and injects it directly into the egg. This usually helps to increase the chances of fertilisation. However, it should be noted that ICSI is an invasive procedure and so it is a standard practice to attempt to improve male fertility so that other less invasive methods could be used first.
Male fertility testing
For men that are looking for fertility testing and diagnosis, we offer a semen analysis that will give comprehensive information on sperm quality and quantity. For further assessment, investigations and advice, we also have our own Consultant Urologist.
For Couples looking for more information about their fertility, we offer our Fertility MOT, which gives comprehensive diagnosis for both man and woman within 1 hour. We also give advice on improving fertility.
For more information, please come to one of our Open Days.
Our Medical Director, Professor Geeta Nargund, contributed to an FAQ on Male Fertility for the Huffington Post.