Male Infertility

Male infertility can be hard to accept for many men. Find out what the most common causes of male infertility are.

Between 10% to 20% of couples are infertile. Of these, male infertility is a factor in up to a third of the cases. Many people incorrectly assign the blame for infertility as a female only issue, even when the woman is potent. However, when male infertility is involved, many associate it with impotence, or erectile dysfunction. While that can be one of the main causes of male infertility, there can be many other reasons why a man contributes to this infertility problem

Treating male infertility starts with a comprehensive infertility testing of both you and your wife. An experienced fertility specialist will be able to determine the exact cause of infertility and advise you on the best treatment option so that you can achieve your dream of becoming a father. Testing the male is part of the fertility diagnosis. 

Diagnosing Male Infertility usually involves:

• Semen analysis. Semen samples is produced by the men and sent for semen analysis. The main factors focused on in the semen report are density of sperm present,  movement (motility) and abnormalities in the shape (morphology). Other abnormalities in the sperm are also taken into consideration. 
• Physical examination of the male reproductive organ
• Scrotal ultrasound – to detect presence of varicocele or other problems in the testicles and supporting structures.
• Hormone testing  – blood test measures the level of testosterone and other hormones.
• Genetic tests – there could be a genetic cause which can be determined by a blood test to reveal whether there are abnormalities in the the Y chromosome — signs of a genetic abnormality.
• Testicular biopsy – samples from the testicle are removed with with a needle. 
• Specialized sperm function tests. Tests to determine sperm survival after ejaculation, ability of the sperm to penetrate an egg and DNA fragmentation of the sperm. 

What causes male infertility?

It can be embarrassing for a man to find out that he has fertility issues. Being unable to conceive a child with your wife is often a stressful and frustrating thing, but knowing the causes of male infertility can help you find the best course of action and treatment.

Male infertility can be categorised into different issues:

• Poor sperm health and quantity

Poor sperm quality, or low sperm quantity is a common cause of male infertility. This is a sperm production issue, where there may be too little sperm in the ejaculate, or where the sperm is unable to fertilise the egg due to its compromised physiological capabilities (motility and ability to fertilize the egg).

There can be many different reasons for poor sperm health. Varicocele, swelling of the veins that drain the testicle, can cause a reduced supply of blood, oxygen and nutrients to the testicle, which in turn results in lower sperm quantity and quality.

Certain infections of the testicle, or sexually transmitted diseases can also cause a reduction in sperm quality and quantity. Poor sperm health can also be caused by genetic conditions, hormone disorders, drug and alcohol abuse, exposure to dangerous chemicals or radiation, injuries to the groin, smoking, and abnormal testicle temperature due to overly restrictive underwear or clothing.

• Sperm blockage

Sperm is produced in the testicles and transported into the penis during ejaculation. When there is a blockage in the tubes that transport sperm, it can cause male infertility due to a lower or zero sperm count in the ejaculate. Such blockages can be caused by injury, infection or abnormal genetic development in the testicles.

While not technically a blockage, retrograde ejaculation is an example of sperm transportation problems, where the sperm is ejaculated into the bladder instead of through the urethra. This results in low sperm count in the ejaculate, leading to infertility.

• Sexual dysfunction

Sexual dysfunction, such as erectile dysfunction and premature ejaculation, is a common cause of male infertility. Sexual dysfunction can happen to any man, but it can be more common in older men. Up to 1 in 4 men above the age of 60 experience sexual dysfunction.

There can be many causes of erectile dysfunction and premature ejaculation. Psychological causes such as stress or performance anxiety can cause both erectile dysfunction and premature ejaculation. Physical causes of erectile dysfunction can be due to poor blood flow to the penis, hormonal imbalance, alcohol and drug abuse, and high blood pressure.

Treating male infertility

Depending on the cause of your male infertility, it is often still possible for you to conceive with treatment. Sexual dysfunction can be treated with medication and counselling. Defects causing blockages in the testicles can be treated with surgery to remove the blockage. For IVF procedures, it is possible to extract the sperm directly from the testicle using a thin needle, and mixing it with the egg. There are many variations of surgical sperm retrieval. PESA (percutaneous epididymal sperm aspiration) is one procedure where a needle is inserted into the testis without making any incision on the scrotum. In cases where the sperm is of poor quality, ICSI is performed where a single healthy-looking sperm is injected directly into a mature egg in order for fertilisation to occur.

Make an appointment with one of ACRM’s fertility specialists to find out more about male infertility and the treatment options.