Male Infertility

What is Male Infertility?

For men, infertility could involve the sperm, the testes, or the ducts that lead out from the testes.  Or it could be a functional problem when having sexual intercourse.

In order to conceive a baby naturally, men must produce healthy sperm that is passed into the semen.  The sperm must be ‘viable’, which means it has to be able to move to reach the egg, and the male must be able to ejaculate them during sexual intercourse.

There also has to be enough sperm in the semen to have a chance of conception. Typically, more than 15 million sperm/ml need to be present in the semen for natural conception, and more than a third of those need to move forward quickly, with at least 4% a normal shape.

How Are Sperm Produced?

The entire process of sperm formation takes about 72 days.

Sperm and testosterone are both produced in the testes. Sperm then pass slowly through a tube called the epididymis, where they mature so they can swim and penetrate an egg cell. They then travel via the vas deferens to the urethra, and out of the penis as they are ejaculated.

A healthy sperm is shaped like a streamlined tadpole.  It has a lashing tail, which helps it swim through the woman’s reproductive system. Abnormally shaped sperm may have problems penetrating the surface of the woman’s egg.  Sperm with poor motility may swim feebly or not at all.

What Affects Sperm Quality?

In general, healthy men create healthy sperm.  Studies show that sperm quality can be affected by lifestyle choices, including:

• smoking
• excessive alcohol
• drug use, including prescription medication, steroids and recreational drugs
• excess weight and high Body Mass Index (BMI)
• frequent exposure to extreme heat (such as working in hot temperatures or regular saunas)
• working in cramped conditions (for example, truck drivers)
• age
• acute viral illness
• operations for undescended testes or hernias

Symptoms of Male Infertility

Dysfunctional problems can manifest in physical symptoms such as:

• impotence – inability to maintain an erection sufficient for sexual intercourse
• failure to ejaculate, premature ejaculation or ejaculating backwards into the bladder (retrograde ejaculation)

Without laboratory tests, it would be impossible to recognise a fertility issue if there are no functional symptoms.  Usually, the quantity and appearance of the ejaculated semen generally appear normal.  The main symptom of infertility is not getting pregnant.

 What Causes Male Fertility Issues?

There are two main explanations for male infertility:

• sperm quality, or
• issues delivering the sperm.

Sexual dysfunction.

Trouble developing or maintaining an erection, premature ejaculation, pain during intercourse, or even psychological problems that interfere with sexual intercourse can all contribute to male infertility. The good news is, these issues can be treated.

Varicocele.

A varicocele is common. It is the swelling of the veins that drain the testicle, which may prevent normal cooling of the testes.  If the testes are not properly cooled, a man may experience low sperm count and reduced quality sperm.  In some cases treating a varicocele may improve sperm count.

Occlusion

Some cases of male infertility are caused by blockages in – or an absence of – the vas deferens linking the testes with the penis. This can be due to injury, previous vasectomy or a congenital absence of the tubes leading from testes to penis. In these cases, sperm can be retrieved surgically from the testes and used for IVF, or IVF with ICSI.

Ejaculatory issues.

Retrograde ejaculation is a condition when semen enters the bladder during orgasm rather than emerging from the penis. Some diseases, spinal injuries, medications, and prior surgeries might cause this. It may be possible to retrieve sperm from urine.

Infection.

Some infections and diseases can interfere with the quality of sperm or stop sperm production. some cases can even cause scarring that blocks the passage of sperm during intercourse. Chlamydia, gonorrhoea, prostatitis, and mumps may all contribute. If permanent testicular damage has occurred, sperm can often still be retrieved.

Immunological Infertility

Occasionally, the man’s body mistakes sperm as infectious cells and creates anti-sperm antibodies against the man’s own sperm.  This can impact the ability of the sperm to reach the egg and fertilise it.

Age

A man’s sperm quality is also affected by his age. After the age of 40, a greater number of DNA abnormalities occur in sperm.

Genetic Diseases

In rare cases genetic diseases, for example cystic fibrosis or a chromosomal abnormality, can cause male infertility.

Vasectomy

Getting sperm after a vasectomy reversal depends on how long ago the procedure was done. If 10 or more years have passed since the vasectomy, there is less chance of having sperm reappearing in the semen.  This can be treated with IVF management.

Radiation/Chemotherapy

Treatment for cancer can impair sperm production.  It is important to collect and freeze sperm prior to any cancer treatment.

Male Fertility Testing

A semen analysis is the most important male fertility test. It’s a very simple test that tells us a lot about your fertility.

I work exclusively with QFG laboratories who provide a full range of analytical services, including routine semen analysis, the detection of sperm antibodies, plus specific sperm functional tests such as sperm-egg interaction and the identification of sperm DNA damage.

Treating Male Infertility

The good news is that there are treatments to use whatever sperm may be available to successfully conceive a baby.

Cancer and Male Infertility

If you are having cancer or other treatments that may affect sperm production and are keen to start or extend your family in the future, collecting and preserving your sperm is a sensible option.

This should be done before your treatment starts, as some medical treatments may cause genetic damage.

Dr Flynn offers a semen freezing service through QFG, where your  sperm can be safely stored for years.