Male Infertility & Investigations
Most people attending an infertility clinic will be familiar with the fact that one in six couples experience problems achieving a pregnancy. However, not so many are aware that of these, almost a third have some type of male factor infertility. Whilst infertility due to female problems is now often talked about in a fairly open way this is often not the case for men, perhaps because a lot of people still wrongly associate fertility with virility.
Bath Fertility Centre has helped many men become fathers and can offer the latest advanced procedures including hormone profiles, chromosome and genetic testing, Sperm DNA fragmentation, fragility test and surgical retrieval of sperm.. It is also quite often possible to improve your sperm count with some simple remedies which are listed further on.
Under the general heading ‘male factor’ there are several types of problem that can cause subfertility; many relate to sperm function although sexual problems (such as impotence or lack of ejaculation) can also affect male fertility. Male partners will attend the clinic for a semen analysis. There is a private room set aside at the Clinic for semen production. Just outside the room is a discreet hatch where samples are left with the appropriate form.
Our fertility specialists will cover male infertility as part of the initial consultation and if tests show that you have a fertility issue then you will be able to discuss your various options with the consultant.
Some men struggle to come to terms with their fertility issues and feel it makes them less of a man. We offer free counselling to both men and women, either individually or as a couple to help you cope better with the emotional journey infertility can take you on.
Types of Male infertility
There are several different types of male infertility, and our specialists use semen analysis techniques to identify these.
The most commonly seen suboptimal factors are:
- Oligozoospermia: low sperm count (less than 15 million sperm per ml of semen) where there are not enough sperm in the ejaculate to reliably reach an egg for fertilisation. Although 15 million may sound plentiful, in terms of fertility values below this can be a significant issue. For men whose count is significantly low then IVF alone may not work and ICSI (intracytoplasmic sperm injection) where a single sperm is injected into each egg to ensure fertilisation may be indicated. For extremely low sperm counts with no obvious explanation, genetic tests may be offered: very low counts are occasionally associated with missing parts of the male Y chromosome or can be associated with the presence of a cystic fibrosis gene. which could be passed on to any resulting male children, along with the associated infertility.
- Azoospermia: no sperm in the ejaculate.
- Asthenozoospermia: low sperm motility where less than 32% of sperm are moving and/or their progression (how fast they swim) is too weak for them to reach an egg. ICSI is usually indicated in cases where motility is compromised to the extent that there are insufficient strongly-swimming sperm for IVF.
- Teratozoospermia: high proportion of abnormally-shaped sperm. Most semen samples have more than 4% normal sperm, but in those with less than this then some structural problem with the sperm may be suspected which could reduce the chance of fertilisation, both in vivo (after intercourse) and in vitro (with IVF). ICSI is recommended for sperm with high abnormal shape (morphology).
- Antisperm antibodies: occasionally found in semen and indicate an abnormal immune response to sperm. Antibodies are substances made by the body as a defence against foreign ‘invaders’ such as bacteria or viruses. Sometimes a man may produce antibodies against his own sperm, especially if there has been injury to or infection of the testicles or vasectomy reversal. Antisperm antibodies can cause infertility because they can make the sperm stick together (agglutinate) so that they are unable to swim. Even if antibodies do not cause sperm to agglutinate they may affect the way sperm swim or can stop sperm attaching to an egg. Where the majority of sperm are affected by antisperm antibodies ICSI provides the best option to maximise the chance of fertilisation.
Causes of Male infertility
It is not always possible to pinpoint the cause of a suboptimal semen analysis, but common causes include:
- Chronic illness eg. diabetes; cystic fibrosis
- Inflammation affecting the testes eg. mumps, fever (e.g. flu) may temporarily affect sperm production
- Medication: some may alter sperm production
- Use of steroids or supplements for bodybuilding
- Previous infection may cause scarring or blockage of the sperm transport tubes
- Surgery (e.g. to correct undescended testes or a hernia) can cause scarring or production of antisperm antibodies. Vasectomy reversal, while often successful, sometimes results in poorer quality sperm than before
- Injury can damage the testis and affect semen quality
- Hormonal disorders diagnosed by blood tests
- Chromosome disorders: see Y chromosome in Glossary
- Genetic disorders e.g cystic fibrosis gene
- Radiotherapy/chemotherapy for treatment of cancer can affect sperm production; in about half of cases this can return to normal within 1-5 years
- Retrograde ejaculation where sperm is produced but is ejaculated backwards into the bladder
- Cigarette smoking, cannabis use and excessive alcohol intake can all reduce sperm quality
- Exposure to environmental toxins e.g. heavy metals, some agricultural chemicals, volatile fumes.
- Heat stress to the testes e.g. from very hot baths, working for prolonged periods in hot conditions which overheat the testes, wearing very tight underwear and/or clothing. Using a laptop computer on your lap rather than a desk has also recently been suggested to affect sperm production!
Improving your sperm count
One piece of advice that is often given to subfertile men is to avoid wearing tight underclothing and avoid hot baths. This is so that the testicles can remain at the temperature nature intended, which is about 4 degrees cooler than normal body temperature. Higher temperatures can result in higher proportions of abnormal looking sperm. Bathing the testicles in cold water is no longer recommended as it is not beneficial – a source of relief to many!
It is a good idea to maintain a healthy lifestyle, including normal body weight, healthy diet and moderate exercise. There is some evidence to suggest that taking vitamin and mineral supplements (especially vitamins C and E, Selenium and zinc) can improve sperm quality for some men. This will not help for all men but if taken in accordance with the instructions on the bottle will not do any harm.
Excessive alcohol consumption or smoking can be detrimental, as can the use of recreational drugs, so these should be eliminated or cut down as much as possible. We probably all know of men who smoke a lot, drink heavily and have a poor diet yet have managed to father children with no trouble. The cruel fact is that for men with a high concentration of sperm these factors will have less impact, because even if their sperm count is reduced there are still plenty of sperm there.
Some of the chemicals used in industrial processes and agriculture are believed to have an adverse effect on male fertility. In the same way some drugs used for treating medical conditions can affect sperm counts. It is important therefore that you tell the doctor if you are undergoing any other medical treatment.