Many people are surprised to learn that men actually account for 30% of infertility in couples. As a result of this lack of general societal knowledge, some men can find it difficult to find out that there is an issue with them that is contributing to the couple not being able to fall pregnant. As with a women who has fertility issues, there is absolutely no need for a man to feel guilty or bad that he is letting his wife or partner down. And he is certainly no less of a man because of it! The good news for men however, is that most diagnosis and/or treatment needed is non-invasive. Let’s look at the most common causes of male infertility.
Low Sperm Motility (ie, the sperm don’t swim very well)
Sperm can generally survive for 3 days, in some cases up to 5 days, which means there is a limited time frame for the sperm to reach the waiting egg. If the sperm fail to move or move too slowly, they will die before they reach their destination. The most common treatment for this is IUI, where the sperm is placed into the uterus to wait for the egg, meaning it doesn’t have to travel far.
*Note – Too frequent sex can affect sperm motility. The ideal frequency for intercourse when trying to conceive is every second day from cycle day 10 to cycle day 16 (assuming you ovulate around day 14).
Low Sperm Count
When the number of sperm is low, the chances of them reaching and fertilising an egg is reduced. In mild cases, IUI (intrauterine insemination) may be an appropriate course of action, as it places the sperm into the uterus, giving it the best possible chance to both reach and fertilise an egg.
If the sperm count is significantly reduced, then ICSI (intracytoplasmic sperm injection) will likely be recommended so that a single sperm can be directly injected into the egg.
Abnormal Sperm Morphology (abnormally shaped sperm)
Abnormally shaped sperm have a reduced ability to (a) fertilise eggs and (b) produce viable embryos. ICSI is usually the standard treatment option in this case, however lifestyle changes (see below) can significantly improve sperm morphology.
No Sperm (azoospermia)
1% of men will have no sperm in their ejaculate. In some cases, this is caused by a blockage somewhere along the route from the testes to the ejaculate. In other cases, there is a partial or complete failure of the testes to produce the sperm which can be the result of a genetic abnormality.
If the sperm are being obstructed by a blockage, it is possible for a urologist to surgically extract sperm from the testes via PESA or TESA to be used to fertilise an egg via ICSI.
If it is confirmed that no sperm is being produced in the testes at all, the only option in this case is to use donor sperm in conjunction with an IUI/IVF or ICSI cycle.
Blocked vas deferens (tube)
Blockages in the tubes or the absence of tubes leading the sperm away from the testes can cause a complete lack of sperm in the ejaculate. The blockage can be caused by a previous injury to the area, previous vasectomy, infections or it can be congenital (present from birth). In some cases, blockages can be fixed, but in most cases, sperm are taken via medical aspiration and used in an IVF/ICSI cycle.
Sperm DNA Fragmentation
Despite a normal semen analysis, up to 8% of men have been shown to have high levels of sperm DNA fragmentation, which in turn both reduces the chance of producing a pregnancy and increases the chance of miscarriage. Causes of sperm DNA damage include drugs, chemotherapy/radiation therapy, smoking, age, hormonal factors, infrequent ejaculation and testicular hyperthermia. Depending on what has caused the damage to the sperm DNA will determine whether or not it can be improved without the need to move to IVF/ICSI.
These antibodies can attach to the sperm’s tails making the sperm clump together, impeding the sperm’s ability to travel through cervical mucous to the egg, and if by chance they do make it through, it will make it difficult for the sperm to attach to the egg. Though steroid treatment can be an option to lower antibody levels, the more common treatment solution is IVF with ICSI.
While there is a decrease in fertility as men age, as well as an increased risk of genetic defects, as a general rule, age does not have anywhere near the impact it does on fertility (and miscarriage for that matter) for men as it does for women.
Klinefelter Syndrome is a chromosomal disorder that affects males. The male will have an additional X chromosome which causes infertility, low testosterone and other characteristics that will become more apparent as he hits puberty. Klinefelter Syndrome is one of the most common male chromosomal variations – however only a quarter will ever be diagnosed, and of those who are, it will not be discovered until well into adulthood. Options for men with Klinefelter Syndrome who want to have children are becoming more and more widely available.
Treatment options for men:
Remembering that sperm is regenerated every 3 months, lifestyle changes can make a huge difference in the quality of sperm over time. Certain things have been proven to improve the quality of a man’s sperm so that the need for medical intervention becomes unnecessary:-
- Menevit men’s multi-vitamin
- Lifestyle changes
- Stop smoking
- Reduce alcohol intake to 1 or 2 drinks a week (preferably none!)
- Reduce caffeine intake to 1 per day
- Improve diet
- Wear boxer shorts instead of briefs to prevent testes becoming overheated
- Make sure mobile phone is kept in back pocket or suit jacket pocket
- Avoid exposure to harmful chemicals and toxins
If it is deemed that medical intervention is the best course of action, the following procedures are the gold standard:-
- Testicular Sperm Aspiration / Surgical Sperm Retrieval