Male Infertility
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In a third of cases, there is a male factor involved in difficulty in achieving a pregnancy. Sometimes a problem is due to impaired sperm production. Occasionally it is due to obstruction of one of the ducts leaving the testicles. Sometimes the problem is hormonal and occasionally there is a genetic element. Lifestyle changes are important.
We know that ceasing smoking improves sperm counts and reduces erectile dysfunction. Restricting alcohol intake improves sperm quality and avoiding high temperatures for the testicles maximises sperm output. Not being overweight improves fertility in males and having less than two cups of coffee a day may improve sperm counts.
Avoiding medications such as injectable testosterone, which is taken by some bodybuilders, is very important for male fertility. Recreational drugs such as cocaine, heroin and marijuana also have a negative effect on sperm count. Investigations of male infertility include a basic sperm count, chromosome analysis, some hormone levels and sometimes sperm antibodies.
Treatment options depend on what the cause of fertility is. Sometimes hormone problems can be treated by injections, such as luteinising hormone and FSH (follicular stimulating hormone). Surgery is sometimes required e.g. reversing vasectomies. There may be a place for treating varicoceles but this is not entirely certain.
Male Infertility Conditions
There are several medical conditions that can affect male fertility. Some of these include:
Primary testicular issues – some of the causes can be post infection, post trauma, chemotherapy or chromosomal abnormalities.
Obstructive issues – such as post-vasectomy or post pelvic surgery.
Hormonal issues – e.g. post-steroid or testosterone injections.
The good news is that many of these conditions can be treated, thanks to recent technological advances.
ICSI (Intracytoplasmic Sperm Injection)
ICSI is a technique which we use to treat male infertility. We obtain a specimen from the male partner and extract sperm. Having obtained an egg using IVF, we use a very fine glass pipette to insert the sperm into the egg allowing fertilization.
2-5 days later, the resulting embryo can be transferred into the uterus. Other embryos can be frozen for use at a later date.
TESA (Testicular Sperm Aspiration)
TESA is a technique whereby, under anaesthesia, a small needle is inserted into the male partner’s testicle and sperm is retrieved. This procedure is used in cases of male infertility, where the sperm quality is poor. In some cases the whole testicle needs to be examined under the operating microscope and individual patches of sperm identified – this is called Micro-TESE. If TESA is unsuccessful, sometimes donor sperm insemination may be required.