Male Infertility
Defining Infertility
Infertility is the inability to conceive after one year of unprotected intercourse, or the inability to carry a pregnancy to term. This definition is reduced to six months for:
• Women over 35
• Women with a history of painful periods, irregular cycles, pelvic inflammatory disease and miscarriages
• Couples who know that the male partner has a low sperm count
'Primary' infertility means failure to achieve a first pregnancy, 'secondary' infertility means failure to achieve a subsequent pregnancy. Primary infertility is an extremely common problem, affecting more than one in seven (15 per cent) couples attempting their first pregnancy. Among those experiencing difficulty with conception, a male fertility problem is considered important in around 40 per cent of couples. In 15 per cent of couples it will be solely a male fertility problem and in around 25 per cent, there will be a problem in both partners.
The earlier you seek help, the greater your chances for success. If you and your partner have been trying to conceive without success, have been diagnosed with infertility, or have a non-traditional relationship inhibiting you from getting pregnant you would benefit from the help of an IVFWales infertility specialist.
When a couple has fertility concerns, IVFWales recommends that both the male and female partner have full investigations in order to determine the most effective treatment option.
Why causes infertility in men?
Sperm disorders
Low sperm numbers, low percentage of swimming sperm, poor sperm movement and high numbers of abnormally shaped sperm are common causes of infertility in men. Semen analysis at IVFWales can identify abnormalities within sperm samples and individual sperrm cells.
Obstructive problems
A blockage in a sperm-carrying tubes has many potential causes. The most common are: groin surgery, trauma (even fairly minor sporting injuries), infection (particularly chlamydia, gonorrhoea and tuberculosis). previous vasectomy. Some men have congenital (present at birth) absence of the vas deferens on one or both sides. The vas deferens is the tube that conducts the testicular component of semen to the urethra, which then carries semen through the penis to the outside world. About 10 per cent of men with an obstructive cause for their infertility will have this problem. The seminal vesicles (where other semen components are made) are often absent too.
Testicular injury and disease
A blow to the testicles, which may occur in sport or during a fight, can cause swelling of the testicles, or bleeding in or around them. This probably causes the blood supply to the testicles to fail, resulting in permanent damage to the sperm production mechanism. Torsion of the testicles (twisting of a testicle on its cord) can have a similar effect if it is not treated very quickly with surgery. Viral infections can cause inflammation of the testicles (orchitis, which usually appears as painful swelling of the testicles) and failure of sperm production. Mumps is the best-known cause, but is not the only one. Mumps will only affect fertility if it causes orchitis and, even then, only rarely. Undescended testicles (cryptorchidism) are another common cause of failure of sperm production. Male infants and children are routinely examined to identify this problem, as future fertility can only be preserved if surgical treatment to fix the testicles in the scrotum is performed in early childhood. Even surgery in infancy does not guarantee future fertility.
Varicocele
A varicocele is a dilation of the testicular veins in the spermatic cord that leads from the testicles to the abdomen. The role of this condition in causing infertility is uncertain and highly controversial. Varicoceles occur in 15-20 per cent of fertile men and 30 to 40 per cent of men with fertility problems. They can occur on either or both sides, but are far more common on the left. A varicocele can either heats up the testicles or impairs their blood supply resulting in a build-up of body waste products, thus affecting fertility. The co-existence of other risk factors, such as smoking, with varicocele seems to have a greater effect on the risk of infertility.
Genetic disorders
Problems with chromosomes (packages of genetic material) occur in about 2 to 20 per cent of infertile men and can affect their fertility in two ways. Chromosome disorders can affect the development of the testicles. Chromosome abnormalities can disrupt sperm production.
Problems with erection and ejaculation
Problems with sex are the principal cause of infertility in about 5% of couples. This can be due to: erectile dysfunction, premature ejaculation, failure to ejaculate, inability to achieve vaginal penetration for other reasons.
Hormonal problems
Testosterone deficiency can reduce fertility and may be caused by problems with testicular testosterone production, or problems with the pituitary gland or hypothalamus in the brain, which control testosterone production. Overproduction of prolactin (hyperprolactinaemia), a hormone produced by the pituitary gland, may also reduce fertility.
General medical disorders that reduce fertility
There are several conditions that may reduce fertility: Fever (These changes usually recover over a few weeks). Diabetes, High blood pressure, Coronary artery disease, Neurological disorders (eg multiple sclerosis, stroke, and spinal cord injury), Kidney disease, Cancer (may directly reduce fertility or drugs and radiation used to treat cancer may severely reduce or stop sperm production, Alcoholism (alcohol is toxic to sperm), Stress: stress causes several hormonal changes in the body that can affect fertility. Stress can have many causes, including anxiety over fertility problems.
Drugs that reduce fertility
Many drugs, both prescribed and those used recreationally (alcohol, tobacco marijuana), can reduce fertility. Any fertility concerns related to prescribed drugs should be discussed with your GP or fertility doctor - do not just stop taking them yourself.
Environmental toxins and radiation It is possible that chemicals in the environment or where you work may affect your fertility. You should discuss this with a member of the IVFWales team if you have concerns