Male Infertility

Infertility is the inability to produce children after at least one year of unprotected intercourse. About one in six couples have difficulty getting pregnant, and male infertility is the cause in a quarter of cases.

That means that around one man in twelve has some kind of fertility problem. The main reason for male infertility is not producing enough healthy sperm.

On average, about 50-500 million sperm are ejaculated during orgasm. However, only a few hundred make it as far as the egg. Therefore, if the number of sperm is too little, or if they are defective, the chances of a healthy sperm fertilising the egg are much slimmer.

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Male Infertility symptoms

Sperm problems can be caused by: 

  • Trapped sperm inside the testicles
  • Orchitis (inflammation of one or both testicles – mumps is a common cause)
  • Sexually transmitted infections (damage to tubes where sperm are stored)
  • Testicles that don't descend into the scrotum at birth
  • Varicoceles (varicose veins of the testicles)
  • Drugs used to treat cancer
  • Reversal of vasectomy, which may be associated with poor quality sperm

Sperm problems are not the only cause of infertility. Ejaculation problems (for example, when the semen goes the wrong way and ends up in the bladder – called retrograde ejaculation), spinal cord injury, diabetes and erectile dysfunction can all make it more difficult for your partner to get pregnant.

Usually, you won't notice obvious symptoms, unless your infertility is caused by an underlying medical condition, such as varicoceles. The first sign of a possible infertility problem is usually when your partner fails to become pregnant after an extended period of unprotected sex. Although, it should be remembered that at this stage, the infertility problem could be due to either you or your partner or both.

All couples can take a while to become pregnant, so it is generally recommended that you try for a year before both you and your partner seek help. However, if you fall into any high-risk categories, see your GP. Risk factors also include having had mumps, surgery in the pelvic area or producing low volumes of semen.

Male Infertility diagnosis

The doctor will first ask you lots of questions to try and find out whether there is anything in your medical history that might affect your fertility. A physical examination of your genitalia will look for abnormalities and varicoceles.

An analysis of your semen will be carried out, looking for factors such as concentration of sperm, mobility, shape and volume. Other examinations include:

  • Blood tests
  • Hormonal blood tests
  • Genetic tests
  • Testicular biopsy (tiny sample of tissue extracted using a needle to look at sperm production).

You may also have a special x-ray to check for any blockages in the tubes that carry the semen.

Male Infertility treatment

At least half of all infertility cases result in successful treatment.

The right treatment depends on the underlying cause. Steroids are occasionally given if you have high antibody levels. Surgery may be offered to remove blockages or varicoceles. If the cause is uncertain, hormonal treatment may be given. If the problem is due to retrograde ejaculation, medications can tighten the bladder neck. In some cases, treatment for erectile dysfunction can help.

Assisted conception techniques

Assisted conception techniques help the sperm to reach the egg inside the womb. For example, with intrauterine insemination (IUI) the sperm are washed, concentrated and injected directly into the woman's uterus. This clearly increases the chances of successful fertilisation.

Intracytoplasmic sperm injection (ICSI) is also an option, particularly if the sperm are not mobile enough for conception. In a laboratory, an individual sperm is injected into an egg, incubated, and then implanted into the womb. Approximately 30% result in a successful birth.

Need more information?

Speak to your GP or consultant if you're concerned about your fertility.

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