While fertility is often viewed through the lens of female reproductive health, male factor infertility contributes to around half of all infertility cases.

Introduction to Male Fertility

Male fertility is a crucial aspect of reproductive health, and understanding the factors that affect it is essential for couples trying to conceive. Male infertility, also known as male factor infertility, refers to the inability of a male to contribute to conception due to various reasons such as low sperm count, poor sperm motility, or abnormal sperm morphology.

The cause of male infertility can include various factors such as specific health conditions, lifestyle factors, and anatomical abnormalities, which are identified through thorough assessments, including medical history and physical examinations.

It’s surprisingly common: according to the World Health Organization (WHO), approximately 15% of couples experience infertility, and in about 50% of these cases, male factor infertility is a contributing factor.

A semen analysis is typically used to evaluate sperm health and identify potential issues. This test measures several parameters, including sperm count, motility, and morphology. A normal sperm count is essential for successful fertilisation, and any deviations from the norm can indicate potential fertility problems.

Intracytoplasmic sperm injection (ICSI) is a common assisted reproductive technique used to treat male infertility, especially in cases where sperm quality is compromised. By injecting a single sperm directly into an egg, ICSI can help overcome issues related to low sperm count or poor motility, offering hope to many couples struggling with male factor infertility.

Common Male Fertility Conditions

Understanding the medical terms used in fertility clinics can help make the process less overwhelming. Here are some of the most common male fertility conditions:

Sperm problems can arise from various factors, including genetic and physical causes.

Azoospermia

Azoospermia is the complete absence of sperm in the ejaculate, and it affects about 1% of all men and 10–15% of infertile men. There are two main types:

  • Obstructive Azoospermia: Sperm is produced but blocked from release.
  • Non-obstructive Azoospermia: The testes produce little or no sperm. Testicular biopsies may be performed to collect testicular tissue for further analysis and potential sperm retrieval.

Oligospermia (Low sperm count)

Total sperm count is a crucial parameter in evaluating male fertility, and oligospermia is the medical term used to describe less sperm than normal in a semen sample (less than 15 million per ml). Mild to severe cases may still allow for conception, especially with assisted techniques.

Asthenozoospermia (Poor sperm motility)

Asthenozoospermia is essentially when sperm have reduced movement or are sluggish at swimming. Sperm concentration is a key parameter in semen analysis that helps diagnose male fertility issues. This motility is key for reaching and fertilising the egg.

Teratozoospermia (Abnormal sperm morphology)

When a semen sample has a high percentage of abnormally shaped sperm, it is described as Teratozoospermia. While morphology alone doesn’t always prevent conception, it can impact fertilisation potential.

Semen quality is assessed by evaluating sperm morphology, motility, and concentration.

Retrograde Ejaculation

This is when semen enters the bladder instead of exiting the penis during ejaculation and is often caused by nerve damage, surgery or certain medications.

Retrograde ejaculation can affect semen volume and may require specific diagnostic tests to confirm.

Varicocele

This condition is similar to varicose veins and is when a man has enlarged veins in the scrotum. It can affect male fertility by leading to lower sperm production and quality due to increased testicular temperature.

Hormonal Imbalances

Low testosterone or abnormalities in Follicle-Stimulating Hormone and Luteinizing hormone levels can impact sperm production. The imbalance is often linked with other conditions like hypogonadism or pituitary gland disorders.

Additionally, testosterone replacement therapy can impact fertility by suppressing gonadotropic hormones.

Genetic Conditions

Genetic abnormalities, such as Klinefelter Syndrome, Y-chromosome microdeletions, and CFTR gene mutations, may impact sperm production or delivery and are typically detected via blood or genetic testing.

Evaluating Sperm Health

Evaluating sperm health is a critical step in diagnosing male infertility. A semen analysis involves examining a semen sample to assess sperm count, motility, and morphology. This test provides valuable insights into sperm production, sperm function, and overall reproductive health. Various factors, including lifestyle choices, environmental exposures, and underlying medical conditions, can affect these parameters.

For instance, sexually transmitted infections (STIs) can damage the reproductive tract and negatively impact sperm quality. A healthy sperm count is typically considered to be above 15 million sperm per millilitre of semen.

In addition to count, sperm motility and morphology are crucial factors, as they determine the sperm’s ability to swim towards and fertilise an egg. Abnormal semen parameters, such as low sperm count or poor sperm motility, can indicate underlying issues that need to be addressed to improve fertility outcomes.

Diagnosing Male Fertility Conditions

Diagnosing male infertility usually starts with obtaining a sperm sample for a semen analysis, which assesses how healthy your sperm is and measures sperm count, motility, morphology, and volume. This process requires two to three days of abstinence before collection.

Other diagnosing methods include:

  • Hormonal Blood Tests assess levels of testosterone, FSH, LH, and prolactin.
  • A Scrotal Ultrasound checks for physical abnormalities like varicocele or blockages.
  • Genetic Testing is recommended in cases of azoospermia or severely low sperm count and can identify structural or chromosomal abnormalities.
  • Testicular Biopsies are used to determine whether sperm are being produced in the testes (especially in azoospermia cases) and may also allow for sperm retrieval (e.g., TESE or micro-TESE).
  • Post-Ejaculate Urinalysis helps diagnose retrograde ejaculation.

What are the Treatment Options for Male Fertility Conditions?

The right infertility treatment depends on the underlying condition, lifestyle factors, and your fertility goals, encompassing various medical and surgical interventions available.

Lifestyle modifications

Improving diet, reducing alcohol, quitting smoking and maintaining a healthy weight can all improve the health of your sperm. Avoiding hot tubs, tight underwear and certain medications may also help.

Decreased body hair can be a symptom of hypogonadism, which affects testosterone levels and fertility.

For more advice on understanding and improving the health of your sperm, check out our guide.

Medical Treatments

Hormone therapy:

Used in cases of imbalances in hormones like follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Hormone therapy can also help address low sperm production caused by hormonal imbalances.

Antioxidant supplements:

Sometimes used to improve sperm DNA quality.

Antioxidant supplements can help reduce sperm DNA fragmentation and improve fertility outcomes.

Antibiotics:

For infections affecting sperm production or function.

Sickle cell disease can cause intratesticular ischemia, affecting sperm production and fertility.

Surgical Treatments

Varicocelectomy

This surgical procedure treats a varicocele by removing the swollen vein to reduce testicular pain and can increase male fertility and improve sperm quality.

Additionally, varicocelectomy can help improve the function of the vas deferens and enhance sperm transport.

Sperm retrieval procedures

These could include:

  • Percutaneous Epididymal Sperm Aspiration (PESA): A procedure where a small needle is inserted into the epididymis (the sperm reservoir) to collect sperm.
  • Testicular Sperm Aspiration (TESA): This procedure removes a small portion of testicular tissue from the testicle, and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI).
  • Microsurgical Sperm Extraction (Micro-TESE): This retrieves sperm directly from the testicles and is especially used when men cannot produce sperm in their ejaculate due to issues like non-obstructive azoospermia.

Assisted Reproductive Technologies (ART)

For many men with fertility challenges, in vitro fertilisation (IVF) offers a pathway to parenthood through various assisted reproductive technologies (ART):

  • IVF: Eggs and sperm are combined in a lab; embryos are transferred to the uterus.
  • ICSI (Intracytoplasmic Sperm Injection): A single sperm is injected into an egg. ICSI is commonly used in cases of:
  • Low sperm count
  • Poor motility or morphology
  • Retrieved sperm (via TESE, TESA, etc.)
  • Low sperm count
  • Poor motility or morphology
  • Retrieved sperm (via TESE, TESA, etc.)
  • Donor sperm: In cases where sperm retrieval is not possible or sperm quality is too poor, donor sperm may be considered. This is a deeply personal decision and is supported by counselling.

Preventing Fertility Issues

Preventing fertility issues requires a comprehensive approach that involves maintaining a healthy lifestyle, avoiding harmful substances and managing underlying medical conditions. For example, drinking alcohol excessively can affect sperm production and overall fertility. Maintaining a healthy weight, exercising regularly, and eating a balanced diet can help support reproductive health. Avoiding exposure to toxins, such as pesticides and heavy metals, can also help prevent fertility issues.

Additionally, managing underlying medical conditions, such as erectile dysfunction, retrograde ejaculation, and testicular cancer, is crucial for maintaining fertility. Regular check-ups with a fertility doctor can help identify potential issues early on and prevent more severe problems from developing. By taking proactive steps to support reproductive health, men can improve their chances of achieving pregnancy with their partner.

Complications of Untreated Infertility

Untreated infertility can lead to various complications, both physical and emotional. Infertile couples may experience significant emotional distress, relationship problems, and decreased quality of life. Furthermore, untreated infertility can lead to more severe health issues, such as testicular cancer, which is more common in men with infertility. Hormonal imbalances, such as low testosterone levels, can also occur in men with untreated infertility.

In some cases, infertility can be a symptom of an underlying genetic condition, such as cystic fibrosis or Klinefelter syndrome. Untreated infertility can also lead to an increased risk of sperm DNA fragmentation, which can affect the health and development of offspring. It is essential to seek medical attention if fertility issues persist, as early diagnosis and treatment can significantly improve outcomes and help prevent these complications.

Friends offering emotional support to a man facing fertility challenges.

What is the Emotional Impact of Male Fertility Conditions, and What Support is Available?

With many societal conversations around fertility often focused on women, male fertility complications can bring up feelings of shame and isolation, and many men delay or avoid seeking help due to feelings of unsubstantiated stigma that surrounds the subject.

But infertility is not one-sided; it is not a male or female issue, it’s a couple’s issue. Evaluating both partners, including the male partner, is crucial in understanding and addressing infertility. It’s important to talk to your partner and be open with fertility specialists, but it can also help to talk to other men who might have experienced similar difficulties and been through treatment. At The IVFN, we encourage open dialogue and have a range of resources, guides and webinars with leading experts on male fertility and other IVF-related matters.