Infertility is defined as the failure to conceive after one year of unprotected sexual intercourse. Approximately 15% of couples attempting their first pregnancy meet with failure. In about 50% of couples seeking treatment, the infertility will be caused by a problem in the male. It is therefore important that both partners are seen and investigated together.There have been great technological advances in the development and success of assisted conception in the last two decades, such that many couples with infertility can now be offered treatment.
There are a number of causes of male infertility including erectile dysfunction, hormonal problems, chemotherapy or radiotherapy, previous surgeries on the testis including undescended testis, drugs and medications. It is important to be aware that in some cases a cause may not be found.
All male patients will undergo a thorough history and clinical examination, hormone profile, genetic studies and ultrasound scans depending upon their semen analysis and clinical findings.
Your consultant will first take your medical history and conduct a careful physical examination. The history will include noting details of: any childhood illnesses; previous surgery; exposure to occupational and environmental toxins, excessive heat, chemicals or radiation; alcohol, drug and medication use; and any medical conditions related to the reproductive system. The physical examination will include a careful examination of the scrotal contents.
The most useful tool in testing for male infertility is the semen analysis. The ‘normal’ values for different measurements of sperm quality have been worked out by testing large groups of healthy fertile volunteers. When a semen analysis is done, the results are compared with the normal range of values and any abnormalities will suggest a male problem. The tests carried out on a semen sample will look for abnormalities in sperm number (the sperm count), sperm movement and sperm shape.
Blood tests to assess the levels of hormones relevant to sperm production are also used to exclude hormonal factors and/or abnormalities. Also, genetic tests will be required in men who are azoospermic or have very low sperm counts.
Infertility treatment options for each patient will vary according to the results of tests undertaken. Almost all causes of male infertility can be treated, with reasonable chances of pregnancy, provided the woman’s age and fertility are not a problem.
The best form of treatment will be discussed during consultation with your specialist. Treatment options include drug therapy for the man, intrauterine insemination (IUI), in vitro fertilisation (IVF) with or without sperm microinjection into the egg (ICSI) or artificial insemination by donor (DI).