Male Infertility
What is it?
Infertility is the inability to produce offspring, after at least one year of unprotected intercourse. About one in six couples have difficulty getting pregnant, and male infertility is the cause in about 50% of cases. Around one man in twelve has some kind of fertility problem. The main reason for male infertility is not producing enough healthy sperm, accounting for 75% of male infertility problems.
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 there is any problem with their quality, the chances of a healthy sperm fertilising the egg are much slimmer.
Sperm problems can be caused by:
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.
What are the symptoms?
You won't normally have any obvious symptoms, unless your infertility is caused by an underlying medical condition, such as varicocele. 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.
As even the most fertile of couples can take a while to become pregnant, it is generally recommended that you try for a year before both you and your partner seek help. However, if you think you may have had problems in the past that may affect your fertility, for example, undescended testicles, mumps, surgery in the pelvic area or are hardly producing any semen, or it has blood in it, you should see your GP as soon as possible.
How is it diagnosed?
The doctor will first ask you lots of questions to try and find out whether there is anything in your medical history that might have affected your fertility. Your GP will also need to know whether you have got anyone pregnant before. 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 will include blood tests, hormonal blood tests, genetic tests and sometimes a 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.
What is the treatment?
At least half of infertility cases can be treated successfully so that conception (getting pregnant) is possible. The treatment of the infertility will very much depend on the underlying cause. Steroids are occasionally given if high antibody levels are the cause. 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 may be given to tighten the bladder neck. If the main cause is being unable to get an erection in the first place (erectile dysfunction), there are many treatment options available
Assisted conception techniques
Assisted conception techniques are another alternative. These methods help the sperm to bypass certain obstacles and barriers. Intrauterine insemination (IUI) has been around a long time now and can work well if the male fertility problem is mechanical rather than a problem with the sperm. The sperm are washed, concentrated and injected directly into the woman's uterus. This means that the number of sperm in the woman's genital tract is much higher than during intercourse, when many sperm do not make it that far. This clearly increases the chances of successful fertilisation.
Intracytoplasmic sperm injection (ICSI) is also an option. This may be used if the sperm are not mobile enough for conception. Outside of the womb, in a laboratory, an individual sperm is injected into an egg, incubated, and then implanted into the womb. Approximately 30% result in a live birth.
Further information
Your local GP surgery is the best place for you to find information on male infertility. Charities can also be useful sources of information and support.
Men's Health Forum www.malehealth.co.uk
BICA (British Infertility Counselling Association) www.bica.net
CHILD (National infertility support group) www.child.org.uk
iSSUE: The National Fertility Association www.issue.co.uk
