A male’s fertility depends on the quality and quantity of the sperm. It may come across as a surprise to both women and men that infertility affects men as often as it does women. Nearly 40% of all fertility problems in couples can be attributed to problems with the male partner. Unfortunately, not enough emphasis is laid on evaluation of the male partner. Our doctors will discuss with you what the role of male parameters is and how to go about the necessary evaluation and fertility treatment options.
In most cases, during intercourse, erection and ejaculation usually happens without difficulty and hence there are no outwardly signs of infertility. Further the quantity and appearance of the ejaculated sperm generally appears normal to the naked eye. To check if the man is infertile, proper evaluation is necessary.
Usually either sperm production or sperm transport processes are the causes of male infertility. For around two thirds of infertile men the problem lies in sperm production, i.e. the amount of sperm produced in the testes is low or the sperm produced does not work properly.
Low sperm count can be caused by numerous factors, such as:
- Infections of the urinary tract or reproductive organs
- Certain medications
- Sperm antibodies
- Hormone imbalances
- Tumors (cancerous and nonmalignant)
- Chromosome defects
One in five infertile men, including men who previously have had a vasectomy, have problems with sperm transport. Blockages or obstructions exist in the passage that lead the sperm from the testes to the penis that can cause reduced or a complete lack of sperm in the ejaculated semen.
The first step towards understanding which factors are affecting your fertility lies in performing a semen analysis and certain hormone tests.
There are a limited number of medical treatments that help improve the chances of conception for infertile men. These include:
A number of patients with hypogonadotropic hypogonadism are seen to respond favourably to gonadotropin-releasing hormone (GnRH) therapy gonadotropin replacement. This is especially effective in treating hypothalamic and pituitary dysfunction.
Immunosuppression using cyclic steroids for 3-6 months has been found to be effective in helping patients with antisperm antibody levels greater than 1:32. However the potential side effects of steroids needs to be taken into consideration during this treatment.
Having semen washed and concentrated in preparation for intrauterine insemination (IUI) will benefit those who have poor semen quality or a low number of sperm.
Retrograde ejaculation is where the semen is redirected towards urinary bladder during ejaculation. This can be assisted by Imipramine or alpha-sympathomimetics. However the efficacy of this treatment is limited. Urine samples may be needed to centrifuge out sperm.
A man’s lifestyle does play an active role in affecting infertility. Patients are encouraged to stop smoking, reduce stress, reduced alcohol intake and limit environmental exposure to harmful substances or conditions.
There has found to be a statistically significant increase in sperm concentration, motility, and strict morphology in men taking Ubiquinol. This could be taken by men during the period of trying to achieve a pregnancy.
There are certain surgical procedures that are effective in treating infertility and these include:
Varicocelectomy is a surgical procedure done to treat a condition called varicocele wherein the veins draining the testicles become enlarged and tortuous. There are various approaches and techniques for Varicocelectomy which have their own advantages and disadvantages. The repair prevents further testicular damage and is found to improve Ledig cell function.
Vasovasostomy or vasoepididymostomy
This microsurgical procedure is performed patients with epididymal or vasal obstruction. This procedure is especially effective in patients requiring vasectomy reversal or those with primary vas obstruction.
Transurethral resection of the ejaculatory ducts
Semen quality in men suffering from ejaculatory duct obstruction can be improved through transurethral resection of the ejaculatory ducts (TURED).
Sperm retrieval techniques
Microscopic testicular sperm extraction has found to be effective in retrieving sperm at an improved rate with minimal tissue excision. This is a safe and feasible option for sperm retrieval.
For men having trouble with ejaculation, electrical stimulation has been found to achieve up to a 90% sperm retrieval rate.