Male Infertility

Male infertility is a condition where the male in a relationship affects the child-bearing ability of the woman. When couples are not able to conceive even after having unprotected sex over a long period of time, it is important that men as well as women get screened for fertility.

Infertility in men is often caused by problems with making sperm or getting the sperm to reach the egg.

Sperm Production Problems

Problems with sperm may exist from birth or develop later in life due to illness or injury.

Sperm production problems: The quality and quantity of sperm are the key factors to male fertility. Any defect such as immature sperm or low sperm count (oligospermia) can lead to infertility.

Causes of Low Sperm Counts

Some men produce no sperm or produce too few sperm. Lifestyle can influence the number and quality of a man’s sperm.

Alcohol and drugs can temporarily reduce sperm quality. Environmental toxins, including pesticides and lead, may cause some cases of infertility in men.

One-third of all infertility cases have been linked solely to issues with the male partner. Male fertility may be impaired by several factors. These include:

Other Causes of Male Infertility

Other causes of Male Infertility:

• Varicoceles: This condition is characterised by swelling of the veins that supply the testicle.
• Backward ejaculation of the sperm
• Blockage of the sperm-carrying ducts
• Development of sperm antibodies (autoimmune disorder)
• Hormonal/stress problems
• Infections/tumours of the male reproductive system
• Genetics (chromosomal disorders)
• Sexual problems
• Use of certain medications such as steroids
• Excessive radiation exposure affects sperm production.
• Work-related cases (example: laptop use elevates the temperature of the testes leading to low sperm production)
• Smoking and alcohol abuse

Treatments for Male Infertility

With the advancements in medical technology, it is now possible to treat this condition. Treatment options include:

• Surgery: Surgery is indicated in cases of varicocele and obstruction of the sperm duct to improve sperm motion.
• Medications: Antibiotics are prescribed to treat infections of the reproductive system.
• Treatment for sexual problems: Counselling sex and relationships can help boost fertility levels.
• Male hormone replacement therapy may be used to treat hormonal deficiency.
• Assisted reproductive technology (ART): These are revolutionary treatment procedures that can help couples with infertility problems conceive. Some of them include in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) methods.
• Lifestyle modification: This would include changing habits such as not smoking, limiting alcohol intake, and using stress reduction techniques.
• women can keep track of changes in their morning body temperature and the texture of the cervical mucus or
• consider a home ovulation test kit, which can be bought at a pharmacy to optimise the timing of intercourse.

Fertility-Preservation Options in Men

The options for men may include:

• Physically protecting the testes from radiation therapy.
• Sperm banking involves preserving (freezing) semen for assisted reproductive procedures.
• Testicular sperm extraction and epididymal sperm aspiration involve removing a small amount of tissue from the testicles or epididymis. The mature sperm are frozen and stored for later use through assisted reproduction (a technique of artificially fertilising a preserved sperm with a woman’s egg outside the body and transferring the embryo into the uterus for development).
• In boys who have not entered puberty, a small portion of the testicular tissue, containing stem cells that will eventually become sperm, is extracted, frozen and stored.

Cancer-Related Issues for Fertility

Radiotherapy and chemotherapy may damage the quantity and quality of sperm in men and decrease the number of mature, healthy eggs produced in women.

Cancers of the reproductive organs such as the testicles, ovaries, uterus, fallopian tubes and cervix may require surgical removal, thus affecting the ability to reproduce. Cancer treatment can also increase the risk of early menopause in women, making them infertile at a much younger age.

Preservation Before Cancer Therapy

Since avoiding cancer treatment is not an option, there are methods to preserve your fertility. Fertility-preserving procedures are most commonly performed before cancer treatment. You must talk to Dr Turner about these methods and plan early to preserve your fertility.

Vasectomy Reversal

Vasectomy reversal or vasovasostomy is an operative procedure to restore fertility to previously vasectomised men. The procedure involves reconnecting the cut ends of the vas deferens (a tube for the passage of sperm from the testicle to the urethra) during vasectomy.

Vasoepididymostomy

Vasoepididymostomy involves cutting the distal end of vas deferens and connecting it directly to the epididymal tubule above the level of blockage or obstruction in the epididymis.

Bleeding within the scrotum, infection, blockage of the vas deferens (possibly by blood clots), and damage to nerves and blood vessels impeding fertility are the possible complications after a vasectomy reversal.

TESA - Testicular Sperm Aspiration

This is a simple procedure where under either local anaesthetic or general anaesthetic, a fine needle is inserted into the testis, and seminiferous tubules are extracted. The scientist then examines these tubules for sperm. 

This is the treatment of choice for a previous vasectomy and, in some cases, for azoospermia. IVF/ICSI [where the sperm is injected into the egg] is then used to create embryos.

TESE - Testicular Sperm Extraction

In azoospermic men, who have no sperm in their ejaculate, MICROtesticular sperm extraction (mTESE) is another possible option to retrieve sperm, especially if a TESA is unsuccessful.

The TESE procedure involves using an operating microscope, which improves the chances of finding testicular sperm.

Microsurgical Varicocelectomy

It is a suitable surgical option for infertile men with varicocele, dilating the pampiniform venous plexus in the scrotum. These dilated veins can cause sperm abnormalities and lead to infertility. 

The varicocelectomy procedure involves ligation of the dilated and abnormal veins that drain the testicle.