If the female partner has not conceived (become pregnant) after 12 months of regular sexual intercourse without using any form of contraception, then the couple is defined as having infertility. In about 20% of couples the main problem is with the male partner, and in another 20% of cases both male and female fertility factors contribute to the delay in becoming pregnant. There are many causes of male infertility, and the first line of testing is a semen analysis (sperm test) where a skilled scientist assesses a semen sample from the male partner.
A semen analysis is the first approach to investigating the male partner. Interpretation of semen analysis results is best done by an expert in fertility care. There are many reasons why this is complex. About 20% of semen samples obtained from couples who have conceived quickly and who have no apparent fertility problems are abnormal on testing, and so semen analysis results are sometimes of limited predictive value. Semen parameters can vary widely in the same man if he is tested many times over a long period of time, and so it is usually when there is a persistent abnormality that test results are most significant. The sperm production process (spermatogenesis) is about 84 days long, and if a man is unwell or has a fever then this can disrupt spermatogenesis for 84 days. Consequently, if repeat testing is planned it is generally best to wait for three months before assessing another semen sample. Even when the first sample reveals that no sperm are present (azoospermia), sperm can be detected in up to 15% of cases when a second sample is assessed.
There may be considerable variation between laboratories in assessing the same semen sample. Therefore, if an abnormality is suspected, it is best to do a repeat analysis in a first class clinic where highly trained scientists will make a detailed and reliable assessment.
If a couple is going to undergo in-vitro fertilization treatment (IVF), then under these circumstances a semen analysis performed by a highly trained and skilled scientist is essential in order to determine the best approach to fertilizing the eggs.
Causes of male infertility
There are a number of possible causes of male infertility. These fall broadly under the following headings;
- Unknown cause
- Sexual difficulties including with erection and ejaculation
- Sperm production problems
- Hormonal problems
- Anti-sperm antibodies (where a man produces antibodies to his own sperm)
- Blockages in the male reproductive tract
- Genetic (where a man inherits a fertility problem)
There is debate about the role of some factors in causing male infertility. For example, a proportion of men have a varicocoele (varicose veins around the testicles). Some specialists believe that surgically correcting these varicocoeles can help to improve fertility potential whilst others point to a lack of evidence that such surgery is helpful. There is an emerging debate about the role of vitamins and trace elements in promoting male fertility. However, there is clear cut evidence that smoking and recreational drug use (such as marijuana) harms sperm production processes, and marijuana use in the man may even lead to retarded growth, impaired intellectual function and abnormalities in babies.
Sometimes there is a clue as to why there is a male fertility problem from a man's medical history, such as where he has had past surgery on his reproductive tract (a vasectomy or hernia surgery) or he had undescended testes where surgery was required as a child to bring the testicles down into the scrotum. For many men there is a subtle abnormality present such as an increased percentage of abnormally shaped sperm, and no further testing may be indicated. For men who persistently have a very low sperm count, there are a range of possible tests that may be recommended by an expert such as genetic testing, hormonal tests, assessment of a urine sample after ejaculation, and screening for certain infections.
Where an abnormality is found on genetic testing, it may be beneficial to be referred to a clinical geneticist to get a detailed explanation of the result, and have the geneticist liaise with your Fertility Specialist about your options for treatment.
If no sperm is present in the ejaculate after repeated testing, then the main priority is to find out if there is a correctable problem, and if sperm is being produced in the testes but is not reaching the semen sample (ejaculate). If there is a blockage in the male reproductive tract but sperm is still being produced, then it is often possible to obtain enough sperm by aspiration to be able to offer treatment with in-vitro fertilization (IVF) combined with single sperm micro-injection (ICSI).
Treatment options depend upon first undergoing a thorough assessment by a Fertility Specialist. Sometimes relatively simple treatments can be offered such as taking care of general health issues, or intra-uterine insemination (IUI). Often a specific cause can't be found and the best approach to treatment is by in-vitro fertilization (IVF) combined with single sperm micro-injection (ICSI). Further information on IVF and ICSI can be obtained by reading the Bubtree fact sheets on these topics.
You can get additional information by going to the contact us page on this website and sending a question or general enquiry. If you have concerns about male fertility then it may be best to discuss your concerns with your general practitioner and obtain a referral to see a Fertility Specialist. In addition, a great deal of helpful information on male fertility issues is available on the Andrology Australia website.
Why should the female partner be investigated even if a male fertility factor has been identified?
In the early days of fertility care, many women would undergo extensive investigations and even surgery without their male partner having a semen sample examined (semen analysis). Sometimes such women would find out later that their partner had male infertility, that some of the procedures they had undergone had been unnecessary and that much time had been wasted before finding out the best treatment for their situation. Nowadays doctors recognize that it is essential to investigate the male partner, and that male infertility is a contributing factor in a high proportion of couples who experience infertility. However, as male factor infertility can often be treated with in-vitro fertilization (IVF) and sperm micro-injection (ICSI), some couples now proceed directly to that treatment without the female partner being fully investigated.
Frequently both male and female factors contribute to a couple's infertility. Furthermore, certain female factors can reduce the success rate of IVF unless they are treated before a couple undergoes IVF. These female factors include endometriosis, poly-cystic ovarian syndrome (PCOS), polyps and fibroids in the uterine cavity, and fluid-filled fallopian tubes (hydrosalpinges). Moreover, there are some medical conditions that should be managed before embarking upon a pregnancy such as an abnormal PAP smear or high blood sugar levels. Therefore, it is essential for both partners to be thoroughly investigated before undergoing treatment, even if an abnormality has already been detected in one partner (whether it is the male or the female).
The psychological impact of male fertility issues
Many men are shocked and distressed at the news that there may be a male fertility issue and this can lead to confusion and even to questioning their sexuality and male identity. Men and women often cope with stress differently, and so male fertility issues can lead to stress within a relationship. Men may not want to talk about things and instead engage themselves in a task that they find rewarding or will want to find a solution to the problem. However, women may want to talk about things, and so these differences in approaches to coping can lead to stress for both partners. Whether there is a male factor, female factor or both we highly recommend that couples see a skilled infertility counsellor who has been accredited by the Australian & New Zealand Infertility Counsellors Association (ANZICA).
A copy of our male infertility fact sheet can be downloaded from the bottom of this page.