Male infertility, what can be done?
My semen analysis was abnormal, what next?
The next step in assessing male fertility if there has been an abnormal semen analysis will depend upon how severe the abnormality was. The sperm production cycle is approximately 84 days long and if a man has been unwell/had a high fever this can reduce/compromise sperm function for up to 84 days after he has recovered from the illness. Therefore, often the next step is to repeat the semen analysis after 3 months to see if the abnormality has persisted. If the abnormality was severe, then this may lead to your fertility specialist recommending you have further tests now including a repeat semen analysis.
Interpretation of semen analysis results is often complex, and it's not unusual for test results to be misunderstood and require further explanation/clarification.
Your fertility specialist is likely to recommend doing tests on your partner. Deciding how best to treat your situation will depend upon whether one or both of you have a fertility problem. Remember that it's common for both partners to have a fertility factor that requires treatment.
There were no sperm on my semen analysis, can anything be done?
Statistics show that if there are no sperm in the first semen analysis then sperm will be found in 15% of cases when the test is repeated. If the repeat test still shows that there are no sperm then this does not necessarily mean that sperm cannot be found to use for treatment. The first step is to do further testing as outlined below, in order to find if there is a reversible/treatable cause. Often (but not always) it will be possible to aspirate sperm from the testes or epididymis that could be used as part of in vitro fertilization (IVF) treatment combined with single sperm micro-injection (so called ICSI).
Is there more testing I can have?
Some men who have a major abnormality in their semen analysis or who have azoospermia can be carriers of certain inherited/genetic conditions and so additional screening may be indicated such as;
- Genetic testing (chromosomes/karyotype)
- Screening for a Y chromosome microdeletion (DAZ gene)
- Screening to exclude being a carrier of cystic fibrosis
Other tests might include;
- Excluding hormone deficiencies
- Sperm Chromatin Structural Assay (SCSA)
- Finding hormone evidence of a problem with the sperm producing tissue
- Finding out if the ejaculate goes into the bladder (so called retrograde ejaculation)
- Performing an ultrasound to exclude a varicocoele (varicose vein in the scrotum) or other physical abnormality
Hormone testing as above can often differentiate between whether there is a blockage preventing sperm from getting into the ejaculate or if the sperm producing tissue is not working well.
What can I do to improve my fertility?
There are a number of lifestyle factors that may impact upon male fertility, and a summary of these is available on our webpage and fact sheet. However, there is recent evidence strongly supporting that the following lifestyle changes can improve male fertility.
- Stop smoking (tobacco and recreational drugs). Smoking damages sperm function and possibly the fertility of children born to smokers. There is also evidence of an association between fathers who smoke and a shortened reproductive lifespan for their daughters.
- Consider taking oral antioxidants (vitamins C and E) as there is strong evidence for a benefit of oral antioxidant therapy in male infertility. However, do not ask your partner to take antioxidants as there is a small amount of evidence that these may be harmful to female fertility.
- Have your vitamin D levels checked (a blood test). If your levels are low then there is some evidence that taking vitamin D supplements may improve sperm motility.
- If you are overweight, then it may be beneficial to lose weight. Recent evidence suggests that male obesity is associated with reduced embryo quality and implantation rates of embryos.
- Do your best to avoid environmental contaminants. For example exposure to bisphenol-A (BPA) has been associated with poor semen quality
What if I have a problem with erection or ejaculation?
The first step is to talk to your doctor. This problem is much more common that you would think, and your doctor will be used to discussing this with people on a very regular basis. Your doctor may want to do some tests to exclude certain medical conditions such as diabetes. They may be able to prescribe medication that will help. If these steps do not help you then a fertility specialist can assess your situation and offer treatments such as sperm collection followed by intra-uterine insemination (IUI) or in-vitro fertilization combined with ICSI.
What if I have a varicocoele?
If you have been found to have a varicocoele, seek expert advice as to whether there is a role for varicocoele ligation. This is a controversial area as there is conflicting evidence as to whether such surgery is helpful. Varicocoele ligation is not recommended in all cases.
Could IVF and ICSI help me?
IVF and ICSI is usually a very good treatment for severe male factor infertility. Sometimes sperm quality can have an impact on embryo development after fertilization and the chance of an early pregnancy loss. There is a new technique called HA-ICSI that can be used to select sperm for ICSI that have a lower chance of having fragmented DNA, with the aim of improving embryo quality and reducing the chance of miscarriage.