Male Infertility – Swimming Around the Question
Despite male factor infertility accounting for almost a half of the reasons for a couple not becoming pregnant, the subject is taboo.
I always ask both members of the relationship to come to a fertility appointment but many times only the female turns up and always with the comment “It must be me.” Even getting a semen analysis can be a challenging request, so I want to break through the haze and take away the mystery of male infertility.
The first thing to say is how easy it is to diagnose male infertility. With women, so many factors are required to find a possible explanation for infertility but with men a simple semen test tells all (or almost all!). The collection usually takes place in the privacy of your own home and either partner may bring the specimen to the lab. Most labs have about a two hour lag time to bring it up and advise a two day abstinence prior to giving a sample.
The analysis report tabled by fertility scientists gives a sperm number, motility rate (or swimming ability rate) and a measure of the normal sperm. If the report is normal then this is immediately reassuring, however if there are some abnormalities, all is not lost. Sperm develops over two to three months and a borderline or poor result may be just a reflection of being unwell recently and so will require repeating.
Sperm is one of the factors definitely affected by lifestyle and it’s not just the unhealthy options that come to mind. Injury to the area can affect sperm quality, for example fit footballers who get scrotal trauma can get poor sperm quality. Seemingly very body conscious men with rippling muscles but who secretly take anabolic steroids have very few sperm. This is reversible when steroids are ceased. However, it is however the old favourites which are the most frequent contributors to male infertility: smoking, alcohol, obesity, age, other drugs. Heavy smokers have 20% less sperm while heavy and binge drinking may damage testicular function.
While improvement can be seen with a change in lifestyle factors, many other longer term sperm problems cannot be easily reversed. Small chromosomal variations (Daz gene deletion) or a variant of cystic fibrosis are found for the first time with a diagnosis of infertility and low sperm counts. Initially this diagnosis seems unfair however when one reflects the man has had a totally normal life (including sex life) and the couple can be treated with IVF most couples immediately smile.
The progress in male infertility has been great and I have personally had some of my proudest moments recently in seeing the success of my patients becoming parents. In some men sperm cannot be accessed in the traditional way. In these men we have retrieved sperm by way of a special procedure from the scrotum and then scientists put sperm inside the egg with an IVF variant known as ICSI. I have used this technique in men with previous vasectomies and even spinal patients in wheelchairs. The success rates with IVF in male factor patients is usually very good compared with other reasons for infertility.
So my advice is when it comes to male infertility don’t swim around the question. Get a sperm test early as it rules in or out all problems and if sperm is the problem then we have solutions.
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