Male Fertility

Infertility is defined as failure to conceive after 12 months of regular unprotected intercourse. Fertility problems affect approximately 1 in 6 couples trying to conceive, and a male factor is implicated in around half of these couples. 
Therefore in total, 10% or so of males trying to conceive suffer from infertility. 

The good news is that over half of male fertility problems are treatable. This can often be overlooked, so it is always worth seeking specialist advice to discuss your options.

Risk Factors for Male Infertility

• Varicocoele: swollen veins around the testicles, most commonly on the left side – varicocoeles are seen in up to 40% of men seen in a fertility clinic. Treating varicocoeles improves sperm counts significantly, and may well improve the chances of pregnancy
• Undescended testes: or surgery for undescended testes when younger)
• Genetic factors: eg Klinefelter syndrome (XXY), or Cystic Fibrosis gene carriers
• Environmental: (eg Smoking, Marijuana, Alcohol)
• Trauma or surgery: to the testes, scrotum or groins
• Infections: such as Mumps, chlamydia, gonnorhoea / epididymo-orchitis in the past
• Steroids: body-building drugs or testosterone
• Other drugs: eg sulphasalazine, Nitrofurantoin, Amiodarone, Propranolol, Chlorpromazine, Quinine
• Ejaculatory problems 

Investigations / Tests:

Some of the following tests may be required to evaluate the causes and determine the best treatment for male infertility:

• Repeat semen analysis: at least 2
• Hormone Tests: Testosterone, Follicle Stimulating Hormone (FSH), LH,  
• Genetic evaluation: Karyotype, Y Micro-deletions, CF gene analysis
• DNA Fragmentation Index (DFI)

   

Effect of lifestyle on male infertility

Mild abnormalities in semen analysis may well benefit from adjustments in lifestyle to optimise sperm parameters. 

Men can take simple steps to increase their chances of producing healthy sperm:

• Eat a healthy diet. Choose plenty of fruits and vegetables that are rich in antioxidants.
• Maintain a healthy weight.  Obesity and being underweight can negatively affect sperm quality, reducing both sperm count and sperm movement.
• Manage stress.  Stress can decrease sexual function and interfere with the hormones needed to produce sperm.
• Get moving.  Men should include physical activity in their daily routine.
• Don't smoke.  Men who smoke cigarettes are more likely to have low sperm counts. Smoking can also decrease sperm movement and cause sperm to be misshapen.
• Limit the amount of alcohol you drink.  Heavy drinking can reduce the quality and quantity of sperm. If men choose to drink alcohol they should do so only in moderation.
• Stay cool. Increased scrotal temperature can hamper sperm production. To protect your fertility, don't wear tight underwear or athletic shorts and avoid hot tubs, saunas, steamy baths and laptops on your lap.
• Avoid excessive caffeine (< 3 cups per day) 
• Consider a trial of supplements (Vitamin C and E, Selenium, Zinc, Folic acid and CoQ10) – eg Proxceed
• Avoid lubricants during intercourse.

Treatment for male infertility (All available at Wessex Andrology)

The treatment for male infertility largely depends on the severity of infertility, but also the underlying cause. 

Relief of obstruction

• Trans-urethral resection of ejaculatory ducts (TURED)

• Vasectomy reversal (vaso-vasostomy)

• Epididymo-vasostomy
  
  

Varicocoele repair

• Evidence suggests the highest success rates and lowest complication rate is with a microsurgical sub-inguinal approach, which is what is offered at Wessex Andrology
• An alternative is an embolization, performed in the radiology department.

Surgical Sperm Retrieval

required where there are no sperm seen in the ejaculate (Azoospermia)

• PESA (a needle is passed into the tubes draining the testis, under local anaesthetic)
• TESE (an open biopsy is performed under general anaesthetic)
• Micro-dissection TESE (a very detailed inspection of the testicular tissue using an operating microscope, to maximize the chances of finding sperm in cases where there is poor sperm production (testicular failure).