Infertility - not being able to conceive after 12 months of having regular unprotected sex - affects about one in 6 couples in Australia. Male infertility, where the problem with conceiving is due to a problem with the male partner, is a major factor in 30 to 50 per cent of couples, and the only factor in 20 per cent of couples.
Male infertility usually results from a problem with the sperm - either low numbers of sperm or poor quality sperm.
See your doctor if you and your partner are having trouble conceiving. Your doctor may recommend tests to work out why you are having difficulties, and depending on the cause, may recommend various treatments to help improve your chances of having a baby.
Symptoms of male infertility
For most men, the only sign that there is a problem is the fact that their partner is having trouble getting pregnant.
Most men who see their doctor to investigate difficulties with conceiving have normal erections and ejaculate semen when they have sex.
Causes of infertility in men
Male factors contributing to difficulty conceiving a baby include the following.
Problems with sperm production or function
The most common cause of male infertility is a problem with the sperm, which are made in the testes. There can be problems with sperm numbers, where there are either too few sperm produced or, in some cases, no sperm at all (called azoospermia).
There may also be problems with sperm quality, where some of the sperm are abnormally shaped (abnormal morphology) or are poor swimmers (poor motility). Poor quality sperm have difficulty reaching and fertilising an egg.
Sperm problems may be due to:
- a hormonal problem (such as too little testosterone);
- a chromosomal abnormality (genetic problem);
- having had undescended testicles in childhood;
- having a varicocele - a collection of dilated veins on the outside of one or both testicles; or
- having had certain infections (such as mumps infection of the testes or certain sexually transmitted infections).
Problems with sperm transport
Infertility may also be the result of a blockage of the passage of sperm from the testes, where they are produced, to the urethra. This may be due to:
- infection or injury involving the male reproductive system;
- vasectomy (surgical male sterilisation);
- complications from surgery involving the male reproductive tract; or
- the tubes that take sperm from the testes to the urethra (called the vas deferens) have been missing from birth.
Men who have erectile dysfunction (impotence) or problems with ejaculation may also have problems with infertility.
Other causes of male infertility
Other factors that can affect male fertility include:
- age (the quality and number of sperm tend to decrease as men get older);
- certain medicines or drugs (such as anabolic steroids);
- treatments for cancer (including chemotherapy and radiotherapy);
- some medical conditions, including diabetes, cystic fibrosis and autoimmune conditions; and
- exposure to some types of chemicals and pesticides.
Some men, especially those who have had a vasectomy reversal, develop antibodies against their own sperm. These antisperm antibodies can reduce fertility in some men by reducing sperm motility.
Lifestyle factors that can affect fertility by reducing sperm count and/or quality include:
- drinking excessive amounts of alcohol;
- using illicit drugs such as marijuana;
- being overweight; and
- regular exposure to warm environments, such as hot tubs or saunas, which can temporarily affect sperm production.
Investigation of infertility
Couples having difficulty conceiving should see their doctor, ideally together, for an initial assessment. This will usually involve the doctor taking a history of the problem (including timing and regularity of sexual intercourse) and performing a physical examination.
Further investigations will depend on the findings of the assessment and what is likely to be the cause of the problem.
If initial investigations of both partners indicates that the cause probably lies with the male partner, the following tests may be recommended.
The most important investigation in male infertility is the semen analysis. A specimen of semen is collected after abstaining from sexual intercourse for 2-5 days beforehand.
The sample must be delivered to the laboratory within one hour of collection. The specimen is analysed for:
- volume and sperm numbers;
- motility (movement); and
- morphology (shape of the sperm).
Other tests for male infertility
If there are no sperm or the sperm numbers are very low, an ultrasound scan of the testes may be performed. A biopsy of the testes may also be carried out.
Other investigations may include:
- testing for sperm antibodies in the semen (antisperm antibody test);
- genetic tests; and
- blood tests to measure the blood levels of testosterone and other hormones.
Diagnosis of infertility in men
Male infertility can be diagnosed when problems with the male reproductive system have been found that will make it difficult for the man to father a child without having treatment.
Your doctor may refer you to a urologist, fertility specialist or a reproductive endocrinologist for investigation and treatment.
Treatments for male infertility
Options for the treatment of male infertility will depend on the cause of the problem, as well as other factors, including the age of your partner. Your doctor will discuss the treatment options available and their likelihood of success.
Some treatments for infertility can be very taxing, taking a toll on you emotionally, physically and financially. It’s important to discuss the pros and cons of treatment before starting.
Your doctor may recommend that you make some lifestyle changes if there are any factors that could be impairing your fertility. For example, reducing your alcohol intake, quitting smoking or losing a few kilos may help improve fertility for some men.
Treatment for hormonal problems
Hormonal treatments and medicines are available that can help restore fertility in certain types of infertility related to hormone imbalances. The type of hormonal treatment will depend on the cause of the problem.
Surgery for male infertility
Surgical treatment may be considered for infertility that is related to having a varicocele or a blockage of the passage for sperm.
A vasectomy reversal is possible in men who wish to restore their fertility after having a vasectomy. However, this procedure is not always successful. The chances of a successful vasectomy reversal are higher the more recently the vasectomy was performed.
Assisted reproductive technology (ART)
Couples with fertility problems of any cause may be referred for assisted reproductive technology (ART) if other treatments have been or are unlikely to be effective. ART involves procedures where eggs, sperm or embryos are handled outside the body, and include the following.
- Intrauterine (or artificial) insemination (also called IUI) is a technique that involves inserting specially prepared sperm into your partner’s uterus. Your partner may or may not take medicines beforehand to stimulate ovulation. Artificial insemination using a sperm donor may be considered if other options are unsuccessful or unavailable.
- In vitro fertilisation (IVF). In IVF, eggs are collected from your partner’s ovaries and put together with your sperm in a dish in a laboratory. Fertilised eggs from this process that develop into embryos can be inserted into the woman’s uterus 3-5 days later. IVF is the most commonly used type of ART.
- Intracytoplasmic sperm injection (ICSI) is a form of ART often used to treat male infertility. Eggs are collected as for IVF procedures, but then a single, healthy sperm is injected directly into an egg. In some cases, sperm can be surgically retrieved from the testicles to be used for ICSI.
Success rates of ART vary depending on several factors. The most important factor is the age of the female partner. The cause of the infertility and the clinic where the procedure is done can also affect the pregnancy success rate.
Always check with your fertility clinic how their success rates are reported. In Australia, there is no agreed format for reporting success, so the data may be presented in different ways. Make sure you understand exactly what their figures mean.
Treatments for unexplained male infertility
There are a number of treatments that have been claimed to be helpful in treating unexplained male infertility (infertility without a known cause). However, there is currently insufficient evidence, or proof, that these therapies are effective.
Support for men with fertility problems
Being diagnosed with fertility problems or infertility can be distressing, and many men feel upset and shocked when diagnosed. Talk to your doctor about how you are feeling - it may help for you to talk to a support group or a counsellor. Talking to people who understand what you are going through or who have been in a similar situation can often help.
2. Andrology Australia. Male infertility (updated Jan 2015). https://www.andrologyaustralia.org/your-health/male-infertility/ (accessed Jun 2017).
3. Family Planning NSW. Fact sheet - infertility (updated Jun 2015). https://www.fpnsw.org.au/health-information/fertility-and-infertility/infertility (accessed Jun 2017).
4. Mayo Clinic. Infertility (updated 2 Aug 2016). http://www.mayoclinic.org/diseases-conditions/infertility/home/ovc-20228734 (accessed Jun 2017).
5. Centers for Disease Control and Prevention (CDC). Infertility FAQs (updated 30 Mar 2017). https://www.cdc.gov/reproductivehealth/infertility/ (accessed Jun 2017).
6. BMJ Best Practice. Male factor infertility (updated 2 Nov 2016). http://bestpractice.bmj.com/best-practice/monograph/497.html (accessed Jun 2017).