By Dr Ashish Das, Medical Director of City Fertility Centre Brisbane.
Reproduction can occur when there is a healthy sperm that can fertilise a healthy egg and begin the process of conception.
Statistics show that in Australia one in six couples have trouble conceiving and up to 30 per cent of these cases are said to be due to a male problem.
While it may be worrying to hear that a male factor or sperm problem might be contributing to a couple’s troubles conceiving, it is also important to understand this is common and many simple and effective treatments are available to help conception occur.
Developing and transporting mature, healthy, functional sperm depends on a specific sequence of events occurring in the male reproductive tract. Many disturbances can occur along that path, preventing cells from maturing into sperm or reaching the woman’s fallopian tube, where fertilisation occurs.
Male infertility may be caused by:
- Damage to sperm production: low sperm count, poor motility (movement), abnormally shaped sperm, or testicular cancer.
- Obstruction of the ducts leading out from the testis: tubes in the epididymis become blocked.
- Hormonal problems: hormonal or chromosomal deficiencies, including a lack of testosterone.
- Health problems: kidney failure; past childhood infections, including mumps; diabetes; and thyroid disorders.
- Genetic problems: genetic factors that impair the normal production of sperm cells.
- Lifestyle choices: for example, smoking, alcohol and certain medications.
- Functional problems: impotence or erectile dysfunction; and vasectomy (acquired factor).
- Unexplained: not being able to conceive after one year despite everything appearing normal.
What are the tests for male infertility?
There are a number of ways to test for male infertility, including:
- Semen analysis: testing for volume of semen; sperm concentration (number); sperm motility (the ability to swim); sperm morphology (shape); white blood cells and sperm antibodies.
- Ultrasound: useful for diagnosing testicular cancer, prostate issues and other structural abnormalities.
- Genetic and hormonal tests: Karyotype Y deletion studies, follicle stimulating hormone (FSH), luteinising hormone (LH), thyroid stimulating hormone (TSH) and PRL (prolactin) testosterone.
- Vasography: useful when diagnosing obstructions and abnormalities (not often used).
- Testicular biopsy: allows direct inspection of the sperm-making tissue. If this procedure is carried out by a properly qualified doctor, it may offer the patient a chance of being a biological father despite the absence of sperm in the ejaculate. It is an important method of investigating lack of sperm (azoospermia).
What are the treatment options?
Diagnosing the cause of male infertility will dictate the best course of treatment and path forward to achieving a successful pregnancy. Treatment options include:
- Lifestyle changes: maintaining a healthy weight, exercise, limiting caffeine and alcohol intake, stopping smoking and drug use, reducing stress, etc.
- Hormonal therapy: if a hormonal problem is the cause.
- Surgery: if an obstruction or abnormality is the problem.
- Vasectomy reversal.
- Surgical sperm extraction: when sperm is not being ejaculated in semen despite it being produced.
- Donor sperm.
After a thorough diagnosis, patients are advised of the best path forward and a tailored plan is devised. The plan can range from making some minor changes and continuing to try to fall pregnant naturally, to utilising assisted reproductive technologies (such as Intra-Uterine Insemination) or proceeding to IVF.
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