Male Infertility
Assessment and treatment of male factors that can affect sperm production, quality or delivery
What is male infertility?
A couple is investigated after a year of regular unprotected sex without conception, or after six months where the female partner is over thirty-five. A male factor contributes in around half of those couples and is the only factor in about a fifth.
Sperm production takes about seventy-four days. It depends on a testis held a couple of degrees below body temperature, on a hormonal signal from the pituitary, and on an unobstructed path out. A problem anywhere along that chain shows up in the same test.
The causes divide into production problems and delivery problems. Production is affected by genetics, undescended testes in childhood, chemotherapy, hormonal disorders, heat and drugs including anabolic steroids. Delivery problems include blockage after infection or vasectomy, and failure of the valve at the bladder neck.
What you might notice
- A semen report with values out of range
- Trying for a baby without success
- A dragging ache in the scrotum
How it is diagnosed
Two semen analyses at least three weeks apart are the starting point, because a single sample varies enormously with abstinence, illness and season. The laboratory reports volume, concentration, motility and morphology against reference ranges.
Examination measures testicular volume with an orchidometer, feels for the vas on both sides, and checks for dilated cord veins while you stand and bear down. Blood is taken for FSH, LH, testosterone and prolactin, and FSH in particular separates a testis that is not producing from a path that is blocked.
Where no sperm is found at all, karyotype and Y chromosome microdeletion testing come before anything surgical, since the result changes the chance of finding sperm and carries implications for any child.
Recovery
Treating a hormonal cause, or stopping a drug that is suppressing production, is judged over three to six months, because the production cycle has to complete before any change shows in a sample.
Where the cord veins have been dealt with, semen is retested at three and six months and improvement, where it comes, is gradual. Recovery from the operation itself is a few days of ache and two weeks before sport.
Collecting sperm directly from the testis is day-case work with a few days of scrotal discomfort. The tissue is examined the same day and anything found is frozen, so the result is known within twenty-four hours and the couple's plan can be built on it.
If it is left untreated
Not every male factor needs an intervention. Mildly reduced parameters in a couple who have been trying for a year often end in a natural pregnancy during the second year, and weight, alcohol, smoking and heat are worth addressing first on their own.
The cost of waiting is mostly the female partner's age, since egg quality falls faster than sperm quality and the couple's overall chance is dominated by it. A year spent on something with a low expected yield is a year the couple do not get back.
One thing must not be left. A semen analysis with no sperm at all can be the presenting sign of a testicular tumour or a pituitary lesion, and low testosterone in a young man has consequences for bone and metabolism well beyond fertility.
Questions about male infertility
Is one abnormal semen analysis enough to make the diagnosis?
No, and acting on a single result is a common mistake. Sperm counts vary widely in the same man depending on the abstinence period, a fever in the previous three months, illness, heat and even the season. Two samples at least three weeks apart, each after two to five days of abstinence and examined within an hour of production, are the standard before any conclusion is drawn. If the two disagree substantially, a third is taken. A result of no sperm at all is confirmed on a second sample examined after centrifugation.
Can anything be done if there is no sperm in the sample at all?
Often, yes. The first task is separating a blockage from a production failure, using testicular volume, FSH and sometimes genetic testing. Where production is normal and the path out is blocked, sperm is readily obtained by TESA or by opening the epididymis, and results with ICSI are good. Where production itself has failed, micro-TESE, in which the testis is opened under an operating microscope and individual tubules are inspected, finds usable sperm in a meaningful proportion of men. Genetic testing beforehand refines that expectation and matters for any child conceived.
How long before treatment shows in the semen results?
About three months at the earliest, because a full cycle of sperm production takes roughly seventy-four days and there is a further transit time through the epididymis. That applies to everything: stopping anabolic steroids, correcting a hormone deficiency, losing weight, treating thyroid disease and varicocelectomy alike. Retesting before three months tells you nothing useful. The standard is an analysis at three months and again at six, with the trend across the two being more informative than either number alone.
Other fertility & reproductive medicine treatments
Evaluation and treatment of factors that may make it difficult to conceive
Day CareAssisted reproduction in which eggs and sperm are combined in a laboratory before an embryo is transferred to the uterus
Day CareTalk to a care coordinator about male infertility
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one