Male infertility

In the past, men with infertility had limited treatment options. Today, new tests and treatments have enabled many infertile men to father children.

A variety of conditions can lead to infertility in men, including:

• problems in the testes, which occurs in 30–40 per cent of cases (of which 15–25 per cent are due to genetic causes)
• a blockage in the sperm pathway caused by prior infection, which occurs in 10–20 per cent of cases
• hormonal disorders caused by conditions of the pituitary gland or hypothalamus, which occur in 1–2 per cent of cases.

In 40–50 per cent of cases, however, the precise cause cannot be determined.

Tests for male infertility

Testing begins with a comprehensive review of the man’s medical history. This includes childhood growth and development, testicular descent, sexual development during puberty, sexual history, illnesses and infections, surgeries, medications, exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy and toxic chemicals), sexual performance and any previous fertility testing.

A physical examination will include examination and sometimes an ultrasound  of the scrotum and testicles.

Semen analysis

This is the most important investigation and provides information about the volume of semen and the number, motility (movement) and morphology (shape) of sperm.

Semen may be obtained either by masturbation or during intercourse using a special non-toxic condom. The semen must be collected after a two to five day period of abstinence from ejaculation (no sex or masturbation), it must be delivered to the laboratory within one hour of collection, and it is important to avoid exposure to lubricants or extremes of temperature.

The results can very and usually semen tests will need to be done more than once and usually with two or more weeks in between.

The analysis tests the following:

• sperm antibodies. These are large proteins occasionally produced by the body’s immune system that attach to sperm and interfere with motility or cover the head of the sperm. This interferes with how it binds to the egg and prevents fertilisation.
• variations in semen volume and appearance. Low semen volume can suggest a number of things. The period of abstinence might not have been long enough; there might be problems with the glands where the semen is made; or the man may have an androgen (male hormone) deficiency.
• azoospermia. This is the total absence of sperm from the ejaculate. The main causes of azoospermia are a severe sperm production disorder or an obstruction. Rarely, an illness or difficulty with collection will cause transient azoospermia.
• oligospermia. This describes sperm concentrations of less than 20 million per millilitre. There is a correlation between sperm concentration and other aspects of sperm quality. Both motility and morphology are usually poor with oligospermia.
• asthenospermia. This describes less than 50 per cent sperm motility. This can be caused by exposure to latex (particularly in condoms), spermicides, extremes of temperature, or long delays between collection and examination.
• teratospermia. A reduced percentage of sperm with normal shape, as assessed using a microscope. This can affect how the sperm binds to and penetrates the egg.

Other tests for male infertility

Sometimes hormone testing will reveal that a man has a particular problem or problems with the parts of the brain that regulate hormone production.

Men may also be tested for retrograde ejaculation, which is the flow of semen into the bladder. This will require a post-ejaculation urine sample.

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