Fertility Fact: Infertility affects men and women equally. About one-third of infertility cases are due to the woman; one-third are due to the man; and the remaining one-third are due to a combination of male and female factor issues.
If you are reading this information chances are that your doctor suspects or has diagnosed that there is a functional, hormonal or sperm problem that needs to be addressed before your partner becomes pregnant. It is important to understand that these kinds of male factor problems are more common that you might realise and that there are many simple and effective treatments available to help you as a couple to conceive.
Traditionally, infertility has been thought of as a female problem, however, this is far from the truth. A male problem can be identified in nearly half of all couples who have difficulty achieving conception. Unfortunately, male infertility is not a highly publicised or discussed medical condition and this can lead to many different emotions including anger, guilt, sadness, and inadequacy. Some men tend to feel that they have been robbed of their virility and masculinity and that they have left their partner down. In dealing with these emotions, it is important that you discuss how you feel with your partner and accept their understanding and support. Your healthcare team, including counsellors will also be able to help with any concerns or questions you may have.
Almost all causes of male infertility are usually related to sperm disorders – either too few or of inadequate quality. It’s for this reason that one of the first investigations of the infertile couple is a semen analysis laboratory test. The male, unlike the female, is constantly renewing his supply of germ cells, and a single ejaculate of semen may contain as many as 200 million individual sperm cells. A sperm count of 20 million per millilitre semen is considered normal for fertilisation. The sample should also show that more than half the sperm cells are motile, and around one-third of normal shape.
Almost all causes of male infertility are usually related to sperm disorders – either too few or of inadequate quality. It’s for this reason that one of the first investigations of the infertile couple is a semen analysis laboratory test. The male, unlike the female, is constantly renewing his supply of germ cells, and a single ejaculate of semen may contain as many as 200 million individual sperm cells. A sperm count of 20 million per millilitre is considered normal for fertilisation. The sample should also show that more than half the sperm cells are motile, and around one-third of normal shape.
What is infertility?
The term ‘infertility’ is used when the ability to become pregnant is diminished or absent. It does not mean that you are unable to have children but that you may require treatment or assistance to achieve a pregnancy. Infertility is generally used if a couple has not conceived after 12 months of regular unprotected intercourse or after six months for women aged over 35. There are two types of infertility. The first is known as primary infertility and this is where a couple has never achieved having a baby before. Secondary infertility is where a couple is unable to conceive after they have already had a child. For men, the infertility problem may involve the sperm, the testes themselves, the ducts that lead out from the testes or be a functional problem in relation to sexual activity.
Signs and Symptoms of Male Infertility
Usually there are no obvious signs or symptoms of an infertility problem other than the inability to fall pregnant. Erections, intercourse, and ejaculation will usually happen normally, and the quantity and appearance of the ejaculated semen generally appears normal to the naked eye.
What are the risk factors for men regarding infertility?
The following is a list of risk factors related to male infertility (also called male factor infertility):
- History of prostatitis or genital infection
- Testicular trauma or torsion
- History of precocious puberty (puberty occurring at a young age) or delayed puberty (puberty occurring at an older age)
- Exposure to toxic substances or hazards on the job, such as lead, cadmium, mercury, ethylene oxide, vinyl chloride, radioactivity, and X-rays
- Cigarette or marijuana smoking
- Heavy alcohol consumption
- Exposure of the genitals to high temperatures
- Hernia repair
- Undescended testicles
- Prescription drugs for ulcers or psoriasis
- Mumps after puberty
Boosting your Fertility
To give yourself the best chance of becoming pregnant, it is recommended that you have unprotected intercourse every two to three days. In addition, changing your lifestyle in certain ways and timing intercourse for when you are most fertile are some of the recommended ways to maximise the possibility of conceiving.
For further information on lifestyle changes click here.
Diagnosing Male Infertility
For your first appointment with a fertility specialist, it is best to go as a couple. Your specialist will initially ask you detailed questions about your medical history and your sex life and should conduct a physical examination. For further information on the initial consultation click here. For further information on Tests and Treatments for men click here.
What are we testing for?
When evaluating a couple, your specialist will try to determine which of the following essential conditions required for pregnancy may not be functioning properly:
- A good quantity and quality of male sperm. There will be a decrease in fertility if the sperm are:
- Not being produced in adequate numbers
- Obstructed and cannot reach the outside world
- Not swimming very well
- Being identified and attacked as a foreign cell by antibodies produced by the male or female’s immune system
- The right balance of hormones to allow egg and sperm development and support
- A healthy mature female egg and whether ovulation regularly takes place
- A functioning reproductive tract (uterus and fallopian tubes) which allows for the egg and sperm to meet and fertilise
- The ability of the female body to allow for implantation of an embryo and to maintain and nourish the embryo
Common Causes of Infertility in Men
One of the most important tasks is to try and establish the cause of a man’s infertility. While it is often very difficult to establish the cause, knowing the reason for your infertility is both reassuring and indicates the best method of treatment to your specialist. Although male infertility is commonly associated with impotence, many infertile men have perfectly normal sexual relationships. Indeed, the most common causes are low sperm counts and in rare cases semen samples which contain no motile sperm cells (a condition known as azoospermia). Smoking, excessive use of alcohol and obesity have all been linked to poor sperm counts.
Lifestyle factors may impact fertility but for men the most common causes of infertility are:
- Damage to sperm production
- Hormonal problems
- Obstruction to the ducts leading out from the testis
- Ejaculation issues
- Sperm antibodies
- Genetic problems such as Cystic Fibrosis
- Certain medications
- Prior surgeries
- Infection and disease such as Mumps
Treating Male Infertility
Discovering the medical reason for not being able to conceive easily and beginning treatment as advised by your specialist, is the start of a new and positive phase of your life. However, it is also important to acknowledge that even with treatment, it may take some time to become pregnant. It can be a long, frustrating, and emotional process and you and your partner should prepare yourselves for this (see our section on Coping Strategies for some suggested coping methods).
A list of treatment options can be found under the Treatments & Services section of our website.
Counselling is an essential part of all infertility services today. We are sensitive to the emotions of each infertile couple and the stress of the treatment itself. Counselling is available to all patients at any time at Medfem Fertility Clinic. For further information visit the Counselling and Support section of our website.