How is male infertility diagnosed?

Posted on 1 June 2020

It is hard for men to be motivated to have a sperm test as many falsely believe that all fertility problems relate to the female. This is very far from true, but unless a man has a sperm test, there is no way to know.

A sperm test involves a bit of preparation. You will need to book a time to do the test after arranging for a request form from your GP or specialist. You should ejaculate two days before your sperm test and then hold out on any further ejaculation until it is time for your test.

Sperm should either be provided on site at the andrology laboratory, or if this is not practical, a sample should be delivered still warm within an hour of ejaculation. To keep the warm, a good tip is to carry it in the breast pocket of a business shirt. You’ll need to dress for the occasion to be prepared. Your sperm will be tested for anti-sperm antibodies and will be analysed looking at sperm count (concentration), movement (sperm motility) and shape (sperm morphology)

If the semen analysis is normal, you may not be required to have extensive further testing beyond a karyotype and routine screening blood tests. If the semen analysis is abnormal, it is likely you will be asked to repeat it, and may also be asked to undertake further in-depth hormone testing and imaging studies.

What treatment options are available to address male factor infertility?
Some causes of male factor infertility are full reversible. Others have no cure. The first step is getting the diagnosis right. To do this you should obtain a GP referral to see a CREI fertility specialist.
Some male factor concerns can be corrected with medicines. Some require surgery. Some couples will get pregnant with IUI. Others will need IVF and ICSI. Occasionally, where no sperm is found, a testicular microdissection (micro-tese) may be offered to search for sperm. Where the search for sperm fails, donor sperm may be the answer to help couples have a family together. Whatever the reason for male factor infertility, A CREI fertility sub specialist will help you find answers and solutions.

Does male factor infertility have any symptoms?
Not necessarily. Before a man has had a sperm test, there is no way to tell whether he has a sperm problem. He may be fit and healthy. He may have fathered a child in the past. Neither of these things mean there is not a sperm problem right now. It is really important to investigate the male of an infertile couple as male factor problems are very common and can be acquired over time.
However, if you are experiencing any of the following signs and symptoms of male infertility, you may have a hormonal imbalance:
• Reduction in face and body hair
• Lower libido (low sex drive)
• Noticed reduction in the size of your testes
• Varicose veins of your scrotum that are pronounced
• Sexual difficulties due to problems with having or sustaining an erection or ejaculating problems

Are certain men more at risk of male factor infertility?
Male factor infertility can affect anyone. However, there are certain populations of men where infertility is more common.
Male factor infertility is much more common:
• If you smoke
• If you are aged over 45 years
• If you are overweight or obese
• If you have had workplace or domestic exposure to toxins and endocrine disrupting chemicals
• If you have had testicular trauma or surgery
• If you have had a vasectomy (even if this is reversed)
• If you have any major current medical illness
• If your testes were undescended at birth
• If you have a family history of a fertility problem, especially if you were conceived by IVF or ICSI
• If you are using medications that affect fertility such as steroids or hormone tablets to promote scalp hair growth

What are some male infertility surgical options?
Varicocoele surgery: Known as varicocoelectomy, this surgery addressed varicose veins of the scrotum, hoping to help with testicular thermo-regulation or temperature control. A fertility-focused urologist performs this kind of surgery. At Women’s Health Melbourne we work closely with Melbourne’s best urological surgeons to help our patients.

Vasectomy reversal: There are many different techniques to reverse a vasectomy. This will work for some patients to return sperm to the ejaculate and allow natural conception to occur. Other men may find surgical reversal attempts are unsuccessful or complicated by sperm antibody formation causing secondary male factor infertility requiring IVF. No matter your circumstance, we can almost always help men who have had a previous vasectomy to conceive again, one way or another.

Ejaculatory duct obstruction surgery: This surgery addresses acquired blockages in the ejaculatory ducts, trapping sperm from escaping into the ejaculate.
Surgical sperm retrieval techniques: When sperm is trapped in the testis and can’t get out, there are various surgical approaches to retrieve sperm. The most common is a fine needle technique, retrieving sperm from the epididymis (PESA) or testis (TESA), performed by your CREI fertility specialist.

Open testicular surgical approaches such as microtese can also be performed where there may be no blockages but widespread testicular failure to produce sperm. In this circumstance, we are looking for tiny pockets of healthy sperm production within a mostly non-functional testis. Cases like this are referred to as non-obstructive azoospermia, meaning there is no sperm reaching the ejaculate.

You can hear more about male fertility surgery on Knocked Up, our Women’s Health Melbourne podcast about fertility and getting pregnant.


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