Two to tango: What is male infertility?
Half of all infertile couples have some form of male factor involved.
Half of all infertile couples have some form of male factor involved. For 30% of couples, a male factor is the main reason they cannot conceive together.
Problems with sperm production, movement or shape are common. Some men form antibodies against their own sperm (anti-sperm antibodies).
Chromosome or DNA problems cause men to have problems producing sperm or may cause their partners to have frequent miscarriages. Men can develop a hormonal imbalance and this can be a contributing factor to erectile dysfunction (ED) and infertility. Ejaculation problems can result as a side effect of certain medications or because of nervous system problems.
Lifestyle factors that damage sperm
Smoking (tobacco or other substances including marijuana), excessive alcohol and caffeine use, being overweight, overheated, having varicose veins of the scrotum (varicocele) or having poorly controlled diabetes are reversible factors that are toxic to sperm. As sperm is regenerated constantly, lifestyle interventions are truly effective at improving sperm quality in many circumstances. It take approximately 3 months of best behaviour to make sure sperm is as good as it can be.
Men get older too
Much is spoken about declining fertility with advancing age in women, but it is important to realise that as men get older, fertility problems become more common. DNA fragmentation levels in sperm and spontaneous or “de novo” genetic and epigenetic conditions are more common in men aged over 40. There is not a lot that you can do to change your age, but recognising that male age can be a factor may help you decide on the right time to seek specialist help getting pregnant.
Rare issues where there is no test
Most causes of “male factor infertility” are readily diagnosed, however some important problems can be more cryptic. Poor sperm to egg binding ability of sperm that technically look normal is a problem that may be unsuspected and often discovered only during IVF treatment in the laboratory.
Treatments for male infertility
Fortunately most male factor problems can be treated or overcome to help a couple conceive.
ICSI or Intra cytoplasmic sperm injection can be used in IVF to literally produce a pregnancy from a single sperm. This can help men with ultra low sperm counts or men who have had a vasectomy (reversal surgery can be much more expensive and invasive than IVF, and can often be unsuccessful), congenital absence of the vas deferens or other obstructive problems. ICSI can also help men with genetic conditions that lead to only small areas of sperm production in the testes. In these cases, sperm may be retrieved through surgical dissection.
Digital high magnification technology (MSOME) is an advanced method of selecting your best sperm for a version of ICSI known as IMSI.Other methods include the use of hyaluronic acid infused PICSI dishes or microfluidic sperm selection devices such as Zymot.
A lot of men never contemplate that their sperm might be part of the problem and can be shocked and disappointed when an issue is discovered. On the other hand, many women just assume that their own fertility issues are the main concern for a couple when this may not be the case. My advice is – forget the blame game. A thorough investigation as a couple from the outset is the best way to ensure any treatment you undertake is targeted, addresses all relevant issues and is aimed at minimizing your time to conceive.
Read more about male fertility here.
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Lovers intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.