Infertility can be due to a problem in either the man or woman, but actually in around 40% of cases both partners have a condition that may be affecting their fertility.
Male infertility is a difficult and emotive problem that requires prompt and thorough medical investigation.
In men, there are often no symptoms to indicate infertility as the most common reasons are no sperm, a low sperm count or abnormal sperm function. However, there a wide range of causes to be excluded, such as testosterone deficiency. Illnesses, sexually transmitted diseases, injuries, chronic health problems, lifestyle choices and other factors can also play a role in causing male infertility.
If no specific cause can be identified, patients require advice and specialist referral for assisted or in vitro fertilisation.
To arrive at a diagnosis of male infertility, history is important. Here, the doctor will be looking for anything in the past that could contribute to fertility problems in the male. These include:
- Problems with sperm production due to infections, testicular injuries and torsion; use of radiation and testicular varicosity. Some of these can also cause blockage of sperms.
- Sexual history. How often does the couple engage in unprotected sex? Any ejaculation problems such as premature ejaculation or ejaculate backflow into the bladder? Also the following are considered:
- Ejaculation failure
- Widely spaced intercourse
- Spinal injury
- Use of certain drugs
A thorough evaluation by a urologist is required to try to determine any causes.
A fertility specialist or urologist usually carries out the physical examination. These include a detailed examination of the male genitalia that will involve the scrotum, the vas deferens, testes, the penis and the pattern of the pubic hair. Another area that will be given attention is the prostate.
- Urinalysis to rule out infections or confirm retrograde ejaculation
- Semen analysis. This checks the size and shape of the sperms; the volume, motility and the amount (number of sperms in a given volume)
- Blood tests will include hormonal tests – testosterone, pituitary hormone levels.
- Serological tests for chlamydia, HIV and hepatitis
The area of focus is the testis. An ultrasound can help to identify tumours, varicocele, abnormal testis and problems with the vas deferens.
Testing of the chromosomes may be indicated where no obvious problem has been identified from the history examination or the above tests. This may help to identify any chromosomal disorders that may be inherited by any baby that could come later.
While many reasons for infertility may be unknown, there is one cause that is very clear and that is if a man has had a vasectomy. In this case, an operation can be carried out to reverse it. It can restore fertility in some men by joining together the two narrow ends of the vas again. It is not available on the NHS, but we can carry this out. See our separate page for this procedure.
Surgical sperm extraction
Sperm can be retrieved from the testicles or the epididymis through certain techniques:
- Percutaneous epididymal sperm aspiration (PESA)
- Microsurgical epididymal sperm aspiration (MESA)
- Testicular sperm aspiration (TESA)
- Testicular sperm extraction (TESE) – single or multi-site
- Microscope-assisted testicular sperm extraction (MicroTESE)
These are appropriate for men who have no sperm in their semen due to a blockage, if they are unable to ejaculate, they have had a sexually transmitted infection or they have a problem with sperm production, which can be the case for men who have had chemotherapy or a genetic condition affecting fertility.