5th February 2020
Male infertility issues are more common than what many people imagine. Whenever a couple is having difficulties in having a baby, more often than not, the problem is assumed to be with the woman. In reality, male infertility problems are responsible for about 40% of couples who want but cannot have a baby.
To arrive at a diagnosis of male infertility, getting an accurate medical history is important. Here, the doctor will be looking for anything in the past that could contribute to fertility problems. These may 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.
- Erection difficulties
- Ejaculation failure
- Widely spaced intercourse
- Spinal injury
- Use of certain drugs
As with many other medical conditions and diagnoses, it is important for a doctor to carry out a physical examination. A fertility specialist or urologist usually does this as they have more specialist knowledge as to what is normal or if anything may need further investigation. The assessment may 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. This is a completely standard approach and is nothing to be nervous of.
As well as a physical investigation, further laboratory tests may help. These include:
- Urinalysis to rule out infections or confirm retrograde ejaculation
- Semen analysis (usually two). 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 – especially if required for sperm storage.
The areas of focus in radiological imaging are the testes and the prostate. An ultrasound can help to identify tumours, varicocele, abnormal testis and problems with the vas deferens such as blockages.
Where no obvious problem has been identified from the history examination or the above tests, testing of the chromosomes may help to identify any chromosomal disorders that may be inherited by any baby that could come later.
Specific genetic tests such as Y microdeletions are required where there are severe problems with sperm production or indeed no production in the semen.
Help and support
We have seen many men who have struggled with infertility and have been able to help whether it is providing a diagnosis to understand what the cause might be or to go on to provide treatment to overcome this. Infertility is something that can be heartbreaking, but it is often not a dead-end. This is something we can discuss in more detail at appointments with urologists in our team.