Problems with sperm production
The most common causes of male infertility are called:
- Azoospermia, no sperm cells are produced
- Oligospermia, where few sperm cells are produced
- Teratospermia, where a high proportion of sperm is abnormally shaped
Sometimes, sperm cells are malformed or die before they can reach the egg. In rare cases, a genetic disease such as cystic fibrosis or a chromosomal abnormality can cause male infertility.
Around one in three cases of male infertility are caused by blockages or absence of tubes which prevent sperm passage. This could be caused by injury, genetic abnormality, or a vasectomy.
It is usually a good sign if you have ever conceived a baby with any partner in the past, but this may not mean that your sperm is compatible with your current partner.
Other factors that adversely affect sperm quality and numbers include:
- Excessive drinking
- Drugs, including steroids and recreational use
- Weight and Body Mass Index (BMI)
- Frequent exposure to extreme heat (working in hot temperatures, or regular saunas)
- Working in cramped conditions (for example, truck drivers)
- Acute viral illness
- Operations for undescended testes or hernias
Sperm production myths
There is no scientific evidence that wearing tight clothes or bike shorts affects the quality of your sperm. Diet, vitamins and supplements actually have very little impact on your sperm count - but they do help you stay healthy.
Sports injuries to the groin or testes will only have an impact on sperm production in extremely severe cases.
Non-obstructive azoospermia (no sperm in the ejaculate) requires careful evaluation and a possible search for sperm in the testis using a technique known as testicular biopsy. In some instances, microdissection of the testis is utilised to more accurately find sperm in the seminiferous tubules. This is done as a day procedure and a few days convalescence is required.
This sperm can be used for Intracytoplasmic Sperm Injection (ICSI). Before retrieving the sperm it is necessary to check the genetic make-up as some abnormalities of the Y chromosome (male chromosome) indicate that finding sperm is unlikely. Furthermore, if genetic abnormalities are found, a couple must be counselled as rarely a genetic problem causing infertility may be inherited by a male child. Sperm that are retrieved can be used fresh (the same day) or frozen in liquid nitrogen for later microinjection.
Retrograde Ejaculation occurs when semen, which would normally be ejaculated via the urethra, is redirected to the bladder at the time of ejaculation. This can occur due to the muscle that closes the bladder not functioning normally, nerve damage caused by illness, removal of the prostate gland, or side effects of medication.
If a couple is experiencing infertility as a result of retrograde ejaculation, sperm may be retrieved through a sample provided to the Melbourne IVF andrology laboratory, whereby the ejaculate is centrifuged and the sperm can either be injected directly into the woman through intrauterine insemination, IVF or ICSI. Sometimes a urine sample after ejaculation may be helpful to make the diagnosis and to obtain viable sperm for use in fertility treatment.
Occlusion is the medical term for a ‘blockage’ or absence of tubes. In men, the duct system (the vas deferens or epididymis) may prevent sperm from reaching the ejaculate. This may be caused by injury, congenital conditions, STIs or a vasectomy.
A Vasovasotomy or vasectomy reversal (where the inner and outer layers of the vas deferens are stitched back together) is one of the treatment options, allowing for sperm to travel from the testicles to the outside of the body, via the ejaculate. This option is only available for reversal of vasectomy and is not suitable for treatment of other causes of obstruction
Another option for treating occlusion is a testicular biopsy, where sperm is directly removed from the testes and stored for possible use with IVF/ICSI in the future or used in a fresh IVF cycle utilising ICSI.
The options can be discussed with your specialist who will recommend the best option for you.
Hyperprolactinaemia is the presence of abnormally high levels of prolactin (the hormone responsible for milk production) in the blood. In men, high levels of Prolactin may cause infertility and erectile dysfunction. Hyperprolactinaemia can be caused by tumours on the pituary gland, thyroid disorders, surgery from previous illnesses, some medications and recreational drugs.
After a formal diagnosis, Hyperprolactinaemia can be treated with either medication or surgery. If hyperprolaconaemia is the sole cause of male infertility it can usually be successfully treated to achieve complete resolution of symptoms and achievement of spontaneous pregnancy.
Sometimes, a vasectomy reversal may be the preferred option for men who wish to conceive with a new partner. This is performed as a day surgery procedure utilising the operating microscope. As the surgery involves very tiny sutures, a week at least must be set aside to aid healing and prevent injury to the especially small area of the vasectomy reversal site. Ejaculation must not occur for 2 weeks and no strenuous activity until discomfort and swelling has disappeared. A semen analysis to evaluate re-establishment of the sperm pathway should be done at 6 - 8 weeks following surgery.
Treating male infertility
ICSI treatment, or IntraCytoplasmic Sperm Injection, is usually recommended for couples where male infertility is a problem, especially relating to the number or quality of sperm produced. ICSI can also be used in cases where a man has had a vasectomy. It involves the direct injection of a single sperm into each egg using sophisticated equipment.