Male Fertility Screening

Male infertility is a significant concern for many couples trying to conceive, contributing to around half of all infertility cases. Understanding the common causes of male infertility is essential for those seeking information and support. This overview explores the predominant factors leading to fertility issues in men, highlighting the importance of awareness and early intervention.

Low Sperm Count (Oligospermia)

One of the leading causes of male infertility is a low sperm count, where the semen contains fewer sperm than normal. A sperm count of fewer than 15 million sperm per millilitre of semen is considered lower than normal. Oligospermia can significantly reduce the chances of fertilising an egg naturally.

Poor Sperm Motility (Asthenozoospermia)

Sperm motility refers to the ability of sperm to move efficiently. Poor sperm motility means that sperm do not swim properly, which can prevent them from reaching and fertilising an egg. It is a common factor in male infertility.

Abnormal Sperm Shape (Teratozoospermia)

The shape of sperm, known as sperm morphology, plays a critical role in the success of fertilisation. Abnormal sperm shape can make it difficult for sperm to penetrate and fertilise an egg. A higher percentage of abnormally shaped sperm can decrease fertility.

Varicocele

A varicocele is a swelling of the veins that drain the testicle. It is the most common reversible cause of male infertility. Varicoceles can decrease sperm quality and quantity, though not all varicoceles affect sperm production.

Lifestyle Factors

Several lifestyle factors can impact male fertility, including:

• Smoking tobacco
• Excessive alcohol consumption
• Illicit drug use
• Overweight or obesity
• Stress
• Exposure to toxins and pollutants

Hormonal Imbalances

Hormones regulate the production of sperm and sexual function. Imbalances in hormones such as testosterone can affect sperm production and lead to infertility.

Ejaculation Issues

Ejaculation disorders, such as premature ejaculation, delayed ejaculation, or retrograde ejaculation, can hinder the delivery of sperm to the egg, thereby impacting fertility.

Genetic Factors

Certain genetic conditions, such as Klinefelter’s syndrome or cystic fibrosis, can affect male fertility by impacting sperm production or causing blockages that prevent the delivery of sperm.

Medical Treatments and Conditions

Some medical treatments, especially those for cancer like chemotherapy and radiation, can negatively affect sperm production. Additionally, surgeries related to the bladder, urethra, and prostate, and conditions like diabetes, can impact fertility.

Environmental and Occupational Factors

Exposure to heavy metals, radiation, and high temperatures can affect sperm production and function. Occupations that involve exposure to these factors can pose a risk to male fertility.

Yes, there are instances where both male and female factors contribute to infertility, impacting a couple’s ability to conceive. This combined infertility is a scenario where issues are identified in both partners, making the journey to parenthood more challenging. Understanding the dynamics of combined infertility is crucial for couples facing difficulties in conceiving, as it highlights the importance of comprehensive assessments and tailored treatment strategies for both partners.

Understanding Combined Infertility

Combined infertility occurs when both partners have one or more factors that impair their reproductive capabilities. In the realm of fertility issues, it’s essential to recognise that infertility is not solely a concern for one partner. Statistics suggest that in up to 30% of infertility cases, both male and female factors are identified, underscoring the complexity of reproductive health.

Common Causes in Combined Infertility

In men, common causes of infertility may include low sperm count, poor sperm motility, abnormal sperm morphology, and issues related to sperm delivery. Environmental factors, lifestyle choices, and certain health conditions can also play a significant role in male fertility.

For women, infertility can arise from ovulatory disorders, fallopian tube damage, endometriosis, uterine or cervical abnormalities, and age-related factors that affect egg quality and reserve. Like with men, lifestyle and environmental factors can also impact female fertility.

The Importance of Joint Assessment

When couples face difficulties in conceiving, it’s crucial for both partners to undergo comprehensive fertility evaluations. This approach ensures that any contributing factors from both sides are identified, allowing for a more targeted and effective treatment plan. Fertility assessments typically involve a series of tests and consultations, which may include semen analysis for men and ovulation monitoring, hormonal assessments, and imaging studies for women.

Treatment Options for Combined Infertility

Treatment for combined infertility depends on the specific factors involved and may include a range of medical interventions and lifestyle modifications. Options may encompass:

• Medications to improve ovulation in women and increase sperm production in men.

• Surgical procedures to correct anatomical issues affecting fertility in either partner.

• Assisted reproductive technologies (ART), such as in vitro fertilisation (IVF), which can be particularly effective in overcoming combined infertility by facilitating fertilisation outside the body.

• Lifestyle changes aimed at improving overall health and fertility, including diet modifications, weight management, reducing alcohol and tobacco use, and minimising exposure to environmental toxins.

The Role of Support and Counselling

Facing combined infertility can be emotionally challenging for couples. Support and counselling services play a vital role in providing emotional support and guidance through the fertility journey. Fertility counselling can help couples cope with the stress and emotional impact of infertility, offering strategies to manage anxiety and improve relationship dynamics during this trying time.

Semen analysis is a crucial diagnostic test in the assessment of male fertility. It involves evaluating a semen sample to check for abnormalities in sperm and seminal fluid, providing valuable information about a man’s fertility status. The process is performed in a laboratory setting by trained professionals, adhering to strict protocols to ensure accuracy and reliability of the results. Here’s an overview of how semen analysis is carried out, offering insights into the steps involved in this essential fertility test.

Collection of Semen Sample

The first step in semen analysis is the collection of a semen sample. Typically, this is done through masturbation, with the sample being ejaculated directly into a sterile container. The collection usually takes place in a private room at the laboratory or clinic. It’s important for the individual to follow pre-test instructions, such as abstaining from ejaculation for 2 to 5 days prior to the test, to ensure the accuracy of the results.

Initial Assessment

Once collected, the semen sample undergoes an initial assessment. This includes measuring the volume of the sample and observing its appearance. The liquefaction time, or the time it takes for the semen to liquefy, is also noted. Normal semen should liquefy within 20 to 30 minutes after ejaculation.

Microscopic Examination

The microscopic examination is a critical component of semen analysis. Under a microscope, the laboratory technician assesses several key parameters:

• Sperm Count (Concentration): The number of sperm present per millilitre of semen. A lower than normal sperm count may indicate infertility.
• Sperm Motility: The ability of sperm to move effectively. This is usually reported as the percentage of sperm that are moving and the quality of their movement.
• Sperm Morphology: The shape and structure of sperm. Abnormal morphology can affect the sperm’s ability to fertilize an egg.

Additional Tests

Depending on the initial findings, additional tests may be performed, including:

• Semen pH: The acidity of the semen, which can affect sperm motility and survival.
• White Blood Cell Count: To check for signs of infection in the semen.
• Fructose Level: To assess the seminal vesicles’ function, which is important for sperm motility.

Analysis and Reporting

After the examination, the results are compiled and analyzed. The report will detail the findings, comparing them to reference values established by the World Health Organization (WHO). This report is then reviewed by a fertility specialist, who will interpret the results in the context of the individual’s overall fertility assessment.

The typical sperm count in a normal adult male ejaculation plays a crucial role in understanding male fertility. According to the World Health Organization (WHO), the normal range for sperm concentration in semen is about 15 million sperm per millilitre (ml) of semen or a total count of approximately 39 million sperm per ejaculate. This benchmark is used as a guideline for assessing male fertility, with counts above this range generally considered normal and indicative of a potentially higher fertility potential.

However, it’s important to note that sperm count is just one aspect of semen quality. Other factors, such as sperm motility (the ability of sperm to move effectively towards an egg) and sperm morphology (the shape and structure of sperm), are also critical in determining a man’s fertility. A semen analysis that evaluates these parameters, in addition to sperm concentration, provides a comprehensive overview of male reproductive health.

Men with sperm counts below the WHO reference values may experience difficulties in conceiving naturally, but it does not necessarily mean that natural conception is impossible. There are various treatments and assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) that can assist couples facing male factor infertility.

Lifestyle factors, including diet, exercise, smoking, alcohol consumption, and exposure to environmental toxins, can also influence sperm count and overall semen quality. Making positive lifestyle changes can sometimes improve sperm count and enhance fertility prospects.

For men concerned about their fertility or sperm count, consulting a healthcare professional or a fertility specialist is advisable. They can provide personalised advice, conduct further testing if necessary, and discuss potential treatment options based on individual circumstances and test results.

Yes, age is a factor that can affect the fertility of males, albeit in a more gradual manner compared to females. While men can remain fertile and father children well into their later years, research indicates that male fertility does begin to decline with age, particularly after the age of 40. This decline in fertility can be attributed to several factors associated with ageing, which impact sperm quality and reproductive health.

Age-Related Changes in Male Fertility

Decrease in Semen Volume and Sperm Quality: As men age, there is a noticeable decrease in semen volume and sperm motility (the ability of sperm to move efficiently). Sperm morphology (the size and shape of sperm) can also be affected, with an increase in sperm DNA fragmentation observed in older men. These changes can reduce the likelihood of successful fertilisation and pregnancy.

Reduced Sexual Function: Ageing can lead to changes in sexual function, including a decrease in libido and erectile dysfunction. These issues can make conceiving more challenging.

Increased Time to Conception: Studies have shown that the time it takes for a couple to conceive increases as the male partner ages. This is partly due to the decreased sperm quality and sexual function mentioned above.

Higher Risk of Health Conditions: Older age in men is associated with an increased risk of developing health conditions such as obesity, diabetes, and cardiovascular disease, which can indirectly impact fertility.

Genetic Risks: There is evidence to suggest that the children of older fathers may be at a higher risk of certain health conditions, including some genetic disorders and autism. This is thought to be related to mutations in sperm that are more likely to occur as men age.

Addressing Age-Related Fertility Concerns

While age can affect male fertility, there are steps that men can take to maintain their reproductive health as they grow older:

• Maintain a Healthy Lifestyle: A balanced diet, regular exercise, and avoiding smoking and excessive alcohol can help preserve fertility.
• Regular Health Check-ups: Monitoring and managing chronic health conditions can reduce their impact on fertility.
• Timely Fertility Evaluations: If experiencing difficulties conceiving, seeking a fertility evaluation sooner rather than later can help identify any issues and explore treatment options.
• Consideration of Future Fertility: For men who wish to delay fatherhood, sperm freezing (cryopreservation) is an option to consider, preserving sperm quality at a younger age.

Sperm freezing, also known as sperm cryopreservation, is a valuable fertility preservation technique for men who may face a risk of losing their fertility. This process involves collecting, freezing, and storing sperm for future use. Several groups of patients should consider sperm freezing as a proactive step towards ensuring they have the option to father biological children in the future. Understanding who might benefit from this procedure is crucial for individuals facing life events or medical treatments that could impact their fertility.

Cancer Patients

Men diagnosed with cancer, particularly those requiring treatments like chemotherapy, radiation, or surgery, may experience temporary or permanent infertility as a side effect. Sperm freezing before starting treatment offers the chance to preserve fertility and pursue biological parenthood later on.

Surgical Candidates

Certain surgical procedures, including vasectomy and surgeries related to the testicles, prostate, or other reproductive organs, can lead to fertility issues. Men undergoing these surgeries might consider sperm freezing as a precautionary measure.

Endocrine Therapy Patients

Treatments involving hormones, such as testosterone replacement therapy, can affect sperm production and fertility. Men planning to undergo endocrine therapy are advised to explore sperm cryopreservation beforehand.

Individuals with Occupational or Environmental Risks

Men exposed to hazardous substances, radiation, or extreme temperatures in their work environment might experience a decline in sperm quality and quantity. Sperm freezing can be a preventive step for those at risk due to occupational hazards.

Athletes Using Performance-enhancing Drugs

The use of anabolic steroids and other performance-enhancing drugs can severely impact fertility. Athletes considering or currently using these substances may wish to freeze sperm to safeguard their future fertility.

Transgender Individuals Prior to Transition

Transgender individuals planning to undergo gender-affirming hormone therapy or surgery may face fertility implications as a result of their transition. Sperm freezing before beginning treatment is a critical consideration for those who may wish to have biological children in the future.

Men with Degenerative Conditions

Certain medical conditions, such as autoimmune diseases or genetic disorders, can lead to a progressive decline in fertility. Early sperm freezing can provide a form of insurance for affected individuals.

Age-related Fertility Decline

Men who plan to delay fatherhood may consider sperm freezing as an option to preserve the quality of their sperm, acknowledging that sperm quality can decrease with age.