Mr Vaibhav Modgil BM MSc FRCS (Urol)
Consultant Urological Surgeon & Andrologist, Manchester University NHS Foundation Trust, Honorary Senior Lecturer – University of Manchester | University of Salford | Edgehill University
Around 15% of couples do not achieve pregnancy within one year. Infertility is when a sexually active, non-contracepting couple does not achieve spontaneous pregnancy within one year.
Although 50% of infertility is associated with a male factor, investigation and treatment of men often remain rare as an initial step in the journey of a couple wishing to seek infertility treatment.
Key male infertility terms
The World Health Organization (WHO) has standardised semen parameters, which often prompt investigation in men.
- Azoospermia is the absence of sperm in the ejaculate and can be found in 10% to 15% of men with infertility.
- Oligospermia is too few sperm in the ejaculate (less than 15 million/ml).
- Asthenospermia is a reduction in sperm motility.
- Teratospermia is the abnormal structure of sperm (<4% normal).
Treatment varies from improving lifestyle
choices to procedural interventions.
Common causes of male factor infertility
- Lifestyle factors
- Use of steroids and testosterone supplements
- Smoking, excess alcohol intake, recreational drug use (eg. cannabis)
- Hormonal imbalance, including low testosterone
- Excess heat exposure to the scrotum and testicles (eg. laptops, hot baths)
- Previous trauma/surgery to the testicle or groin
- Cancer or cancer treatment
- Infections, including sexually transmitted infections or mumps affecting the testicle
- Sexual dysfunction: inability to develop an erection, orgasm and ejaculate
- Structural abnormalities; some of which the patient may have from birth and others that may be acquired (eg. varicocele enlarged veins in the scrotum, which raises temperature)
- Genetic abnormalities, such as those causing cystic fibrosis and Klinefelter’s syndrome
Assessment of men with infertility
This should ideally be done by a men’s health specialist (urologist). It involves a thorough history and examination of the patient to explore what the underlying cause may be. This also provides an opportunity to treat reversible causes like reducing alcohol and stopping smoking. It is highly recommended that all men have a semen analysis, testicular scan and hormonal blood tests as well.
Infertility treatment options
Treatment varies from improving lifestyle choices to procedural interventions like varicocele corrections in men with too few sperm. For men with no sperm in their ejaculate, once all other aspects have been optimised, there is often the chance of surgical sperm retrieval. This can be achieved through a variety of techniques, including microsurgical retrieval in specialist units.
