Male Infertility

Male Infertility

Over one third of infertile couples have problems with the male partner's semen as the principal or a contributing cause of infertility. A semen analysis is one of the first tests done when investigating infertility. 

For natural pregnancy to occur a threshold of around 10 million sperm must be deposited in the vagina at intercourse. These sperm must then have sufficient motility (swimming ability) and be of normal shape to successfully fertilise an egg. 

Although no test is absolute, a semen analysis can give a good indication of whether there is a problem. Parameters measured in which abnormalities are significant are:

• Low sperm count – men with counts less than 20 million/ml may be contributing to the infertility.
• No sperm in the semen – either due to an obstruction or failure of the testes to produce sperm.
• Poor sperm motility – The sperm do not swim in a good forward progressive manner and therefore can not make their way to the egg.
• Poor sperm morphology – The shape of most of the sperm is abnormal, a factor we know to be associated with the inability to penetrate and fertilise an egg.
• Sperm antibodies – the immune system produces antibodies against the sperm themselves. Sperm coated with antibodies have difficulty penetrating cervical mucus and eggs.

Treatment options

There are not many treatments that will improve the quality of the sperm itself, however, we can make the best of the sperm quality as it is and still produce a pregnancy.  While in the past patients would have to resort to donor sperm, today we can literally produce a pregnancy from just one sperm. Options include:

• Artificial insemination with partner semen
• IVF
• ICSI

A small number of men produce low sperm numbers due to low reproductive hormone (gonadotrophin) levels. For these men, Gonadotrophin treatment can help produce more sperm in each ejaculate.