Always consult your GP or fertility specialist before undertaking any fertility treatments or interventions. Your healthcare provider will be best able to advise which interventions you may or may not be eligible for.
The Male Reproductive System
understand male factor infertility, let’s take a quick overview of how the male
reproductive system functions and what factors contribute to fertility.
Sperm needs to be produced: Luteinizing hormone (LH) and
follicle-stimulating hormone (FSH) made by the pituitary gland trigger
sperm and testosterone production by the testicles. Both hormones and testicles
need to function correctly to facilitate this.
Sperm must meet semen: As the mature over the
course of 72 days, sperm wind their way toward the prostate through a delicate
network of seminiferous tubules, the epididymis (where they gain strong mobility),
vas deferens, scrotum, groin, and pelvis. The prostate gland and the seminal
vesicles produce semen.
There has to be enough sperm: Sperm count is the amount of
sperm once it has mixed with semen and lower counts decrease the chances of
fertilizing the egg.
The sperm needs to be able to get to the egg and
fertilize the egg: The male must be able to deliver the sperm to the egg. This means he should
be able to sustain an erection and successfully ejaculate. Sperm has to have
good movement (motility) to make it up the fallopian tube to meet the egg. The
sperm’s shape (morphology) also plays an important part in penetrating the egg
in order to fertilize it.
What is male infertility?
when a couple has unprotected sex for 12 months and is unable to conceive.
infertility (or male factor infertility) is when both partners undergo medical
testing with a GP or a fertility specialist, and reproductive concerns are
found in the male partner.
infertility will be a result of deficiency in one of the above functions. However,
50% of underlying causes go undetermined.
Treatments for male infertility will
be based on the underlying cause of the infertility and recommendations will be
made to correct or improve fertility.
Some causes of Male Factor Infertility and
your GP or fertility specialist before undertaking any fertility treatments or
Your healthcare provider will be best able to advise which
interventions you may or may not be eligible for.
Below are only some causes
for infertility and some of the procedures available for that specific ailment
Some treatments may overlap or be the available remedy for more than one
condition. Often, treatments are used in conjunction. However, duplicates have
been intentionally removed.
1. Hormonal deficiency
rarely the cause of infertility, hormonal deficiency can still attribute to
about 1% of infertility cases.
The causes of the deficiency can range from lack
of production of Luteinizing hormone (LH) and follicle-stimulating
hormone (FSH) by the pituitary gland from birth, to benign pituitary tumours,
to anabolic steroid abuse.
disturbances or inadequacies inhibit proper functioning of the testicles.
Insufficient production of LH affects the amount of testosterone production,
which may inhibit libido and even cause erectile dysfunction.
directly correlates with sperm production. Sub-fertility is when not enough
sperm is produced and the chances of fertilization are decreased.
Male fertility drugs/hormone therapy: Human chorionic
gonadotropin (hCG) alone or with a combination of other gonadotropin related fertility
drugs can be used in an attempt to increase the production of sperm by
stimulating production of the lacking-hormone.
Male fertility treatments
frequently take 1 to 2 years before significant improvement in sperm count is
2. Structural problems and/or abnormalities
causes of male infertility may range from an absence of, or blockage to sperm
Common obstruction or
blockage problems include severed or
missing connections relating to the vas
deferens, previous vasectomies, and duct blockages in the epididymis or
ejaculatory tracts, among others.
They may also be caused by previous
infections or injuries.
Varicoceles are abnormally dilated veins located within the
They are thought to either increase the temperature of the testicles
through localised extra blood supply or pooling, subsequently compromising
sperm cell count, motility, and/or morphology (shape) through excessive heat
Corrective or reparative surgical procedures
About 85% of
vasectomies are reversible. Other blockages or obstructions can typically be
resolved through minor surgeries.
The aim is to correct or repair the pathway
for transport of sperm.
do not guarantee nor always restore fertility, most are medically uncomplicated
and inexpensive compared to other treatments.
Particularly the Ejaculatory duct
resection, used to treat cysts, calcification, or stones obstructing the
seminal duct, can be performed in as short as 1 hour.
3. Quality of Sperm
varying causes of reduced production, or the production of low-moving
(low-motility) or misshapen sperm.
For successful fertilization, the sperm must
be vital (alive), able to swim up the female reproductive tract, AND enter the
A normal concentration of sperm with the ideal shape and good movement
increase the chances pregnancy. 2/3 of men experiencing infertility attribute
to sub-par sperm production or quality.
can be tricky to diagnose as most men affected will be able to sustain an
erection and successfully ejaculate during sex.
Motility or morphology issues
can go undetected as there are no visible signs or symptoms.
can be categorized as non-motile (not moving), non-progressive motile (moving
but not getting anywhere), and progressive motile (moving and in a direction).
The female ovum secretes hormones that attract the sperm, allowing them to
“know where to go”.
of progressive motile sperm within a sample of ejaculate should be above 40%,
or above 20 million.
Numbers below are a condition called asthenozoospermia.
In addition to
good movement, sperm must be of a shape conducive to penetrating the egg. 4% of
a sampled ejaculate must not have morphological abnormalities for normal
chances of conception.
Shape can also have an effect on sperm movement, as a
bent tail or misshapen body can render the sperm’s ability to “swim”.
Intracytoplasmic sperm injection (ICSI)
ICSI is a type
of Assisted Reproductive Technology and is the most successful treatment
available for male infertility.
A single sperm is isolated from a sample of
ejaculate and injected into the egg.
The procedure is also an effective remedy
for various other fertility problems, such as erectile dysfunction, previous
vasectomy, or other conditions in which sperm delivery is inhibited.
cells can be retrieved from the testes or epididymis directly, or collected
from a semen sample.
Additional physiological testing (PICSI) may be done to specifically isolate sperm that has the
attributes to detect and bind to the ovum, and facilitate better chances of
4. Sexual, unexplained, or other causes of infertility
dysfunction or ejaculate issues may be grounds of infertility.
premature, or failure in ejaculation prevents the sperm from entering the
female reproductive system.
Or, Anti-sperm antibodies may be present, which
cause the male’s immune system to attack his own sperm when it comes in contact
This can cause sperm to clump, or inhibit its motility and thus
lowering the chances of the sperm fertilizing the egg.
If the quality
and quantity of sperm are not compromised and mechanical delivery is at the
root of the issue, IUI may be an option.
IUI is a procedure in which a semen
sample is placed into the uterus.
The sample undergoes special washing and removes
any antibodies that could potentially inhibit its movement.
Placing the semen
in the uterus gives it a “head start”, which is helpful if the sperm is
Natural conception still has to take place, and the semen must
swim to and fertilize the egg.
Improving fertility without medical intervention
modification often gets the back-seat when it comes to improving fertility. Although
some causes to infertility can be hormonal, genetic or structural; external
factors such as nutrition, heat exposure, drugs, alcohol, and other toxins may
also impact sperm production and quality. Vitamin D has a specific correlation
with movement in sperm tails. Improving your general health is not only great
in the long run, but may have added benefits to fertility. As always, consult a
medical professional before commencing any diet or exercise regimen.
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