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 – this could be caused by injury or a vasectomy.
It’s 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.
What else affects sperm quality?
Other factors that affect sperm quality 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
Other causes of male infertility
Retrograde ejaculation is a condition in which some or all semen flows backwards into the bladder rather than out through the urethra during ejaculation. Symptoms include producing little or no semen during ejaculation and can be diagnosed with a urine sample and semen analysis. If you are trying to conceive, retrograde ejaculation can be treated using assisted reproductive technology such as intrauterine insemination, IVF or ICSI procedures. Sperm can be collected from the urine or surgically retrieved from the testis. A fertility specialist can explain your options and help you choose the best path for you.
Male immunological infertility occurs when a man develops antibodies against his own sperm. These anti-sperm antibodies attach to the sperm affecting the way they move and their ability to penetrate a woman’s cervical mucus and fertilise the egg. The presence of anti-sperm antibodies is commonly the result of vasectomy, injury or injection but it does not mean a man won’t be able to conceive a child. Intracytoplasmic Sperm Injection (ICSI) can be used to help achieve a pregnancy.
Hyperprolactinemia refers to elevated levels of the prolactin hormone in the blood stream. In men this can cause infertility by affecting the function of the testicles, decreased testosterone levels, decreased sex drive and abnormal sperm production. If hyperprolactinemia is affecting your fertility there are treatments available and your fertility specialist will guide you on the one most appropriate for you.
Occulsion refers to a blockage in a man’s reproductive system, often in the epididymis or vas deferens, which prevents sperm reaching the urethra. Occlusions in men could be a result of injury, vasectomy or a congenital condition. It can be treated using a Vasovasectomy which is a surgical procedure which reconnects the ends of the vas deferens together or a testicular biopsy to surgically retrieve sperm from the testis for use in IVF or ICSI treatment.
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 will only have an impact on sperm production in extremely severe cases.
What is a semen analysis?
Semen analysis is the most important test in the evaluation of a male’s fertility. The test provides an accurate measurement of the number of sperm [stated in millions per ml] the motility of the sperm, their size and shape as well as the volume and consistency of the sample. A semen sample is produced via masturbation, following 2-5 days of abstinence, into a clean, dry container either at home and delivered within an hour to our lab, or in a discreet room within the Clinic.
A normal semen analysis result will show a sperm count of at least 15 million sperm per ml, with at least 40% of the sperm showing forward progressive movement.
A minimum of 4% of the sperm should be normally formed and anti-sperm antibodies should affect less than 50% of the sperm. A repeat test will be undertaken if the initial results are poor to rule out natural fluctuations in sperm quality. If no sperm are present, this may suggest a blockage in the vas deferens [the tubes that transport the sperm from the testes], or that sperm are failing to be produced. A physical examination and hormone assessment may confirm the cause.
How do you treat 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.
You should make an appointment to see an Andrology Specialist, who specialises in male reproductive disorders.
What is a sperm DNA fragmentation test?
If a man has a repeated abnormal sperm analysis the scientists may suggest further advanced scientific testing including a sperm DNA fragmentation test which will assess the number of sperm in a sample that have DNA damage that may affect fertilisation. This test is suggested for:
- Couples with past history of recurrent miscarriage
- Men with leukocytes detected by semen analysis
- Men approaching 50 years of age
- Men with past history of prostatitis or Type II diabetes
- Poor fertilisation results
- Poor embryo quality and embryo development
- Long history of unexplained infertility
- After 2 or 3 failed ART attempts
- Males who are exposed to workplace chemicals or extended increased heat
If a high Sperm DNA fragmentation is discovered our clinics offer further advanced technologies to then sort the sperm so only the very best sperm unaffected by vacuoles in the sperm head are selected for fertilisation. Talk with your fertility specialist.
How to treat high sperm DNA fragmentation?
In some couples with otherwise unexplained infertility, the only problem that can be identified is a higher than usual level of fragmentation of the DNA [genetic material] in the sperm. This means that the sperm may not be able to fertilise the egg.
Digital High Magnification is an advanced technique enabling scientists to view and select sperm most likely to produce a viable pregnancy.
How do you treat Azoospermia (no sperm cells)?
The condition of 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 also 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.
What's involved in a Vasectomy Reversal?
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.
A simpler procedure to collect sperm surgically may also be possible and you should discuss your options with a fertility specialist.
If you want to know more about your sperm quality call 1800 111 483 or email us to book an appointment with a fertility specialist. Appointments are available within the next couple of weeks and will cost approximately $150 for a couple after the Medicare rebate.
Alternatively call 1800 111 483 for a confidential chat with a fertility nurse.
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