Male Infertility: cases, treatments & symptoms

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
  • Blocked or absent vas deferens:
    • Vas deferens is the tube that transports the sperm from the testes
  • Genetic condition such as cystic fibrosis or chromosomal abnormality
  • High sperm DNA fragmentation that can affect a sperms ability to fertilise an egg
  • Sperm antibodies that can interfere with sperm motility and fertilisation

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 affects sperm quality?
  • Health & lifestyle factors such as smoking, excessive drinking, drugs including steroids and recreational use, and weight and Body Mass Index
  • Past medical conditions such as an undescended testes, hernia, STD or severe trauma.
  • Acute viral illness can also temporarily affect sperm health.

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.

While the effect of age on a man's fertility is not as significant as it is with women, there is a decline in the quality of sperm after the age of 45. After this age, sperm volume, motility and morphology declines and damage to sperm DNA increases.

Other causes of male infertility

Retrograde ejaculation

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.

Immunological infertility

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

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.

Occlusion

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.

Male fertility tests

A semen analysis is the most important test male fertility test. 

If a male has had repeated abnormal semen analysis a specialist may suggest a sperm DNA fragmentation test.

Read more about semen analysis > 

Treatment for male infertility

There are not many treatments that will improve the quality of the sperm themselves. However there are a number of treatments available to help a couple make the best of sperm quality as it is, and achieve a pregnancy include:

  • Lifestyle changes
  • Simple drug treatments such as Gonadotrophin to improve sperm numbers
  • Intrauterine insemination if sperm abnormalities are not too severe
  • In-vitro fertilisation with Intra-cytoplasmic Sperm Injection (ICSI) for severe sperm abnormalities which involves injecting a single sperm into each egg to achieve fertilisation
  • Micro-epididymal sperm aspiration or (MESA) to surgically retrieve sperm from the epididymis if there are no sperm in the ejaculate or from the testes themselves with Testicular Sperm Aspiration (TESA)
  • Digital high magnification for high level of DNA fragmentation to view and select the healthiest sperm
  • Donor insemination in the most severe cases

Top 10 Sperm Killers

Transcript

Top 10 Sperm Killers - Fertile Minds Video

After a woman's age, male infertility is the most common cause for a couple of having difficulty in conceiving.

So in today's video we're going to talk about the top 10 Sperm killers. I'll share with you the top factors that affect sperm health and some things to look out for in regards to male fertility.

I'm Dr Shadi Khashaba, a fertility specialist with IVFAustralia and I've helped both men and women over the last 10 years achieve their dreams of having a family. As a fertility specialist with an interest in male fertility factors, I know that male infertility affects around 40% of all infertile couples. Thanks to our evolving technology and expertise, we can diagnose the most common causes of male infertility and help find the right treatment option for you.

When a couple experiences difficulties conceiving with a male factor involved, we start off by analysing the male partner's sperm or semen analysis and overall lifestyle factors such as BMI and analyse the medical history and other lifestyle choices. When investigating male infertility a semen analysis is usually the first test a man will have. Understanding the results is therefore a crucial step of the process. And will help to find the cause of why you've been unsuccessful in trying to conceive.

But what information does a sperm analysis tell you?

Well, if we start with the semen volume, the average volume of semen produced at ejaculation is around 1.5 ml. That's what we need it at least to be. Motility and morphology, which is basically how many good looking swimmers are in the sample. And the total number of sperm in the whole ejaculate. A normal semen analysis results would show a sperm count of at least 40 million, with at least one third of those showing forward movement or good swimming movement.

So what are the top factors, our top 10 factors that can diminish sperm count and or quality and prevent you from having a family sooner?

All right. So we're gonna start with number one, which is smoking. Smoking definitely affects men's fertility. And how does smoking affect actually fertility? It's by having an oxidative stress on the sperm. So when a sperm gets produced in the testicle and it passes through the production line, it gets attacked by a lot of oxidative stress or oxidants that damages the sperm DNA and hinders their swimming capacity. Not only that it can kill some of the sperm that is being ejaculated hence reduces the chances of them fertilising the egg.

And that will take us to number two, alcohol. Alcohol can affect men's fertility in multiple ways. The first thing that it can actually increases your estrogen level in the body. And by increasing your estrogen level that will affect two things. Sperm production and sexual function. So definitely limit alcohol intake or to moderate amounts. One or two standard drinks, once or twice a week.

Number three. Recreational drugs. Studies have shown that smoking cannabis can actually affect the sperm's swimming capacity. So they become a bit dizzy when you produce the sperm and they can't find the egg. Steroids have been major, has major impact on sperm production. When you provide your body with excess testosterone or steroids, the testicles stop producing its own testosterone. And hence it stops producing the sperm production too. So that definitely has a great impact on your fertility potential.

The fourth point: Excess weight. When men accumulate body fat especially around the tummy area, this fat doesn't stay idle. It's actually hormonally active. And it transform your body's testosterone into estrogen. And that also has detrimental effects on sperm production. Not only that. Excess fat around the thigh areas and the pubic area can reduce the ventilation and the aeration of the scrotum and the testicle. So it will be warmer down there. And we know that warm temperatures is no good for sperm production.

And that will bring me to that fifth point: Bad diet. We all know that healthy diet can actually improve your fertility potential, especially Mediterranean Diet, which is rich in antioxidants and essential oils that is necessary for sperm productions.

And of course, we look at your past medical conditions or history. If you had undescended testicle, when you were a child and then didn't necessarily do a surgery to bring it down. So hernias, any operation in the pelvic area or previous STIs. So it was just chlamydia or gonorrhea or history of severe trauma that you had a road traffic accident or a motorbike accidents. Those are definitely gonna affect your sperm production.

But the seventh killer is acute viral illness. Which is actually like severe cold. Or you got mumps virus. These can actually increase your body temperature and can halt sperm production. The effect could last up to 72 or 90 days, and that's where actually the sperm production cycle takes. So any of intervention about your health, will take around 70 to 90 days to find the results of your lifestyle changes.

Bring me to the eighth point: exposure to chemicals or toxins. Certain workers in certain industries get exposed to harsh chemicals. And we know by either inhalation or contact through the skin, they can absorb some of those chemicals which can affect the sperm production.

The ninth point: advanced paternal age. Recent studies shows that actually men's fertility drop by getting older. Not only that, certain genetic conditions can be more common as we get older for men. So do you have to freeze sperm when you're young. Maybe, maybe not. The jury is still out about that, but try to conceive as soon as you're financially, psychologically and you have a partner and you're ready to start a family.

And last but not least: hormonal problems of erectile and ejaculations difficulties. If you can't perform sexually, definitely there'll be a delivery problem. And definitely we can help you with this part either by using some tablets or medications that could help you with achieving an erection and ejaculation.

While these are all important factors to consider when trying for a baby, there are some myths that despite what you've might have heard, do not have an impact on your fertility. So I'm gonna go through a few of those myths and debunk them.

Number one. Is tight clothes such as bike shorts will lower sperm counts? No, if you cycle for a very long period for many times during the day, yeah it might lower your sperm count. Stay away from hot tubs. Now come on, how many hours can you spend in a hot tub. An hour or two would not affect your sperm count. Cell phones and laptops will lower sperm quantity. None of that has been proven.

Too much coffee can kill your sperm? Not really. Actually they've been some studies that showed men who consume more than four cups of coffee can have higher sperm swimming capacity. Another myth is being hit in the groin during sports will affect your ability to have children. Now, everyone plays sports and something happened in the past. Not necessarily, unless it was severe injury that caused a trauma to the testicle that needed hospitalisation and surgery.

Sperm only survives an hour after ejaculation. Not true at all. Actually sperm survives seven days after ejaculation in the woman's body. And they take their time to find the egg and just wait for the egg to ovulate. And then they start fertilising the egg and they move to implant inside the uterus.

If you'd like to find out more about male fertility tests and treatments, book a semen analysis or make an appointment with a fertility specialist. We're always happy to help. And if you want to see more videos speaking on all things fertility, make sure you hit the subscribe button (for our channel). And if you have questions on anything I've spoken about in this video, leave a comment below. I'll get back to you. Thanks for watching and take care.

*All opinions expressed on the Fertile Minds YouTube Channel belong to the individual doctors, scientists and specialists, not the Virtus Health group.

What’s next?

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.

Find an IVFAustralia andrologist or male reproductive disorder specialist...
Find out more about male infertility tests...
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