Diagnosis and treatment of infertility in men

How is male infertility diagnosed?

Your doctor is likely to begin with a physical examination and then discuss your sexual and medical history. After this, if there is no evident cause for the issue, he/she may conduct additional tests.

In order for a male to be fertile, the testicles must produce adequate amounts of healthy sperm that is effectively ejaculated into the vagina during intercourse and in turn, travels to the egg inside the woman’s fallopian tube where conception occurs.

Specific fertility tests may include:

• Semen analysis –your doctor may ask for semen specimens which are obtained through masturbation or interrupted sexual intercourse which involves the ejaculation of semen into a specialised condom that does not contain any spermicide (a type of contraceptive liquid that kills sperm).  The ejaculate from this condom is then carefully transferred to a clear container that is provided and sent to the lab for analysis. It is important that no lubricants or spermicides are used during this process as this will distort the semen results.
  It is also possible to test the urine for sperm, which can sometimes be present in infertility cases due to retrograde ejaculation.
• Genetic testing – this is done in order to find out if there is a genetic defect causing infertility.
• Hormonal testing – this is often done through a blood test to determine testosterone levels.
• Imaging – is sometimes used in certain situations and is obtained through an MRI, bone mineral density scan, scrotal or transrectal ultrasound or when a vasography (X-ray of the vas deferens) is performed.
• Testicular biopsy – this is sometimes conducted to identify any abnormalities that may be contributing to infertility as well as to retrieve sperm to use in reproductive techniques that are medically assisted, such as IVF (In Vitro Fertilization).
• Other speciality testing – can be used to determine and evaluate the sperm quality and also pick up on DNA abnormalities.

Treatment of infertility in men

Treatment for men is dependent on the cause of infertility, the man’s age and his partner’s age (men over 40 have less probability of having a baby than men who are younger), the man’s personal preferences for treatment, and the duration of time that he has been infertile. Treatments can range from oral tablets and injectables to microsurgery.

Fertility treatments can often require a significant amount of time, effort and financial investment.

That being said, the following are treatment options for male infertility:

• Changing lifestyle factors –improving behavioural and lifestyle factors such as stopping harmful medications and substances, ensuring that the time of intercourse lines up with a woman’s ovulation cycle, establishing healthy lifestyle habits through a nutritional diet and exercise as well as optimising the factors that can improve the chances for fertility.  If your semen analysis results are poor, then it is advised that you stop smoking and drinking alcohol in order to improve your fertility and the chances of conception.
• Surgery – in certain conditions, surgery may be required. This is often needed when a sperm blockage needs to be reversed or surgery is required to repair a varicocele (caused by enlarged veins in the scrotum). Medication – there are a number of medications that are able to improve a man’s sperm count by increasing testicular functionality which includes sperm quality and production.
• Sperm retrieval – this is needed when ejaculation is an issue or when no sperm is found in the fluid ejaculated. These techniques are also used when sperm counts are low or abnormal.