Male Infertility

Dr Jenny Cook | Fertility, Gynaecologist & Advanced Laparoscopic Surgeon

Understanding and Managing Male Infertility

Sperm quality and quantity are key factors in male fertility. Issues may arise from birth (such as undescended testes or genetic abnormalities) or later in life due to illness (mumps, cancer treatment) or injury (repeated scrotal trauma).

Low sperm count (oligozoospermia) or no sperm (azoospermia) can lead to infertility.
Defects such as immature sperm also reduce fertility potential.

Around one-third of infertility cases are linked solely to the male partner. There are clear ways to investigate the cause and manage it with tailored treatment options.

Causes of Azoospermia (No Sperm)

Genetic abnormalities such as Klinefelter’s Syndrome, Cystic Fibrosis, or chromosomal translocations and deletions
Vasectomy or other obstruction (including those caused by infection)
Testicular failure

Causes of Low Sperm Counts

Varicoceles (swelling of veins around the testicle)
Backward ejaculation of sperm
Blockages in sperm-carrying ducts
Sperm antibodies (autoimmune disorder)
Hormonal or stress-related problems
Infections or tumours of the male reproductive system
Chromosomal disorders
Sexual problems
Use of certain medications (e.g., steroids)
Excessive radiation exposure
Work-related exposure to toxins (e.g., in paint)
Smoking and alcohol abuse
Environmental toxins (e.g., pesticides, lead)

Supplements for Sperm Health

Anti-oxidants can support sperm production. Helpful options include:

Extra green vegetables
Co-enzyme Q10
Menevit
A daily handful of walnuts

Treatments for Male Infertility

Advances in medical technology mean that effective treatment is now possible. Options include:

Surgery: For varicocele or duct obstruction, to improve sperm movement.
Medications: Antibiotics for infections of the reproductive system.
Sexual problems: Counselling for sexual health and relationships.
Hormone therapy: Male hormone replacement for deficiencies.
Assisted Reproductive Technology (ART): Including IVF and ICSI.
Lifestyle modification: Stopping smoking, limiting alcohol, reducing stress.
Donor sperm: In cases of azoospermia or significant genetic disorders.

Surgical Sperm Retrieval Options

Percutaneous Epididymal Sperm Aspiration (PESA):
Performed in a Day Stay Unit under general anaesthesia (~30 minutes). Sperm are aspirated from the epididymis using a needle. Often used after vasectomy. Most men return to normal activities the next day with only minor discomfort or bruising.
Testicular Sperm Aspiration (TESA):
Used if insufficient sperm are obtained from PESA.
Testicular Biopsy:
Performed when sperm retrieval from PESA or TESA is inadequate.

Fertility Preservation in Men

Cancer treatments such as radiotherapy and chemotherapy can damage sperm production. Cancers of the reproductive organs, such as testicular cancer, may also require surgery that affects fertility.

Options before cancer therapy include:

- Freezing sperm prior to treatment
- Physically shielding the testes during radiation
- In prepubertal boys: freezing small sections of testicular tissue containing stem cells

Take the Next Step with Expert Care

Male infertility can be successfully managed with the right investigations and treatment plan. I am here to guide you through every step of the journey.