The possible causes of male infertility are numerous.
It can be divided into congenital abnormalities, meaning that, for example, a man can be born
with a testicle which is fairly high up and may require surgery to correct it or it can
be caused by, for example, infection, and that can cause a swelling in the testicle
and, classically, a viral infection such as mumps can cause infertility.
Other causes can include anything that increases the temperature of the scrotum, so, for example,
very tight-fitting underwear is not helpful, or if you have dilated veins around the testicle
called a varicocele that can cause infertility. There are general other causes such as issues
with the hormones or the endocrine system, where sometimes some men may have a low testosterone
which can result in infertility. There are other more rarer causes where there
is underlying genetic abnormalities such as Klinefelter's that can contribute.
Other things can include, for example, patients may have had previous malignancies and may
have required chemotherapy or radiotherapy in the past and that can affect fertility
too. The other causes can include immunological
causes, for example, you can have antisperm antibodies, which can affect the sperm, and
sometimes, unfortunately, there is no cause and that’s known as idiopathic, and that
means that we've not been able to find a cause and unfortunately that can be in a significant
proportion of patients.
Male infertility is predominantly tested by a semen analysis and that’s to look at the
volume of semen, the quality in terms of the number of sperm available, the way it looks
(the morphology), and in terms of motility, meaning the way it swims.
That tends to be a very important test in terms of male infertility.
Other additional tests can include hormone tests which look at your luteinizing hormone
or follicle-stimulating hormone, as well as testosterone to see how well the testicle
itself is producing the sperm.
The results normally take between 1-2 weeks, depending on the particular medical establishment
to obtain the full set of results.
Unfortunately, in a proportion of patients, we are unable to explain why they have infertility
and this is known as idiopathic, and that unfortunately can affect up to 30% to 40%
of patients. Unfortunately, it means we are not able to
give the patient the reason, but instead we then need to work out how best to help them
moving forward.
Okay, so in terms of once you find the results and that unfortunately there is a degree of
infertility, what we try and do is to determine the type of infertility.
In terms of the sperm count, that might be reduced or may be a small volume and that’s
a common problem and that can normally be tackled by lifestyle interventions, such as
losing weight, stopping smoking, or reducing your alcohol intake.
A second type of infertility which can be more difficult to deal with is having no sperm
and that is known as azoospermia. There can be two causes for this: one can
be due to a blockage and that’s known an obstructive azoospermia and nonobstructive
azoospermia. With that, you have to determine whether it
is obstructed or not obstructed and there is a method in which you can extract the sperm
either through aspiration or actually through making a small incision in the testicle to
obtain the sperm. There are occasions where patients may require
a further, more complicated procedure called microsurgical testicular sperm extraction,
which can find sperm in patients who have previous efforts of being found to be negative.
Just because you have been told that the semen analysis is negative, that doesn’t mean
that we can’t still find sperm available for fertilization.