All about male infertility

Infertility is a fairly common obstacle to couples trying to have a baby. What causes infertility in men? How can you test for male infertility? What can be done if the results show infertility? Find out all the answers and more with expert urologist Mr Mohammed Belal!

What are the possible causes of infertility in men?

The possible causes of male infertility are numerous. 

They can be divided into:

• Congenital abnormalities - for example, a man can be born with a testicle which is fairly high up and may require surgery to correct it.
• Infection – this can cause a swelling in the testicle. Classically, a viral infection such as mumps can cause infertility.
• Anything that increases the temperature of the scrotum, so, for example, very tight-fitting underwear is not helpful, and dilated veins around the testicle (a varicocele) can cause infertility.
• Issues with hormones or the endocrine system – for example, some men may have low testosterone, which can result in infertility. 
• Rarer causes include underlying genetic abnormalities such as Klinefelter syndrome, which can contribute.
• Previous malignancies and treatments, including chemotherapy or radiotherapy in the past can affect fertility too.
• Immunological causes – for example, you can have antisperm antibodies, which can affect the sperm. Sometimes, unfortunately, this is idiopathic, meaning that we've not been able to find a cause and unfortunately that can be in a significant proportion of patients.

How is male infertility tested?

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 they look (the morphology), and their motility, meaning the way they swim.

This 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. 

How long does it take to receive the results?

The results normally take between 1-2 weeks, depending on the particular medical establishment, to obtain the full set of results.

What is unexplained infertility?

Unfortunately, in a proportion of patients, we are unable to explain why they have infertility. This is known as idiopathic, and that unfortunately can affect 30-40% 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.

What happens after I receive test results that show I am infertile?

Once you get the results and find that, unfortunately, there is a degree of infertility, what we try and do is to determine the type of infertility.  

The sperm count might be reduced or may be a small volume. 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 (azoospermia). There are two types:

• obstructive azoospermia (caused by a blockage)
• non-obstructive azoospermia

First, you have to determine whether it is obstructive or non-obstructive 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 previously been found to be negative. Just because you have been told that the semen analysis is negative doesn’t necessarily mean that we can’t still find sperm available for fertilisation.

If you and your partner are having difficulty conceiving and you suspect it may be due to male infertility, book an appointment with Mr Belal at his Top Doctors profile.