Treatment

Male fertility care

In roughly a third of couples the contributing factor is on the male side, and in many more it is a factor on both. Assessing both partners from the start saves months.

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Male fertility assessment is quicker, simpler and cheaper than the equivalent female workup, and yet it is frequently left until later. There is no good reason for that. A semen analysis is a single non-invasive test that can change the entire direction of a couple's treatment plan.

Semen analysis

The core investigation. It measures volume, sperm concentration, motility (how well the sperm move) and morphology (their shape), along with markers of inflammation.

Results fluctuate — sperm production takes around three months, so a single poor result after an illness or a fever is not conclusive. An abnormal result is usually repeated after a few weeks before conclusions are drawn.

Preparing for the test. Two to five days of abstinence beforehand gives the most representative sample. Shorter or much longer intervals both distort the result.

Further investigations, where indicated

Hormone profile

FSH, LH, testosterone and prolactin help distinguish a problem of sperm production from a blockage, and occasionally identify a treatable hormonal cause.

Sperm DNA fragmentation

Assesses damage to the genetic material inside sperm, which a standard analysis does not detect. It is considered where there has been recurrent miscarriage, repeated IVF failure, or unexplained infertility with a normal-looking semen analysis.

Scrotal ultrasound

Looks for a varicocele — enlarged veins that can raise testicular temperature and impair sperm production — and for structural abnormalities or obstruction.

Genetic testing

Where sperm count is very low or absent, karyotype and Y-chromosome microdeletion testing can identify a genetic cause, which affects both prognosis and counselling.

Surgical sperm retrieval

Where there is no sperm in the ejaculate (azoospermia), sperm can often still be retrieved directly from the epididymis or testis and used with ICSI. The appropriate technique depends on whether the cause is obstructive or non-obstructive, which the investigations above help determine.

What actually helps

Stopping smoking and chewing tobacco — one of the clearest associations in the evidence
Reducing alcohol
Reaching a healthier weight, where BMI is raised
Avoiding prolonged heat — long hot baths, saunas, a laptop on the lap
Treating a varicocele where it is significant and other factors are excluded
Reviewing medicines and anabolic steroid use with a doctor — testosterone supplements suppress sperm production, sometimes profoundly
Allowing three months for any change to show, since that is how long sperm take to develop

Being told there is a male factor is difficult, and men are frequently given less explanation than their partners at this point. Ask for the same detail. Many male factors are treatable, and a great many more are bypassed effectively with ICSI.

Please note. This page is general information, not medical advice. What is appropriate for you depends on your history, your investigations and a specialist assessment. No fertility treatment can guarantee a pregnancy.

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