You’ve been trying for a while, you’ve done the semen analysis and now you’ve been told that your results suggest male infertility is a factor — that can be gutting. But you’re not alone. Male infertility contributes to one in four cases of assisted reproductive treatment in Australia but could be a factor in up to 50% of all infertile couples.
It’s also not the end of the road when it comes to starting a family. Here’s what you need to know about the treatment options for male infertility and your next steps.
What is male infertility?
Infertility is typically defined as not conceiving a pregnancy after 12 months or more of regular, unprotected sex. Male infertility can be caused by issues with sperm, including:
These can be caused by blockages in your reproductive tract, certain health conditions and behaviours that might be changed like smoking, poor diet and carrying extra weight.
Treatment for male infertility
The way male infertility is treated depends on its cause.
Most men can change their behaviour to improve their chances of conceiving. Prioritising your wellbeing before conceiving a baby can not only improve your fertility, but also your partner’s pregnancy and the health of your future child.
You can learn more about improving your preconception health here.
To determine the best course of treatment, you’ll be referred to a specialist in male reproduction, like an endocrinologist, urologist or obstetrician/gynaecologist with subspecialty training in reproductive endocrinology and infertility.
If you have a varicocele
Clinical varicocele is a common and reversible cause of male infertility. A varicocele occurs when the veins in the scrotum that drain blood from the testis (testicle) become abnormally dilated and enlarged. Around one third of infertile men, and up to 80% of men with secondary infertility (the inability to conceive after previously doing so) have a varicocele. If your varicocele is causing or contributing to abnormal semen parameters, sperm DNA fragmentation, recurrent pregnancy loss and poor ART outcomes, you can be treated with surgery. There is a range of surgical options available that your urologist will discuss with you.
If you have anejaculation
If a man has azoospermia (no sperm in his semen) because he’s unable to ejaculate, there are a few ways doctors can try to collect sperm. In some cases, medication can help trigger ejaculation. Doctors can also use specialised medical techniques, such as vibration or electrical stimulation, to cause ejaculation in a controlled setting. If these approaches don’t work, a minor surgical procedure can be performed to retrieve sperm directly from the testes.
If you have retrograde ejaculation
If a man has retrograde ejaculation — where semen goes into the bladder instead of out through the penis — there are several ways doctors can try to retrieve sperm. Medication can sometimes help restore normal ejaculation. Another option is to collect sperm from the urine after preparing the bladder to make it safer for the sperm. If these methods aren’t successful, a minor surgical procedure can be performed to retrieve sperm directly from the testes.
If you have an obstruction or blockage
Obstructive azoospermia (OA) is when obstruction at any site in the entire male reproductive tract prevents the transport of sperm. They’re usually caused by infections, injuries, surgery, or congenital conditions. Men with obstructive azoospermia can undergo reconstructive surgery.
If you have non-obstructive azoospermia
Non-obstructive azoospermia (NOA) is when the testes produce little or no sperm. It can be caused by genetic conditions like Klinefelter syndrome, hormone imbalances, cancer treatment, exposure to heavy metals or toxins, undescended testes, orchitis, certain medications and lifestyle choices.
If you have hypogonadotropic hypogonadism
Hypogonadotropic hypogonadism is a rare cause of male infertility, prohibiting the testes from producing testosterone and sperm. You can be born with it, or develop it. Treatment of hypogonadotropic hypogonadism focuses on restoring hormone levels to stimulate sperm production in the testes, and involves gonadotropin injections (hCG and/or FSH).
If you have hyperprolactinaemia
Hyperprolactinaemia is when you have abnormally high levels of the hormone prolactin in your blood. The most common cause is a prolactinoma, a benign (noncancerous) tumour in your pituitary gland. Certain health conditions and medications can also cause hyperprolactinemia.
If you’ve been taking testosterone
Use of testosterone induces infertility by suppressing your body’s natural hormone production, resulting in testicular shrinkage and low sperm count. You can reverse testosterone-induced infertility by stopping use but it usually takes around six to 18 months for fertility to return. Withdrawing from testosterone abuse can be difficult, with effects include headache, tiredness, nausea, muscle pain, restlessness, poor sleep, low mood, low sex drive, body dysmorphia and suicidal thoughts. If you’re using steroids and want to stop, be honest with your doctor to get the right support.
If you have Klinefelter syndrome
Klinefelter syndrome is the most common chromosomal disorder in men, occurring in up to one in 500 newborn boys, but many go undiagnosed throughout their lives. For some men with Klinefelter syndrome, the condition is picked up when they try to start a family. This is because even for those with mild symptoms, most men with Klinefelter syndrome produce very few or no sperm and are infertile.
But when a semen analysis shows that you have no sperm in your ejaculate, it doesn’t mean you have no sperm at all. Surgical sperm retrieval procedures can be used to find sperm in the testes (testicles) of some infertile men. This sperm can then be used to fertilise your partner’s eggs through assisted reproductive technology (ART). There are a few different procedures used to retrieve sperm, including percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), and micro testicular sperm extraction (micro-TESE).
What is microTESE?
MicroTESE is an advanced technique performed by specialised microsurgeons. They use a high-powered microscope to find and remove small sections of the testes where sperm are likely to be found. MicroTESE is the preferred technique for sperm retrieval in men with non-obstructive azoospermia. In men with non-obstructive azoospermia, the success rate – defined as finding viable sperm suitable for fertility treatment – ranges from 38% to 60%, depending on patient factors.
If you have unexplained infertility
As the name suggests, unexplained male infertility is a broad term used when standard testing can’t identify a specific cause. Your semen analysis appears normal, there are no major red flags in your medical history, and physical examination and other testing have come back fine. We don’t have data about how common unexplained male infertility is in our general population, but we do have good information from couples going through fertility treatment. The latest Assisted Reproductive Technology in Australia and New Zealand (ANZARD) report shows that of all the IVF treatments in Australia and New Zealand in which male infertility is involved, 76.6% of the time it is unexplained.
There are currently no treatments for unexplained male infertility, but there is a fertility treatment called intracytoplasmic sperm injection (ICSI) can help you and your partner conceive.
If treatment is unsuccessful or irrelevant?
In many cases of male infertility, there are no treatment options available. And in some, treatment doesn’t work. But there are ways to bypass fertility issues and conceive with assisted reproductive technology (ART).
What is ART?
ART uses medical, surgical and laboratory techniques to get around the problems that cause infertility.
ART involves the collection of semen or sperm from a male, which is then used to fertilise an egg. For ART, eggs are collected from a female’s ovaries (using a needle inserted through the vagina, guided using ultrasound imaging) after one to two weeks of hormone injections. Sperm and eggs can be used fresh, soon after collection, or frozen for later use (after thawing and examination to make sure they’re healthy).
ART can use people’s own sperm and/or eggs, or donated sperm and/or eggs. In Australia, people’s own sperm and eggs are used in 97% of cases.
Intrauterine insemination (IUI)
IUI is when semen is placed directly into the uterus through a narrow tube (catheter) inserter through the vagina and cervix. It gives your swimmers a head start to get to the uterus and fallopian tubes to allow natural conception. IUI may be suitable for couples with unexplained infertility, mildly reduced sperm count or motility, or for ejaculatory problems.
In vitro fertilisation (IVF)
IVF is when sperm are placed, with an egg, in a plastic dish in a laboratory. Placing the sperm in direct contact with an egg increases the likelihood of fertilisation, compared to IUI or natural conception. IVF is useful for most causes of infertility, unless there is a severe problem with sperm numbers or quality.
Intracytoplasmic sperm injection (ICSI)
ICSI is when a single sperm is injected directly into an egg, under a microscope in a laboratory. The fertilised egg is then placed into a plastic dish in a laboratory for the first stages of development, the same as for IVF. Sperm used for ICSI can be collected from a semen sample, like for other types of ART, or they can be collected directly from the testis, epididymis or vas deferens using a needle or a surgical procedure.
