What is male infertility?​

Male infertility is a term used when a man is unable to naturally impregnate a woman.
​​Under such circumstances, fatherhood may be achievable through IVF or injection of a single sperm into an egg (ICSI).

CAUSES

Damage to testis

• Undescended testes
• Trauma
• Torsion of the testes
• Infection
• Testicular cancer

Damage to Vas Deferens

The vas deferens is the tube that transports sperm to the outside.

• Cystic fibrosis
• Born without a vas deferens
• Previous vasectomy
• Blockage due to infection
• Damage from previous surgery

Disruption in hormone balance

    Central endocrine system:

• Inadequate hormones produced by Hypothalamus or Pituitary gland (low FSH and LH) can lead to low sperm production.
• This is rare but important to recognise as it's possible to restore natural fertility with hormonal treatment. 

​    Peripheral endocrine system:

• Thyroid
• Obesity
• Diabetes or Insulin resistance

Other

• Genetic
• Chemotherapy or radiotherapy
• Environmental
• Anabolic steroids (testosterone)
• Cigarette smoking
• Marijuana 
• Chronic illness
• Medications
• Advanced age
• Erectile dysfunction
• Retrograde ejaculation
• Unexplained Infertility

Other

• Genetic
• Chemotherapy or radiotherapy
• Environmental
• Anabolic steroids (testosterone)
• Cigarette smoking
• Marijuana 
  
• Chronic illness
• Medications
• Advanced age (DNA fragmentation is more common in men over 50)
• Erectile dysfunction
• Retrograde ejaculation
• Unexplained Infertility

INVESTIGATIONS

Semen analysis

• This will provide information relating to the volume of ejaculation, sperm count, sperm motility and sperm shape. In the event of any abnormality, a repeat of semen analysis is necessary

Investigation of abnormal sperm

• ​Blood tests - Bloods are taken to assess the pituitary-testicular axis (hormone profile) and other causes of low sperm count
• Genetic tests - Genetic causes of very low or absent sperm include Cystic Fibrosis, Klinefelter's syndrome, karyotype, microdeletion of the Y chromosome
• Scrotal ultrasound - this may be indicated after a physical examination to look for varicoceles, masses, past infection.
• Urine test to exclude infection
• Post-ejaculation urine - If retrograde ejaculation (movement of semen into the bladder) is suspected, sperm may be found in post-ejaculate urine
• Sperm DNA fragmentation - may be indicated when there is unexpected low fertilisation
• Testicular biopsy involves placing a small needle in the epididymis or testis to find sperm. This is usually performed under local anaesthesia