Male fertility
In about half of couples who struggle to conceive, sperm are part of the reason. Assessment for men is straightforward and confidential, and many causes can be treated.
With Datuk Dr. Navdeep Singh Pannu, FRCOG, at Alpha IVF & Women's Specialists, Kota Damansara
- First test
- A semen analysis
- Also checked
- Hormones, an examination and sometimes a scan
- Sperm take
- About three months to develop
- Confidential
- Seen privately, with or without your partner
What it is
Male fertility depends on making enough healthy sperm, and on the sperm getting out. A semen analysis measures the count, how well the sperm swim (motility) and their shape (morphology).
Common causes of problems include hormone imbalances, a varicocele (swollen veins in the scrotum), past infections or surgery, genetic conditions, some medicines, and lifestyle factors such as smoking, heavy drinking, obesity and heat. Sometimes no cause is found.
When there are no sperm in the semen (azoospermia), the first question is why. In obstructive azoospermia, sperm are made but a blockage stops them getting out, for example after a vasectomy or an infection. In non-obstructive azoospermia, the testes make few or no sperm, often because of hormone or genetic causes. Hormone tests, a scan and genetic tests help tell the two apart.
Sperm can often still be retrieved surgically and used for IVF with ICSI. PESA and TESA use a fine needle, through the skin, to take sperm from the epididymis or the testis, usually under local anaesthetic or sedation. TESE takes a small piece of tissue from the testis through a small cut, and is more often used when sperm production is low. Sperm found can be used fresh or frozen for later cycles.
Sperm can also be frozen to keep for later. One or more samples are collected after a few days without ejaculation, checked in the laboratory and frozen in liquid nitrogen. Before cancer treatment, tell your cancer doctor as soon as possible: sperm can usually be frozen within days, ideally before treatment starts.
Who it can help
- Low sperm count, poor movement or abnormal shape
- No sperm in the semen
- Erection or ejaculation problems
- A varicocele or past testicular problems
- Past cancer treatment
- Couples starting fertility tests together
- Freezing sperm before cancer treatment or a vasectomy, or with a falling sperm count
- Men who may find it hard to give a sample on the day of an IVF cycle
How it works
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History and examination
Your general health, past illnesses and operations, medicines, work and lifestyle, followed by a brief examination.
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Semen analysis
Collected after 2–5 days without ejaculation. An abnormal result is usually repeated, since counts vary.
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Further tests if needed
Hormone blood tests, a scrotal ultrasound, genetic tests or a sperm DNA test, depending on the results.
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Treatment
Lifestyle changes, medication for hormone problems, surgery for a varicocele or blockage, or referral to a urologist.
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Assisted conception
If needed, IUI for milder problems, or IVF with ICSI when the count is very low. If there are no sperm in the semen, sperm retrieval (PESA, TESA or TESE) is planned, either on the day of your partner's egg collection or beforehand, with the sperm frozen.
Good to know
Side effects and risks
- Lifestyle changes take about three months to show in a semen test
- Surgical sperm retrieval is a minor procedure, with small risks of bruising, swelling or infection
- Some causes, such as certain genetic conditions, cannot be reversed, but treatment can still help
A couple's issue
Infertility is not only a woman's problem. Dr. Navdeep encourages both partners to be tested together from the start.
What helps
Stop smoking, cut down on alcohol, aim for a healthy weight, avoid hot baths and saunas, and keep laptops off your lap. More tips.
Freezing sperm
Frozen sperm can be stored for years and used later for IUI or IVF with ICSI. There is a storage fee; ask about it at your consultation. For your partner, see egg freezing.
Genetic tests first
With azoospermia or a very low count, a blood test for chromosome changes and Y-chromosome deletions helps predict whether sperm retrieval is likely to find sperm, and whether a son could inherit the same problem.
Questions people ask
Can a low sperm count improve?
Often, yes, especially when there is a cause that can be treated or lifestyle factors that can change. Results take about three months to show.
Do I need a referral?
No. You can book directly, alone or with your partner.
What if there are no sperm at all?
Further tests show whether sperm are being made. If they are, they can often be retrieved from the testes and used for ICSI.
Can a vasectomy be worked around?
Yes. Sperm can be retrieved with a needle (PESA or TESA) and used for IVF with ICSI. A vasectomy reversal by a urologist is another option.
Do supplements help?
Some antioxidants may help in some men, but the evidence is mixed. A healthy lifestyle matters more.
Further reading
This page is general information and does not take your personal circumstances into account. Please speak to your doctor for advice that is right for you. Disclaimers