Male sub/infertility

Male subfertility/infertility.

Having children can be a wonderful experience but often, getting pregnant can be a source of anxiety and stress for many couples.

Even in perfectly healthy couples the chance of successful pregnancy in any given month is about 15-25%. So, many months of trying may be necessary to be successful.

If there are factors affecting fertility (in either partner) then this chance drops.

Here I will consider the male side of infertility. Male infertility is considered to be responsible for 20% of cases of infertility in couples and contributory in approximately 30-40% of cases.

Just note that sperm is the actual sex cell involved in fertility while semen is the encompassing liquid that is produced during ejaculation. Semen contains sperm as well as other nutrients such as glucose and protein.

What to check first?

The first test that can be done is seminal analysis. Preparation will involve abstaining from sex or masturbation for at least 3 days. The next step would be to collect a semen sample into a sample pot and getting it to the laboratory within 1 hour of ejaculation (sperm doesn’t last long outside the body unfortunately so getting it to the lab earlier will produce better results). Once that is done then we would have to wait for the results which can take up to a week.

A variety of parameters are checked with semen analysis but the most important are listed below:

  • Volume – this measure overall semen volume and a normal amount should be more than 1.9ml
  • Sperm concentration – overall concentration of sperm within the semen itself and this should be above 19,000,000 per millilitre.
  • Active movement (motility) – this looks at the percentage of sperm that have normal movement and should be above 60%. This is important because even if normal appearing sperm has poor movement then it will be very challenging for the sperm to fertilise the egg.
  • Morphology – This looks at the general appearance (shape and size) of the sperm. Normal appearing sperm should be more than 30%.

The next step of investigation would be a scrotum ultrasound. This is a quick and painless (also radiation free) method to assess the testicles and surrounding structures. Here we can check the anatomy of the testicles as well as check to see that there are no other issues causing reduced fertility. Some examples here would include hydroceles (fluid around the testicles) and varicoceles (prominent veins around the testicles). The reason these issues may lower fertility is because good sperm quality requires a cooler body temperature (approximately 2 degrees Celsius below that of normal body temperature). Prominent veins or fluid around the testicles act like insulation and increase the overall temperature leading to reduce sperm quality.

What can be done?

If there is an abnormality found on the ultrasound scan of the scrotum then simple surgical procedures may be needed. This is usually performed by a specialist.

If there is an issue with the sperm quality then a variety of measure can be taken.

  • Firstly lifestyle changes may be needed to improve sperm quality.
    • This would include losing weight.
    • Regular exercise
    • Stopping smoking
    • Reduction in alcohol
    • Wearing looser underwear (boxers rather than briefs) and looser trousers.
    • Reducing long distance cycling.
    • Avoiding sitting for extended periods – even getting up just to walk around for a few minutes at a time is enough.
  • Secondly medication can be used to improve sperm count, quality and motility.

It is worth mentioning here that sperm production takes approximately 60 days so effects from lifestyle change and medication may not become apparent until 2-3 months after starting.

In conclusion

Male infertility is an important consideration for couples trying to conceive. Investigation is quick and easy and many factors can be corrected to varying degrees.


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