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Male Infertility
Explained
Queensland Fertility
Group’s guide
to Andrology
Public Information 1800 111 483
www.qfg.com.au
Many couples are surprised to learn that approximately
50% of fertility issues are male-related. The male
plays an equally important role in assisted conception,
and a comprehensive fertility investigation will examine
causative factors in both partners. Fortunately, the most
common causes of male infertility are readily diagnosed
and can be treated or overcome to help a couple
conceive successfully.
The information in this booklet outlines the fertility
investigations and treatments available for males at
Queensland Fertility Group.
The Male Reproductive System
Females are born with a limited number of eggs; however, sexuallymature males produce new sperm every day of their lives. Sperm take
72 days to be produced and a further 12 days to travel through the
epididymis in preparation for ejaculation.
Satisfactory sperm production requires four key components:
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normalhormonalstimulationfromthepituitarygland
normalspermproductioninthetubulesofthetestes
anunobstructedspermpathway
effectivenaturalspermdelivery.
Vas
Deferens
Penis
Testicles
Known Causes of Male Infertility
Lifestyle
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Age
Smoking
Recreationaldrugs
Steroidabuse
Weight
Occupation
Exposuretotoxins
Radiationdamage
Exposuretoexcessiveheat
Sperm Problems
• Productionofviablesperm
–ChromosomeandDNAabnormalities
– Undescended testes
– Infections
– Twisted testes
– Varicocele
– Illnesses and medications
– Chemotherapy
• Transportofthesperm
– Obstructions
–Absenceofvasdeferens
– Problems relating to the prostate
– Infections
– Nerve damage due to surgery
–Recreationaldrugsandsteroidhormones
Sperm Antibodies
• Injuryordamagetothebloodspermbarrier
• Oftenfoundinpatientswhohavehad
vasectomy reversals
Erectile and Ejaculation Difficulties
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Spinalcordinjuries
Retrogradeejaculation
Prematureejaculation
Somemedications
Hormonal Problems
• Pituitarytumours
• Defectsatbirth
• Steriodhormoneuse
How do we test a male’s fertility?
Following a consultation with your Queensland Fertility Group
specialist,ourteamofdedicatedAndrologyscientistscanperforma
number of tests in order to determine your ability to produce viable
sperm. These tests include the following options:
Semen Analysis
Asemenanalysisisthefirst,andoftentheonlytest,requiredto
diagnose whether or not a male is experiencing fertility problems.
ThisinvolvesanAndrologistexaminingasemensampleundera
microscope and searching for abnormalities.
TheAndrologistwillcheckthesampleforthreekeyspermtraits:
Sperm Count
Low Sperm Count (Oligospermia) – Males with low sperm
counts may be contributing to a couple’s infertility.
Sperm Motility
PoorSpermMotility(Asthenospermia)–Thespermdonot
swim in a good forward-progressive manner and therefore
lack the ability to make their way to the egg and then
fertilise it.
Sperm Morphology
Poor Sperm Morphology (Teratospermia) – Most of the sperm
in the semen sample are abnormally-shaped, which can
result in their inability to penetrate and to fertilise an egg.
You will be required to provide a semen sample for this test (refer to
semen collection instructions).
Sperm Antibody Test
Althoughrelativelyuncommonasacauseofinfertility,thepresence
ofspermantibodieshasbeenlinkedtomalefertilityissues.An
estimated one in 16 males produce antibodies to their own sperm,
and while they are most commonly found in males who have had
vasectomy reversals or who have suffered injury or infection of the
epididymis, in some cases there is no explanation for their presence.
Spermcoatedwithantibodieshavedifficultypenetratingcervical
mucusandeggs.YourspecialistmayorderaSpermAntibodyTest
to be performed in conjunction with your semen analysis.
Sperm Chromatin Structure Assay
The genetic material contained in the head of the sperm is known as
Chromatin.ASpermChromatinStructureAssay(SCSA)determinesthe
percentageofsperminyoursemensamplecontainingdamagedDNA.
AhighlevelofdamagedDNAcansignificantlyaffectacouple’sability
to conceive, and can also result in early pregnancy loss.
Andrologyscientistsexaminethousandsofspermwithinashorttimeperiod
usingamachineknownasafluorescence-activatedcellsorter(FACS).
Sperm Chromosome Studies
Atthetimeoffertilisation,theheadofthespermshouldcontain23
chromosomes, which join with the 23 chromosomes contained in the
egg.Anabnormalnumberofchromosomes(knownasaneuploidy)in
the sperm reduces a couple’s chances of natural conception.
ASpermChromosomeTestisusuallyonlyperformedwhenthereare
indications that the sperm chromosome complement may be an issue.
QueenslandFertilityGroup’sAndrologistsexaminethefivechromosomes
commonly linked to various foetal abnormalities in order to determine
the level of aneuploidy in a male’s ejaculate. The contents of the sperm
head are stained using fluorescent probes, and the chromosomes are
counted.Ahighlevelofaneuploidymayaffectthesperm’sabilityto
fertilise an egg and to produce a chromosomally-normal embryo.
Y Chromosome Abnormalities
Men with very low sperm counts, or no sperm at all in their semen, may
have small parts of their Y chromosome missing (deletions). Queensland
Fertility Group’s Molecular Genetics laboratory has the capacity to detect
thesedeletionswithabloodtestknownastheDAZDeletionTest.
Therearetwobenefitsarisingfromperformingthistest.Inthecaseof
there being no sperm in the semen (azospermia), the test can predict
thelikelihoodofstillbeingabletofindsmallnumbersofspermin
thetestes.Thesecouldbesurgicallyextracted(TESA)andusedin
IVFandICSItofertiliseeggs.KnowledgeofDAZdeletionsalsoallows
consideration of the likelihood of passing this genetic abnormality on
to any sons arising from treatment of the infertility.
How do we treat male infertility?
Whiletherearenotmanytreatmentsinexistencethatwillimprovethe
quality of the sperm themselves, there are a number of options available
to help couples maximise the sperm’s ability to fertilise the egg. In the
past, many couples have had to resort to donated sperm; however,
today we can literally produce a pregnancy from a single sperm.
Reversible Conditions
There may be medical or environmental causes for damaged sperm
DNA.Additionally,recentillnesses,recentdrugtreatments,regularheavy
alcohol consumption, steroid hormone use, obesity, frequent hot baths or
saunas and failure to follow correct specimen collection instructions can
result in poor semen analysis results. You should tell your Queensland
Fertility Group specialist if any of these factors are involved.
Drug Treatment
There are not many simple drug treatments that will increase sperm
numbers or make the sperm swim or look better. Some males,
however, produce low sperm numbers due to low reproductive
hormone (gonadotrophin) levels. Gonadotrophin treatment can help
these males to produce more sperm in each ejaculate.
Intrauterine Insemination with Partner Semen (AI)
This relatively simple procedure involving washing and concentrating the
male partner’s sperm and inseminating them directly into the female
uterusassistsspermthatexhibitonlyminimalabnormalitiestofindand
tofertilisethefemaleegg.Aswecannevertotallyexcludetheabilityof
sperm (regardless of their quality) to produce a pregnancy, this procedure
isoftenthefirsttreatmentrecommendedwheremaleinfertilityisinvolved.
In Vitro Fertilisation and Embryo Transfer (IVF-ET)
Incasesofsubstandardspermquality,IVFcansignificantlyimprovea
couple’s chances of conception. The strongest-swimming sperm are
selected from the semen sample, and then placed with the eggs in a
culture dish. IVF produces fertilisation in about 90% of male infertility
cases, with the remaining 10% yielding no fertilisation. In addition to
being performed as a treatment for male infertility, IVF provides a good
diagnostictestofthesperm’sabilitytofertiliseeggs.Acrosstheboard,
approximately 70% of eggs fertilise using IVF.
Assisted Fertilisation by Microinjection (ICSI)
The intra-cytoplasmic sperm injection (ICSI) of eggs has revolutionised
the treatment of males with severe sperm abnormalities. In the past, the
use of donor sperm or adoption were the only viable options for couples
facing these circumstances; however, we can now inject a single sperm
into each egg and achieve high fertilisation rates. The sperm injection
isperformedasanadditionalpartoftheIVFprocedure.Aslongasthe
sperm are alive, any motility or morphological abnormalities should not
affect the procedure.
Wheretherearenospermintheejaculate,spermsurgicallyretrieved
fromtheepididymis(micro-epididymalspermaspirationorMESA)or
thetestesthemselves(testicularspermaspirationorTESA)arequite
usable in this procedure.
Combined with frequent ejaculation protocol, ICSI is often the best
treatmentforhighlevelsofdamagedspermDNA.
Donor Insemination
For many couples confronted with severe male infertility, the
complexity or cost of the treatments listed above becomes prohibitive.
In such cases, the couple may accept the simpler treatment option
of the female being inseminated with donated semen. Semen donors
are screened for prescribed genetic and infectious diseases.
Acceptingdonorsemencanbeadifficultdecisionandcouplesare
required to consult one of our specially-trained psychologists to discuss all
aspects – both present and future – of this treatment before proceeding.
Preimplantation Genetic Diagnosis (PGD)
Sometimes there is a genetic basis for the
male’s infertility. If there is a known or raised
risk of a genetic disorder, or in cases of recurrent
miscarriage, PGD can detect chromosome
abnormalities and single gene disorders at the
embryostage.PGDidentifiesembryosthatare
free of suspected chromosomal abnormalities
or genetically-linked diseases so that they may
be transferred to the uterus to achieve a
normal pregnancy.
What will the male need to do?
In order for Queensland Fertility Group to examine a male’s sperm, he
mustfirstprovideasemensample.Masturbationisthemostobvious
and the easiest method of sample collection; however, a number of
specialist methods exist to extract sperm where necessary.
Sperm Collection Methods
Ejaculate
The most common way to collect a semen sample is by masturbation
(usually in the privacy of your own home) after two to three days of
abstinence. It is very important for the whole of the ejaculate to be collected
andexamined,asthesperm-richpartoftheejaculateisthefirstpart.
This semen sample will need to be delivered to the Queensland
Fertility Group Laboratory within one to two hours of its collection. The
Laboratory will provide you with more detailed instructions on specimen
collection so that maximum information can be derived from the tests.
Other
The condition where a male’s ejaculated semen does not contain
any sperm is known as azoospermia. One of two approaches can
be taken to attempt to retrieve sperm in this situation:
TESA
Surgical extraction of sperm from the testes, usually under
general anaesthetic.
MESA
Surgical extraction of sperm from the epididymis under
general anaesthetic.
CAIRNS
Queensland Fertility Group’s
Network of Care
1800 111 483
www.qfg.com.au
TOWNSVILLE
MACKAY
BRISBANE
IPSWICH
TOOWOOMBA
GOLD COAST
Brisbane
Auchenflower (Wesley Hospital), Capalaba,
City, Everton Park, South Bank, Spring Hill,
Springfield Lakes
Ipswich
T [07] 4638 5243
T 1800 111 483
Mackay
T [07] 4965 6500
Cairns
T [07] 4041 2400
Toowoomba
T [07] 4638 5243
Gold Coast
T [07] 5564 8455
Townsville
T [07] 4772 8900
QFG-COMM-PI-005 29-06-2013
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www.qfg.com.au