Male Infertility

Male Infertility

What is infertility?

Infertility means that there is difficulty in conceiving a child. Problems can arise because of the man's reproductive system, the woman's, or a combination of both.

Many infertile couples have primary infertility, which means they were never able to conceive. Some people however have secondary fertility, which means they are having trouble conceiving even though they already have children.

In about one third of couples who have difficulty conceiving, male causes will be identified. The major cause of male infertility is failure to produce enough healthy sperm. This is investigated by analysing a sample of the man's semen. A man is diagnosed as infertile if he produces too few sperm (20 million sperm per millilitre of fluid is considered the lower limit of male fertility) or his sperm may be abnormal in structure or motility (ability to move) and unable to reach or penetrate an egg.

If you and your partner are actively trying to conceive and have no results after a year, you should visit your doctor.

What are the different types of male infertility?

There are many different reasons why a man may be infertile.

There may be problems with ejaculation — either premature ejaculation or retarded ejaculation.

There may be a disorder affecting sperm production, such as varicoceles (varicose veins in the spermatic cord) or undescended testes.

Less common reasons include side effects of the treatment of testicular cancer, testicular damage from infections e.g. mumps or trauma or injury to the testes.

A man may have a rare genetic or hormone deficiency which causes infertility.

What is an ejaculatory problem?

During sexual intercourse, if ejaculation doesn't deposit enough semen into the vagina, the migration of sperm to the fallopian tubes may become increasingly difficult.

My partner has been told he has backward ejaculation. What does this mean?

Backward, or retrograde, ejaculation is a condition in which semen is ejaculated back into the bladder rather than out through the penis. It is then discharged when you urinate. It is a harmless condition and is often associated with diabetes and the use of certain drugs. The only time this condition should cause a problem is when a couple is trying to conceive. In such cases, contact your doctor for advice.

What is premature ejaculation?

Premature, or rapid, ejaculation is the inability of a man to control delay ejaculation until his female partner has achieved orgasm.

Premature ejaculation is thought to be quite common but may not be so premature as to prevent conception.

Can I prevent premature ejaculation?

Unfortunately there is no way to anticipate when this condition will begin. Once you experience it however, treatment may stop it recurring (for more details, see our section on premature ejaculation).

Is premature ejaculation dangerous?

Not usually. It is not usually associated with any serious underlying problem. However, it may affect the quality of a man's sex life which could lead to other problems such as anxiety or depression. Therefore do not hesitate to discuss this topic with your doctor as treatment of the underlying cause has a high success rate.

Can a low sperm count affect fertility?

Yes. A low sperm count can result in difficulty in conceiving. It can be caused by a number of things, for example, an injury, radiation therapy (for cancer), excessive heat such as a fever, and certain medications. Anabolic steroids, like those used by some bodybuilders to build up their muscle bulk, are known to reduce a man's sperm count.

Cigarette smoking, excess alcohol and stress can also contribute to a low sperm count.

Your doctor will be able to advise you if your low sperm count is causing difficulty in conceiving.

I have been told that my sperm are immotile. What does this mean?

Sometimes the testicles produce a sufficient number of sperm, but these sperm are unable to 'swim'. They are said to be immotile. When the sperm are ejaculated into the vagina, they have to make their way to the mature egg by 'swimming' through the cervical opening, up the uterus, and into the fallopian tubes. Some sperm cannot make this journey. This may be due to a number of reasons; for example some drugs may affect a sperm's motility.

How can male infertility be treated?

There are a number of methods currently available and research is ongoing. Treatment will depend on the cause identified. Medication can be used to treat hormone deficiencies, antisperm antibodies, or infection.

Surgery may be considered if the vas deferens are blocked or there are varicoceles in the spermatic cord. Insemination of sperm into your partner’s cervix or uterus may work in cases of retrograde ejaculation (ejaculation into the bladder instead of the penis), premature or delayed ejaculation, poor sperm quality or low count, and unexplained infertility. If infertility is due to a prior vasectomy, reversal may be possible.

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