Normal fertility

'Normal' fertility is usually defined as conception occurring within a 12 – 15 month period of regular unprotected sex.

Fertility is a highly complex process and infertility can be attributed to either male or female factors, or both. A male must produce semen that contains sufficient numbers of healthy motile sperm and have the ability to achieve erection and ejaculate semen into the vagina.

The male genital tract includes the testes, the epididymis, the vas, the prostate and urethra. The testes, situated in the scrotum, are mainly made up of loops of fine tubes (seminiferous tubules) which produce the sperm. The sperm cells mature as they pass through the epididymis (a narrow system of tubes on the surface of the testes). The vas is a hollow tube, which carries the sperm from the epididymis to the urethra.

It takes three to four months for sperm to develop, during which time production may be affected by febrile illness, exposure to drugs, toxins, radiation, local trauma or infection.

The primary laboratory test for male fertility is ‘semen analysis’. The sample is obtained by masturbation or collected from a special condom following intercourse. Sterile containers must be used to collect the sample following three days of sexual abstinence.

A normal assessment should show:

• Semen volume of two to four mls
• Sperm count - more than 20 million per ml
• Sperm motility - more than 50% moving
• Sperm morphology - more than 30% of normal shape
• White blood cells - should be less than one million per ml
• Anti-sperm antibodies test - should be negative

Common male infertility problems

Although male infertility is commonly associated with impotence, many infertile men have perfectly normal sexual relationships.

Absence of sperm

Sometimes the testicles fail to produce sperm. This can be due to past trauma to the testicles, severe mumps infection or hormone deficiency. The vas deferens tube may be either blocked or undeveloped which results in sperm not being present in the ejaculate.

Poor sperm quantity or quality

This can result from several factors such as natural hormone deficiency, infection, use of drugs such as antidepressants, anabolic steroids or marijuana. Excessive alcohol, heavy smoking and surprisingly, frequent hot baths and saunas can also affect sperm quantity and quality.

Dysfunctional sperm

The sperm may have a poor fertilising capacity due to abnormal head movements or the inability of the sperm to bind to the zona (the covering layer that surrounds eggs).

Inability to ejaculate into the vagina

This could be due to impotency, premature ejaculation, or the inability to ejaculate.

Assisted reproductive techniques for male infertility

Intrauterine Insemination (IUI) combined with superovulation using washed sperm is often effective in the case of mild abnormalities in sperm parameters.

In Vitro Fertilisation (IVF) requires fewer motile sperm because natural transport barriers are bypassed, and sperm come in contact with multiple oocytes from superovulation.

Intacytoplasmic Sperm Injection (ICSI) has revolutionized the treatment of severe male factor infertility problems, especially when the sperm is surgically retrieved. One single sperm is injected into each egg, with a fertilisation rate of around 70%.

In severe cases of male factor infertility, azoospermia, or genetically transmitted diseases, Donor Sperm Insemination (DI) is an option.

Surgical Sperm Retrieval (SSR) is a technique for collecting immature sperm directly from the vas, epididymis or testes. Sperm retrieval may be performed under local anaesthetic or under general anaesthetic, especially during an operation to repair an obstruction in the vas. The sperm are withdrawn from the vas, epididymis and the testes using a fine needle and gentle suction.

Percutancous Epididymal Sperm Aspiration or Testicular Sperm Extraction may be used in cases where sperm are not found. A sample of tissue (testicular biopsy) can be taken from the testes through a small incision. Once the sperm have been collected fertilisation is achieved using ICSI. Excess sperm can be frozen for future use.

Counselling

Counselling is available to all of our patients and can be arranged for individuals or couples. The HFEA considers counselling to be a key element in the provision of infertility services, and has made 'implication counselling' a requirement in the case of sperm or egg donation. We offer support counselling at all times and the first session is offered free of charge?. Appointments can be booked via the nurses.

The major cause of male infertility is failure to produce enough healthy sperm.