Male Factor Fertility

It goes without saying that the fertility journey is one of the most emotional and stressful journeys a woman can go through. If you have a male partner, there is actually quite a lot he can do to support you.

Male factor issues alone contribute to 30% of fertility problems in heterosexual couples. An additional 30-40% account for dual factors in combination with the female. Therefore up to 50% of primary or contributing causes to the couple’s fertility issues involve the male partner.

If you have a male partner, have you both considered the following tests, investigations, fertility treatments, supplements and lifestyle changes?  

Explained Male Fertility Factors:

Here are some of the diagnosed causes of male fertility issues. These factors account for up to 30-40% of male issues.

·       Hormone imbalance – testosterone, FSH or prolactin.

·       Congenital or developmental testicular disorder

·       Undescended testes

·       Structural issues, obstruction of sperm transport

·       Injury

·       Surgery, including vasectomy

Immune Factors:

Immune factors account for approximately 5% of male fertility issues and may originate from any of the following:  

·       Infection

·       Inflammation

·       Sperm antibodies

·       Auto-immune disease

·       Chromosomal defects

·       Mumps

·       Testicular trauma such as a sports injury

·       Varicocele

·       Tumour

Unexplained Male Fertility Factors:

Unexplained factors account for up to 40-50% of male fertility issues and may be due to the following causes:

·       Ageing

·       Obesity

·       Poor nutrition

·       Alcohol

·       Smoking

·       Radiation exposure

·       Heavy metal toxicity

·       Pesticide exposure

·       Excessive heat

·       Environmental oestrogen

·       Some tap water

Investigations and Assessments for Men:

·       Sperm analysis

·       Blood tests for sex hormones: FSH, LH, progesterone, prolactin, testosterone, sex hormone binding globulin

·       General health blood tests: full blood count, blood type, liver function test, vitamin D, iron, zinc, copper, selenium and thyroid.

·       STI infection screen

·       Investigations or ultrasound to check for testicular trauma

·       Genetic screening, karyotype chromosomal screen

·       DNA fragmentation

·       SOS test – Sperm Oxidative Stress test

Sperm Issues Affecting Fertility:

·       Sperm Count

The number of sperm per milliliter, also known as the sperm concentration. A low sperm count is thought of as lower than 15 million sperm per milliliter of semen.

·       Sperm Motility

Sperm motility is the percentage of moving sperm. Sperm must swim through cervical fluid to reach the egg. If there is a high percentage of sperm that cannot swim properly, it may impair embryo formation. Sperm motility can be affected by sperm anitibodies, structural problems with the sperm’s tail, medication, alcohol or toxins.

·       Sperm Morphology

This is whether the sperm are the correct shape, size and structure. Shape is an important predictor of the sperm’s ability to fertilise an egg. Abnormal sperm can have two heads, or midpiece or tail defects. A normal sperm sample has at least 4% of sperm with correct morphology according to the World Health Organisation’s strict criteria.

·       Sperm Vitality

Sperm vitality or viability refers to the amount of live sperm in a sample.

If there are sperm antibodies, the vitality or viability of the sperm may be affected. If greater than 75% of sperm are dead, sperm antibody tests may be conducted.

·       Sperm Progression  

Sperm progression is the quality of movement of sperm, graded up to grade 4. This refers to the rate and speed of forward movement of sperm cells.

·       Sperm Agglutination

Sperm agglutination is when sperm clump together in a circle without moving anywhere. This can be caused by an infection or by sperm antibodies.

·       Sperm Antibodies  

Sperm antibodies attach to the surface of the sperm and reduce their life expectancy. They can impair sperm motility and the ability to access the female cervical mucus. If there are antibodies on the head of the sperm, they may prevent the sperm fertilising the egg. This is when ICSI is usually performed.    

·       DNA Fragmentation

20% of sperm can normally have some fragmentation. This refers to breaks, damage or lesions to the genetic material. Sometimes a high quality egg can repair the sperm damage but if more than 20% of sperm have DNA damage or there is damage to two DNA chains, there is an increased risk of poor fertilisation, impaired embryo development, implantation failure and miscarriage.

Treatments include: ICSI and sperm selection techniques such as MACS (magnetic activated cell sorting) and zymot.

·       Varicocele – this is enlarged veins found in the scrotum that cause an abnormal flow of blood in male genitals and can cause infertility. Varicocele can be a cause of DNA fragmentation.

Supplements for Sperm:

·       Folic Acid

·       Zinc

·       L-Carnitine and Acetyl L-Carnitine

·       Vitamin E and Selenium

·       Vitamin D3

·       Vitamin C and Beta Carotene

·       Proxeed

Lifestyle Changes:

·       Avoid smoking – smoking exposes the testes to heat, causes DNA fragmentation and lowers liver birth rates

·       Avoid alcohol – 10 units per week compromises male fertility

·       Avoid excess heat in the testes area, such as phones in the pocket, laptops on the lap and tight clothing, especially during or after cardio exercise.

·       Take Chinese herbs.

With lifestyle changes and Chinese herbs, changes to the sperm take 100 days. However, initial improvements are usually seen very quickly.

Key Terms for Male Fertility:

·       Sperm Wash – washing of sperm, carried out before artificial insemination. This removes toxic chemicals, reducing cramping and allergic reactions in females. It can reduce the overall sperm count but increase the motility and overall quality as the non-motile sperm are removed.

·       Azoospermia – no sperm in the ejaculate

·       Astheozoopermia – reduced sperm motility

·       Oligospermia – low levels of sperm

·       Teratozoospermia – large number of sperm, with abnormal morphology

·       PESA/MESA/TESA – Different methods of testicular or epidydimal sperm aspiration – sperm are extracted from the testes or epididymis with a needle. If there is no sperm in the semen, surgical sperm retrieval is possible using the above methods.

Getting the Best From Your Sperm:

·       Avoid ejaculation 2 days prior to the sample being given. But no longer than 10 days.

·       The sample should be examined within 45 minutes of ejaculation, so aim to get it to the clinic within 30 minutes and keep it at body temperature.

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