Male Infertility: causes, genetics, and assisted reproductive technology

In around half of couples who are struggling to conceive, male infertility is the cause. But there’s no need to despair. A fertility specialist may be able to identify the problem and help you and your partner to become parents.

Common causes of fertility issues in men

Infertility often carries a stigma, particularly for men, but it’s a lot more common than most people think. Dr Chris Evans, a urologist at Mediclinic Kloof, says 1 in 10 couples have trouble conceiving and in roughly 50% of these cases, male infertility is the issue.

“A variety of factors can contribute to male infertility and a thorough examination is crucial,” Dr Evans explains. “It can show us whether a man has a low sperm count, reduced motility [sperm don’t move efficiently], or atypical sperm morphology [head or tail defects in the sperm].”

These problems are frequently related to lifestyle choices like smoking, too little physical activity, or environmental factors such as exposure to plastics and smoke.

Dr Evans points out that in cases of azoospermia (where sperm counts are almost zero), the cause could be obstruction or production issues. Obstructions can occur due to infections, trauma, or congenital abnormalities. At the same time, production (non-obstructive) issues could stem from hormonal problems or testicular damage from trauma, infection, or varicocele – a condition where the veins draining the testes become dilated.

“Testosterone supplements that young men often use to bulk up can also significantly damage sperm production,” he warns.

When is it time to see a fertility specialist?

If you and your partner have not become pregnant after a year of unprotected sex, both of you should be evaluated to determine any clinical reasons why you’re not conceiving.

Are there medical procedures to improve male fertility?

• Obstructive azoospermia: It may be possible to correct the obstruction through surgery, which will allow you to conceive naturally. If not, a procedure will be done to retrieve sperm directly from your testes or epididymis (a narrow, coiled tube attached to each of the testicles). This can then be used in an assisted reproduction technology (ART) procedure.
• Nonobstructive azoospermia: The procedure to find usable sperm for use in ART is micro-testicular sperm extraction (mTESE). A small incision is made in the scrotum under general anaesthetic. The inside of one or both testicles are examined under a microscope so sperm can be harvested for use during ART.

What kind of lifestyle changes are recommended?

• Maintain a healthy weight. Being overweight has been linked to decreased sperm count and sperm movement.
  
• Eat a healthy diet. Fruit and veg are rich in antioxidants to help improve sperm health.
• Manage stress. Stress can harm your sexual function and interfere with sperm-production hormones.
• Get moving. Moderate physical activity boosts your levels of antioxidant enzymes, which help protect sperm.
• Quit smoking. Men who smoke are more likely to have lower sperm counts.
• Limit alcohol. Heavy drinking may cause you to produce less testosterone, leading to impotence and decreased sperm production.
• Avoid toxins. Exposure to pesticides, lead and other toxins can affect sperm quantity and quality. If you must be exposed to them, take preventive measures.

The effect of genetic abnormalities on male fertility

Dr Evans says while lifestyle changes and addressing any blockages may improve fertility, some cases have underlying genetic causes. “If sperm counts are very low, you need to check the genes on the Y [male] chromosome,” he explains. Certain genetic abnormalities can indicate a problem with sperm production.

That’s why genetic testing is vital to understand the chances of successful conception. Although some genetic causes of fertility can be treated, some couples may be guided towards alternatives, such as donor sperm or adoption. Your fertility doctor will help you understand why particular treatments may or may not be recommended and what your options are.

Assisted reproductive technology as a solution

For many couples facing fertility problems, assisted reproductive technology (ART) is a viable solution.  There are two main ART procedures that both involve taking an egg from your partner and combining it with your sperm outside her body, generally in a laboratory:

Intracytoplasmic sperm injection (ICSI)

For couples experiencing infertility, ICSI is used when there in cases of male infertility issues. This treatment involves a single sperm being injected into one of your partner’s eggs in a laboratory. The procedure creates an embryo that is then transferred into her uterus, after which pregnancy may occur.

In vitro fertilisation (IVF) 

This procedure is used in cases of female infertility or when the cause of infertility is unexplained. It also involves an egg being fertilised outside of your partner’s body. During this process, your partner is injected with fertility medications that cause multiple eggs to mature in her ovaries. These eggs are then collected when they’re ready and exposed to your sperm in the lab. After a sperm cell fertilises the egg, the fertilised egg (embryo) is placed inside your partner’s uterus.

Dr Evans explains that successful ART treatment requires a team approach, with urologists working alongside fertility specialists. A urologist often performs surgical procedures like sperm extraction, but a fertility specialist is responsible for comprehensive assessments and guiding couples through the various treatments.

Remember that although ART can’t solve all fertility problems, working collaboratively with fertility specialists can put about 70-80% of couples on the road to parenthood.