Male Factor Infertility
What is the Definition of Infertility?
According to the World Health Organization, infertility can be defined as the inability to achieve a spontaneous pregnancy through unprotected sexual intercourse for more than 12 months. Infertility is quite a common problem, as it is estimated that in the Western world, one couple in 10 is infertile. In the case of infertility, both the male and female partner need to be investigated. Although in some couples the cause of infertility cannot be found, which is the case of unexplained infertility, in most cases, a cause can be identified. In around one–third of cases, the cause is found in the male, in one–third in the female, while in the remainder, both the male and the female are to some extent subfertile.
What are the Causes of Male Infertility?
A cause of male factor infertility can be found in more than 80% of cases. When a cause of infertility cannot be found, infertility is defined as unexplained or idiopathic.
Male factor infertility can be caused by many congenital (you are born with them) or acquired factors. Surgery, radiotherapy, and some medications can cause infertility. In many cases, the cause of infertility can be identified and addressed with medical or surgical treatment.
What is a Varicocele?
Varicocele represents the most common cause of male factor infertility, as it accounts for around 25% of cases. Varicocele is a clinical condition characterized by the presence of varicose (enlarged) veins around the testicles. The condition is more common on the left than on the right testicle, although both testicles can be affected. It is still debated how the varicocele causes infertility, but it is suggested that the increase in temperature and presence of toxic metabolites, which stagnate in the varicose veins around the testicle, can potentially damage the testicle, leading to deterioration in the quality of the sperm.
How is Varicocele Treated?
Varicocele can be surgically treated. Among the various techniques, it is widely recognized that the microsurgical approach leads to the best results, as it is a safe procedure and is associated with a lower risk of recurrence. The operation consists of a small subinguinal incision to allow the exposure of the cord. All the varicose veins are then carefully identified and ligated under magnification. Particular care has to be paid to preserve the testicular artery and the lymphatics. Once the varicocele has been successfully corrected, an improvement of semen parameters in the semen analysis can be noticed after 3 to 6 months. The literature suggests that correction of the varicocele is associated with an increase in pregnancy rate, both with natural conception and assisted reproduction (IVF).
What is Azoospermia?
Azoospermia is a clinical condition characterized by the complete absence of sperm in the ejaculate. This condition is identified with the semen analysis. Two consecutive semen analyses showing azoospermia are required before the clinician can diagnose azoospermia. Azoospermia can be either congenital or acquired (secondary to other conditions).
To help the clinician in the identification of the causes of azoospermia and in treatment planning, azoospermia can be divided into two categories: obstructive (OA) or non-obstructive (NOA).
Obstructive azoospermia is caused by an obstruction in the seminal tract (tube) that leads the sperm to the outside of the body. In these patients, the production of sperm is normal. It is very important to identify with targeted specialist investigations the exact location of the obstruction, as frequently, the obstruction can be bypassed, thanks to specialistic microsurgical procedures. If the reconstruction is successful, sperm will be again present in the ejaculate, and the patient will be fertile again. When reconstruction is not possible, sperm can be surgically extracted from the testicle and used in combination with assisted reproduction techniques to obtain a pregnancy. In these patients, the success of surgical retrieval of sperm is close to 100%.
Non-obstructive azoospermia is instead due to the reduced or absent production of mature sperm in the testicle. In these patients, there is no blockage in the seminal tract and therefore, surgical reconstruction is not an option. It is important in this group of patients to perform targeted specialist investigations to try to identify the cause of azoospermia and to give the patient a rough idea of whether the surgical sperm retrieval can be successful or not. Surgical sperm retrieval is the only way to try to find sperm suitable for assisted reproduction techniques. Overall, the success of sperm retrieval in patients with non-obstructive azoospermia is around 75-80%, although in some subgroups, the success can be much lower or even zero. If sperms are retrieved, they are stored in the fertility lab by an embryologist until the couple is ready to undergo assisted reproduction (in vitro fertilization – IVF) with intracytoplasmic sperm injection (ICSI) in a dedicated fertility centre.
Which Investigation Should Be Performed in the Infertile Male?
The most important investigation in the infertile male is the semen analysis, which should be performed after 3 to 5 days of sexual abstinence. This simple investigation will provide the clinician with very precious information and will suggest which other investigations and procedures are required to identify and correct the problem.
History taking, physical examination, and specific blood tests often provide enough information to the clinician. More specialistic investigation can provide precious information for selected patients.
Am I Suffering from Infertility?
If you have not been able to conceive after 12 months of unprotected sex, chances are that you are suffering from infertility.
You should be assessed as a couple, as in around 50% of cases, the cause of infertility lies in your partner.
When you book a consultation with Mr. Garaffa, you will undergo a thorough examination and a test called semen analysis to assess the quality of your semen. According to the result, more targeted investigations, including blood tests, scans, and sperm DNA fragmentation tests may be arranged to identify the cause of infertility and to find the best solution to your problem. Mr. Garaffa has massive experience in the management of the infertile male, both from a medical and surgical point of view.
Management of Male Factor Infertility
Dr. Giulio Garaffa is an expert in male infertility diagnosis and male infertility treatment in London. With his extensive training and experience in complex male fertility issues, Dr. Garaffa provides advanced solutions that have helped hundreds of couples achieve parenthood and their ideal reproductive health.
