Reduced fertility in men* is more common than you might think.
Fertility issues affect up to 20% of couples, with men contributing to an estimated 50% of cases.
When we focus on conception and fertility as a women’s health issue, we’re only getting part of the story.
It takes two to dance the reproductive tango.
ON THIS PAGE
- When to visit your doctor
- Common causes of male infertility
- Diagnosis: How we figure out what’s going on
- What treatments are available?
- Male fertility and mental health
- Tips to boost your fertility
- About Dr Michael Macpherson
The WHO regards infertility as an inability to achieve a pregnancy naturally after 12 months or more of frequent unprotected sexual intercourse.
These definitions serve only as a guide as every couple’s situation is unique.
When to Visit a Doctor Experienced in Male Fertility
It’s perfectly reasonable to discuss fertility with your GP at any stage of trying for a baby.
Particularly, couples wanting to start a family later in life might seek medical advice after just a few months.
From the outset, I’d like to reassure you that not conceiving in your ideal timeframe doesn’t necessarily mean anything is wrong with you.
There are many times in a man’s life when he can face temporary physical, hormonal, or psychological obstacles to conception. Such obstacles include erectile dysfunction, a hormone imbalance, or low libido (sex drive).
Even when your swimmers are swimming swimmingly, it’s fair to say there’s a healthy dose of luck to the right sperm meeting the right egg at the right time.
Visiting your GP is an excellent first step if you have any fertility concerns.
Once I’ve taken stock of your history, examined you, and reviewed your initial lab tests, I’ll have a good idea if you’ll benefit from assisted conceiving.
If I feel you will benefit, I’ll typically refer you to a fertility specialist or a nearby male fertility clinic.
* I recognise and appreciate not all patients identify with binary genders. For ease of understanding, I’ve chosen to use a cis-gendered heterosexual context to discuss this complex area of medicine.
What Can Cause Male Infertility?
There are lots of reasons your fertility may not be at its peak. Rest assured, I can readily diagnose and manage most problems.
Working out if sexual dysfunction is at play is a great starting point. Persistent erectile dysfunction (impotence), premature ejaculation, or low libido can impact sexual intercourse, which is obviously necessary for the pursuit of having a baby.
In my experience, there’s almost always a psychological component involved with sexual dysfunction. If it didn’t bother you initially, it likely will after happening a few times.
Adding the extra layer of sexual expectation within your relationship coupled with external pressures, for example, your parent’s desire for a cuddly grandchild, can create the perfect storm.
Having an idea of what’s contributing to your stress levels and overall mental health can be beneficial. Support from your GP or a psychologist is available.
Hormonal issues often centre around your body not producing enough testosterone, known as hypogonadism. Testosterone at adequate levels is necessary for a healthy libido, reliable on-call erections, and healthy sperm.
Issues with your sperm can be another cause of male infertility.
To fertilise a woman’s egg as it travels along her fallopian tube, the number of sperm in each ejaculation must be plentiful to the tune of 40 to 300 million sperm per millilitre (ml). A low sperm count of 10-39 million per ml can still lead to pregnancy if your sperm are healthy.
Sperm must also have fully functioning tails and enough stamina, known as good motility, to propel themselves towards their final destination.
Sperm count and motility naturally decrease with age.
There are a few tubes your sperm must move through before ejaculating from your penis. Sometimes blockages along your vas deferens or in the epididymis can prevent sperm from being released.
The Male Reproductive System
There are several reasons for blockages, including previous injury or issues with the blood vessels and other plumbing around the testicles or prostate.
Research has also identified unhealthy lifestyle factors that impact a man’s fertility.
Time after time, results indicate that smoking, excessive drinking, a poor diet, and drug abuse contribute to infertility.
Diagnosis: How Doctors Figure Out What’s Going On
Diagnosing the reasons for reduced fertility begins with thoroughly evaluating your medical, reproductive, and social background.
This helps guide us down specific avenues of inquiry.
A targeted physical exam looks for any structural issues in your groin, testicles, and penis and can provide clues about certain genetic conditions.
Tests to assist diagnosis may involve:
- A blood test to look at your hormone levels
- Taking a semen sample and analysing your sperm
- Scans and ultrasounds
- Genetic testing to rule out Y chromosome genetic irregularities and congenital disorders
What Treatments are Available?
Once I get a clear picture of what’s going on physically and mentally, I’ll often refer you to a fertility specialist or urologist to address specific fertility challenges.
Though medical science can’t yet improve the quality of your sperm, doctors use numerous methods to help your sperm fertilise a woman’s egg.
Assisted reproductive technologies
IVF is essentially fertilisation in a laboratory. It involves extracting an egg from your partner’s ovaries and mixing it with your sperm sample in a specialised lab.
An embryo is then placed in your partner’s uterus for implantation.
ICSI involves injecting a single sperm into one of your partner’s eggs. Couples may opt for this method if they have no luck with IVF.
If we find that a blocked tube is contributing to your reduced fertility, surgery may be an option. Doctors use many forms of surgery to clear blockages.
If deemed necessary, I’ll refer you to a specialist.
This treatment is often used if erectile dysfunction is a problem, your sperm count is low, or your sperm struggles to make its way to your partner’s egg naturally.
Artificial insemination involves manipulating your semen sample to achieve a high concentration of sperm. This sample is then physically introduced into your partner’s uterus through her cervix.
If you’re diagnosed with hormone abnormalities, your GP may refer you to a specialist endocrinologist.
Doctors usually look at treating any underlying medical conditions or addressing lifestyle factors affecting your hormone levels before considering testosterone replacement therapy or other medications.
Mental health challenges, including stress, anxiety, depression, and trauma, sometimes contribute to low libido, erectile dysfunction, and premature ejaculation.
Psychologists, councillors, and psychiatrists have been shown to help markedly in treating headspace-related causes of male infertility.
Male Fertility and Mental Health
Unsurprisingly, male infertility often leads to poor mental health, especially for those with a history of psychological issues.
Even for the manliest of men, being unable to get your partner pregnant can be demoralising.
Unhelpfully, society can emasculate and stigmatise infertile men as failures. Not all people feel comfortable talking to their friends about these issues, which disguises how common it is.
Similarly, the stress and anguish of male infertility can strain relationships – at times to breaking point.
If this sounds familiar to you, please reach out.
Your mental health should be treated just as intently as any physical health issues.
Tips to Boost Your Fertility
These tips aren’t quick fixes but sensible ideas to help boost your fertility.
For some men, simply telling yourself, “I’m gonna be a dad!” can be an excellent motivator for getting as healthy as possible and upping your chances of conceiving.
Limit alcohol consumption
Excessive alcohol intake is detrimental to sperm quality. Moderate intake of alcohol (1-2 standard drinks on normal days, 3-4 drinks on occasion) is unlikely to affect sperm production but may impact sexual function.
Smoking is associated with decreased sperm quality. Keep in mind the three-month wash-out needed for your sperm to recover from a smoking habit.
Talk to your GP if you would like help quitting.
Watch your weight
Obesity (BMI over 30) will likely reduce fertility and sexual function. For blokes with borderline testosterone levels, a reduction in body weight can have tremendous benefits.
Consider the heat downstairs
Scrotal exposure to elevated temperatures is thought to be associated with reduced semen quality.
In saying this, the people of Finland manage to conceive despite the national pastime of sauna use, and humanity has survived the changing fashions of underwear.
Still, it’s something to keep in mind.
Avoid recreational and performance-enhancing drugs
Certain drugs can impair sperm production, not to mention impact sexual dysfunction. Opioid abuse, marijuana, stimulants, and steroids should all be avoided.
Have sex frequently
Prescribing and scheduling sex isn’t much of an aphrodisiac. Vaginal intercourse every 2-3 days around ovulation is what fertility specialists tell us to aim for.
Visit your GP
Talk with your GP if you’re worried about your fertility.
Even if no medical care is required, an experienced men’s health doctor will offer fertility advice tailored to your personal circumstances.
Dr Michael Macpherson is a local GP at Doctors of South Melbourne.