Male subfertility

What is male subfertility? 

Male subfertility refers to a reduced ability to achieve conception despite regular unprotected intercourse. Unlike infertility, which implies a complete inability to conceive, subfertility indicates a lower-than-average chance of conception within a given time frame. 

What are the causes of male subfertility? 

Several factors can contribute to male subfertility, including: 

• Hormonal imbalances:  Low levels of testosterone or other hormonal imbalances can affect sperm production and quality. 
• Genetic factors:   Conditions such as Klinefelter syndrome or Y chromosome deletions can impact fertility. 
• Structural problems: Blockages or issues in the reproductive organs, such as varicoceles (enlarged veins in the scrotum), can impair sperm delivery. 
• Infections:  Sexually transmitted infections or other infections can damage the reproductive organs. 
• Lifestyle factors:   Smoking, excessive alcohol consumption, drug use, and obesity can negatively affect sperm quality. 
• Environmental exposures:  Exposure to pesticides, heavy metals, and other toxins can reduce fertility. 
• Medical conditions:  Conditions such as diabetes, thyroid disorders, or previous surgeries in the pelvic area can impact fertility. 

What can I do to improve the condition? 

Improving male subfertility involves lifestyle changes and medical interventions: 

• Healthy diet:  Eating a balanced diet rich in antioxidants can improve sperm quality. 
• Regular exercise:  Moderate exercise helps maintain a healthy weight and improves overall health. 
• Avoiding toxins:  Limiting exposure to environmental toxins and avoiding smoking, excessive alcohol, and recreational drugs. 
• Stress management:   Reducing stress through relaxation techniques or counselling can improve hormonal balance. 
• Medical treatments:  Hormonal treatments, medications to address underlying conditions, or surgery to correct structural problems may be recommended. 

How will I be assessed? 

Assessment for male subfertility typically involves: 

• Medical history and physical examination: A detailed medical and sexual history, along with a physical exam, to identify potential causes. 
• Semen analysis: Evaluates sperm count, motility, and morphology. 
• Hormone testing: Blood tests to check levels of testosterone and other hormones. 
• Genetic testing: Identifies any genetic anomalies contributing to subfertility. 
• Imaging tests: Ultrasounds or other imaging techniques to detect structural abnormalities. 

What are the types of subfertility? 

Male subfertility can be categorised into several types based on the underlying cause: 

• Pre-testicular subfertility: Caused by hormonal imbalances or issues in the hypothalamus or pituitary gland. 
• Testicular subfertility: Results from problems within the testes, such as varicoceles or genetic conditions. 
• Post-testicular subfertility: Involves issues in sperm transport, such as blockages or ejaculatory problems. 

What options are available? 

Treatment options for male subfertility include: 

• Lifestyle changes: Improving diet, exercise, and avoiding harmful substances. 
• Medical treatments: Hormonal therapy, antibiotics for infections, or medications to improve sperm production. 
• Surgical interventions: Correcting structural issues like varicoceles. 
• Assisted reproductive techniques (ART): Methods like Intrauterine Insemination (IUI) or In Vitro Fertilisation (IVF). 
• Advanced sperm retrieval techniques: For severe cases, techniques such as electro-ejaculation or surgical sperm retrieval are available. 

What is electro ejaculation? 

Electro ejaculation is a medical procedure used to obtain sperm in men who cannot ejaculate normally. An electrical probe is inserted into the rectum, stimulating the nerves responsible for ejaculation. This method is particularly useful for men with spinal cord injuries or other conditions that impair ejaculation. 

What is surgical sperm retrieval? 

Surgical sperm retrieval involves extracting sperm directly from the testes or epididymis when there is a blockage or other issues preventing sperm release. Procedures include: 

• Testicular sperm extraction (TESE): Sperm is extracted directly from the testicular tissue. 
• Percutaneous epididymal sperm aspiration (PESA): A needle is used to aspirate sperm from the epididymis. 

These techniques are often combined with ART methods to achieve conception.