Studies increasingly indicate that male fertility rates are declining and have been doing so for some time. Globally, an estimated one in six couples struggle with infertility, which is defined as having unprotected intercourse for six months or longer without achieving a pregnancy, where the female partner is older than 35.
Historically, women carried the blame for a couple’s infertility, because it is women who carry the baby and deliver them. Today we know that the female partner is not automatically responsible for infertility in a couple.
In fact, in about one-third of infertile couples, the infertility is due to a male factor, most often a problem with the sperm. In a further one-third of couples struggling with infertility, it is due to fertility challenges in both partners. In the remaining one-third of infertile couples, the challenge lies with the female partner.
Given this reality, it is important for couples who have not fallen pregnant not to make any assumptions but to have all the proper fertility tests done for both partners before making any decisions.
While the statistics confirm that male infertility is a significant issue affecting increasing numbers of couples, male fertility is not spoken about as publicly or as much as female fertility. This contributes to a widespread lack of awareness of the fact that male fertility issues are a significant contributor in many infertility cases.
What forms do male infertility take?
Male infertility can take various forms, for example, a complete absence of sperm, a low sperm count, or problems with the shape or movement of the sperm. When a sperm analysis is done, there are various factors that are investigated.
- The first is the volume of the sperm. A normal volume is at least 1.5ml and if there is less, it may point to an obstruction somewhere between sperm production and ejaculation.
- The number of sperm in the semen sample or the concentration of the sperm is also measured. What is usually regarded as normal is around 15 million sperm in 1ml of a semen sample. Below 10 million will raise concerns about low sperm count and may affect natural conception.
- Another functional aspect of the sperm that is measured is the motility or the movement of the sperm. Generally, about 40% or more of the sperm should be normally moving.
- The shape of the sperm is also investigated. There may be lots of sperm, but the shape of the sperm cells may be strange. For example, the sperm may have too many heads or tails, or may simply have an odd shape, in which case they don’t function well.
What causes increasing male infertility?
According to studies, research papers and semen analysis results among fertility clinics, there is a decline in male fertility levels worldwide. A closer look at the known and suspected causes of male infertility sheds some light on this trend.
While the exact causes are not known, but there are many possible factors in the environment that could be damaging the testicles or affecting sperm function.
- Sperm problems may be due to genetic disorders or a problem with hormone function, or even due to specific childhood diseases, for example, mumps – a viral illness that affects the testicles as well.
- Other important possible causes include infections from sexually transmitted diseases (STDs) like chlamydia and gonorrhoea. This is because these infections block the little tube between the testicle and the penis where the sperm travels through, called the vas deferens. So, there may be sperm in the testicles, but it can’t be ejected anymore.
- It may also surprise many people to discover that lifestyle factors also have a significant impact on male fertility. For example, there is definitely a link between high alcohol consumption and male infertility, and between the use of steroids and male infertility. While anything done in moderation should not have an extremely negative impact on your health, the excessive use of alcohol – as well as smoking – undoubtedly decreases fertility in both partners. So, a drink once a day should be okay in terms of male fertility but drinking four units a day will certainly decrease sperm function.
- Other lifestyle factors, such as being overweight, drinking excessive amounts of coffee or poor nutrition, will also negatively affect fertility in both partners. Certainly, lifestyle diseases such as diabetes can also significantly affect sperm function.
- Another certainty in terms of sperm problems is the use of steroids, especially testosterone. It is often used by gym enthusiasts building big muscles. The reality is that taking testosterone will automatically switch off this hormone production in the brain, which is responsible for producing sperm. Many men who are using anabolic steroids struggle with fertility. Thankfully, the good news is that this can be reversed. It takes around three to four months after quitting the use of anabolic steroids for the process of producing new sperm to be re-established.
Treatment options for male infertility
Fortunately, there are as many treatments for male infertility as there are possible causes. At Cape Fertility, we can help even patients with severe male factor infertility. Some treatments are quite simple, for example, insemination involves preparing the male partner’s sperm before inserting artificially it into the female partner’s uterus when she’s ovulating. This treatment is suitable when there is a mild sperm problem.
For more serious challenges, in vitro fertilisation or IVF treatment may be used. During this treatment, the female partner’s eggs are extracted and mixed in the lab with the male partner’s prepared sperm to be fertilised. One or two of resulting embryos (fertilised eggs) are then placed back in the female partner’s uterus, where one will hopefully implant and become a baby.
An advanced treatment called ICSI (Intracytoplasmic Sperm Injection), involves injecting one single sperm cell into each egg cell. This treatment has revolutionised male infertility treatment because even the most severe sperm problems can now be treated. For example, even in cases where there’s no sperm being ejaculated at all, sperm cells can be extracted from a tiny piece of tissue from a testicle to be injected into the eggs.
Even if all these options are unsuitable or exhausted, there is still the option of using donor sperm along with assisted reproductive therapies (ART) such as IVF or insemination.
Dr Sulaiman Heylen is an Obstetrician and Gynaecologist and a Subspecialist in Reproductive Medicine. He is one of four specialists at the Cape Fertility Clinic in Claremont and works at Life Kingsbury Hospital. Dr Heylen is a specialist in reproductive surgery (laparoscopy and hysteroscopy). He performs very specialised procedures like the removal of Asherman’s syndrome and laparoscopic transabdominal cerclage. He has extensive experience in surgery for endometriosis and fibroids.
He introduced the use of TESA (Testicular Sperm Aspiration) and ESA (Epidydimal Sperm Aspiration). Dr Heylen was the first to perform laparoscopical tubal re-anastomosis in South Africa. With the embryology team of Cape Fertility Clinic, he had the first Pre-implantation Genetic Diagnosis (PGD) pregnancy in 2003. He devotes himself to the further development of infertility in South Africa.
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