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Male Fertility Problems In 40% of couples with fertility problems the predominant cause will be found to be with the male. A semen analysis is an essential early step in investigation of any couple with fertility problems. The early recognition that “male factor” issues are present may profoundly alter the way I choose to further investigate and treat a couple. I will insist that this simple test be performed at an early stage of our investigations. It is often very unclear what causes abnormal sperm test results. In some cases they may be “environmental”, or due to previous damage to the testis. In many cases we suspect that the cause may be genetic in origin. In a small proportion of cases it is now possible to demonstrate genetic errors in the man’s chromosome count, or in a portion of his Y chromosome. At the present time we lack efficient treatments for many of the causes of abnormal sperm results. In the majority of cases there are no simple medicines to ensure that the sperm test results will improve substantially. In a small group of men with abnormal test results we can show that this is due a hormonal malfunction. These men will usually respond very well with corrective hormonal treatment. General health measures may certainly help to improve a man's sperm results. Avoiding obesity, excessive alcohol consumption and heavy smoking, may certainly improve results in some cases. The use of supplements, such as folic acid and zinc, and possibly anti-oxidants, may also possibly improve sperm function in some men. At the present time, however, it would be fair to say that in the majority of cases we do not have simple medications that have the ability to markedly improve a man’s (poor) semen analysis result. The news is not all gloom and doom by any means, however. New IVF techniques have revolutionized the management of couples with fertility problems where the main cause of their difficulties is found to be “male factor”. Today, even men with severely abnormal sperm test results have the potential to have a family, using their own sperm, with special IVF techniques using sperm micro injection (ICSI). Indeed, some men who have no sperm at all in their semen analysis tests have the potential to have children using their own sperm. It is possible, in some cases, to remove sperm directly from the testis and enable IVF to be performed. The days are gone where a diagnosis of “azoospermia” (no sperm seen in the semen at all) automatically means that a couple have to resort to the use of donor sperm. |
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