by Dr Agilan Arjunan, Fertility / IVF Specialist & Gynaecology , KL Fertility Centre ( Malaysia)
Male infertility is on the rise. About 40-50% of IVF treatments are done for male infertility.
But do men know about male infertility ?
Read more below to find out .
This article was published in The Star ( Health) .
Infertility is often attributed to the female partner . Many do not realise that the male partner contributes equally to the problem.
In my daily fertility clinic , couples ask a variety of fertility questions. In this column , I would like to share some of the more common male infertility questions asked by couples.
- I can ejaculate regularly during sex, can I still be infertile ?
The answer is YES. Your semen or ejaculate comprises of a mixture of fluids from seminal vesicle and prostate and the sperm cells . Sperm cells, which are produced in the testicles , travel through a tube called vas deferens and mixes with the fluids from seminal vesicles and prostate before being ejaculated. Thus, presence of semen does not equate to presence of sperm cells in it. Semen can be of normal volume and consistency even without presence of sperm cells.
- Do I have a low sperm count because my semen volume is low ?
This is another common misconception. Semen volume does not indicate your sperm cell concentration in the semen. Semen volume can be low for various other reasons. The reasons can be as simple as short abstinence period before the sperm test and incomplete ejaculation to a more pathological reasons such as retrograde ejaculation and ejaculatory duct obstruction.
Even in a man with low semen volume, the sperm concentration can still be within normal range, which is above 15 millions of sperm in each millilitre (ml) of semen volume.
- My erection is weak, can I be infertile ?
This is a very common question and I can understand why. Poor erection can directly lead to “infertility” due to inability to deposit semen in vagina. Thus it is natural for every men to assume that poor erection leads to infertility. This is a false alarm.
If erectile dysfunction (ED) is the main issue, there are simple fertility treatments such as intravaginal sperm insemination (IVI) or intrauterine insemination ( IUI) which can overcome the issue of semen deposition in vagina or into the womb.
However, I urge men to seek the consultation of fertility specialist or urologist to find the root cause of their erection issue. While fertility treatment can give them immediate fertility solution, the couple need to find a long term solution which may enable them to get pregnant naturally in future.
- I was diagnosed with Azoospermia, what can I do ?
Azoospermia ( no sperm cells seen in the ejaculate or semen) is not the end of the world.
The first step is to see a male infertility doctor. Next step, would be to start assessment to determine the likely cause for azoospermia , either sperm production issue or its a sperm transport blockage issue.
The most likely cause is related to production issue rather than blockage issue.
In this situation , several blood test will be done to assess your sperm production capability together with assessment of the size of the testicles. In some situation, a testicular ultrasound will be done.
Hormonal treatment can be started for a few months to stimulate sperm production. If this fails , a minor surgery is needed to retrieve sperm from the testicles. This procedure is known as surgical sperm retrieval.
Besides hormonal treatment, supplements to improve both quantity and quality of sperm will be recommended.
Once sperm cells are obtained, either via ejaculation or surgery, assisted reproductive techniques can be used to make the couple pregnant.
- Is IVF the only treatment in male infertility ?
In most cases the answer is YES.
This is because even if hormonal treatment worked, the amount of sperms found is usually minimal. Furthermore , the effect of hormonal treatment may not last forever . Thus IVF treatment is more appropriate.
However, there are men with azoospermia who , with hormonal treatment , managed to make enough sperm and successfully became parents with Intrauterine Insemination (IUI) . Therefore, the treatment options are determined based on the amount of sperm cells , taking into account the couple’s fertility history.
These are some of the most common questions asked in my male fertility clinic.
My advise to couples diagnosed with male infertility is to come forward earlier than later to seek help.
Female partners play an important role in supporting their male partners to go through this challenging journey towards parenthood.