Frequently Asked Questions
This is a sensible idea as normal test results can be reassuring and abnormal test results will at least give you plenty of time to explore all the options.
We would recommend you have a male reproductive health assessment. You need to have a semen analysis and then we can discuss the results and any recommendations with you.
We are able to refer your partner to a Gynaecologist if she would also like to undergo some initial tests.
At Andrology Solutions we acknowledge that fertility clinics provide an invaluable service and many couples have successful outcomes following treatment. However, often the focus is on the female partner.
Andrology Solutions is able to offer a unique service just for the male partner. Our aim is to work alongside the clinic offering treatment by investigating any male factors possibly contributing to the subfertility, and maximising the chance of a successful outcome.
We recognise the very sensitive nature of male infertility and at our centre you can be assured that discretion and confidentiality are our priority. Andrology Solutions is licensed by the Human Fertilisation & Embryology Authority (HFEA) where confidentiality is a mandatory requirement. The clinic is also registered with the Information Commissioner’s Office (ICO) for General Data Protection Regulation (GDPR).
Correspondence will generally be sent to you by email and sensitive information will be sent using Egress, a secure encrypted emailing platform. We share building facilities with a UKAS accredited laboratory, which offers a full range of diagnostic tests. As all patients attend the same waiting room, there is no distinction between patients attending Andrology Solutions and those attending for routine blood tests.
Most men prefer to attend on their own as this aids a more open discussion with the focus on themselves. Some men may also feel more comfortable to discuss their past sexual health and history without their partner present. However, it is ultimately your choice if you also wish your partner to attend.
Semen quality is known to vary widely in the same person for a variety of reasons. For instance, alcohol, smoking (particularly cigarettes and cannabis), caffeine, recreational drugs, prescribed medications including antibiotics, and bouts of illness have all been associated with poor sperm quality.
Similarly, high stress levels and over exercise may contribute to decreased fertility potential. Sperm need to be stored at a cooler temperature than the rest of the body, which is why the testicles are outside of the body cavity. Long periods of sitting down, particularly when tight clothing is worn, increase the temperature and may adversely affect sperm.
We suggest that you reduce these potentially compromising life-style hazards and maintain a healthy diet with plenty of fruit and vegetables. Vitamin supplements we recommend are vitamins C and E, selenium and zinc, together with garlic capsules, which protect the sperm from oxidising reagents.
And remember – whatever you are doing now will affect your sperm quality 3 months down the line, as this is how long it takes the young immature sperm to develop to maturity.Please contact us with any other questions you may have.
Almost every discussion about fertility these days seems to focus on women while men are generally forgotten about, probably because in part, men are often reluctant to talk about it and seek advice. About one in every six couples experience problems starting a family. For 25% of these couples, the infertility is due solely to the man while in another 25% of couples, both the man and the woman have a problem. That means that in 50% of couples having problems conceiving, there is a contributing male problem. So it is very important that we take the male contribution seriously if we are going to be able to help couples to achieve a pregnancy.
Because a male factor is equally likely as a female factor in contributing to a couple’s infertility, it is imperative that men are investigated as well. Importantly, the man should be investigated at the same time as the female partner, to prevent a delay in determining the cause of the infertility. We see far too many couples where the woman is investigated every which way, sometimes for years before any consideration of the man is taken into account. Women have a biological clock and cannot afford to be wasting their time when they are trying to start a family. No amount of management of a woman’s fertility issues will result in a pregnancy if the man has no sperm. Treatment for male infertility may take several months before any improvement is seen, so the sooner male infertility is diagnosed, the sooner it can be treated. Furthermore, a diagnosis of male infertility may help to determine the most appropriate treatment for the couple.
Male infertility is defined as the inability to cause a pregnancy in a fertile woman. It may be due to poor sperm quality or absent sperm (known as azoospermia), or the inability to have intercourse. First of all, it is important to try to discover the causes of the problem in order to treat the condition and improve your fertility, and for that, men require some investigations. The gold standard test for male infertility is the semen analysis, conducted in a properly accredited laboratory. The journey for the sperm to travel through the female reproductive tract is a mammoth task so there needs to be a good number with strong swimmers to be able to get enough sperm to the egg. The shape (morphology) of the sperm needs to be normal to give the sperm the best chance of recognizing and getting into the egg. Some morphological defects may mean that the sperm will never get into the egg, for example if they have severe tail defects that stops them moving or if they have a completely round head, although other types of shape defects may not prevent sperm from getting in. However, sperm count, motility and morphology are not the only things that matter. The presence of antibodies or white cells, or changes in the consistency, pH or volume of the sample may indicate inflammation, infection or prostatitis, all of which may affect fertility irrespective of whether the other parameters are fine.
Receiving a poor semen analysis result can be devastating, however a person with poor semen parameters is not necessarily infertile and likewise a person with good parameters is not necessarily fertile. There are plenty of men with poor parameters who are able to father children – it may take a little longer, but especially if the partner is fertile, the couple may not experience any undue problems. Indeed many men have poor semen parameters and do not have any fertility issues. There are also many couples who conceive who have been trying for ages to get pregnant while on the waiting list for ICSI treatment.
However, poor semen parameters mostly lead to infertility, so it is very important that further investigations are carried out to try to understand the cause and rectify the problem. Interestingly, sperm parameters are also a marker for a man’s general health. Poor semen parameters may indicate an underlying health problem such as diabetes or a cardiac condition, so if there is no immediate known cause for the fertility issues, a general health and wellbeing check up with a GP is advised, as it may be indicative of an unrelated health issue.
With any medical condition, a doctor would usually take a full medical history and this is no less important for investigation of male infertility. Taking a full medical history may reveal issues that have a profound effect on trying to start a family, such as medical conditions, previous surgeries, lifestyle factors, or erectile dysfunction (ED), otherwise known as impotence. Impotence is a major contributing factor to infertility. It can be a physical problem but it is most likely due to psychological issues. Men are under huge pressure to perform when they and their partner decide they want to try to have a baby. This in turn causes performance anxiety, guilt, and low self-esteem. It is paramount that their partners are sympathetic and understanding in these situations. Impotence is quite common, affecting about 20 – 25% of all men, but most men will probably experience this at some point in their lives. Physical reasons include diabetes, high blood pressure, heart and vascular disease, stress, hormone problems, pelvic surgery and trauma. There are also some drugs which can cause ED including Propecia and antidepressants. In terms of treatment, some men find hypnotherapy quite helpful. Many men with ED are perfectly able to ejaculate on their own and in this case, treatment using intrauterine insemination (otherwise known as IUI) may be very effective.
The doctor should also perform a physical exam. This combined with an ultrasound scan of the testes can provide even more information about the physical state of the reproductive tract. This will help to identify any structural defects with the male reproductive system such as undescended testes, missing tubes (vas deferens), cysts, obstructions, varicoceles or even a tumour. As none of these defects can be confirmed from a semen analysis, it is essential that the man is properly investigated if he and his partner are struggling to conceive.
Varicocele is the leading known cause of male infertility. It is a clump of varicose veins in the testes, usually on the left side. It causes an engorgement of blood into the testes, elevating the temperature and restricting blood flow. Varicocoeles are quite common, occurring in around 15% of all men, however, they are much more common in infertile men, occurring in up to 40% of men with primary infertility and 80% in men with secondary infertility. They are associated with low sperm count, poor motility and vitality, and poor sperm shape, but can also occur in men with normal semen parameters. The good news is that varicoceles can be repaired. If a varicocele is found and sperm quality is poor, a referral to a urologist to discuss the benefits of varicocoele repair should be arranged. There is growing evidence to show that varicocoele repair can improve semen parameters in up to 80% cases. There are also reports of it significantly improving chances of a natural pregnancy in your partner equivalent to rates seen with assisted conception treatment (IVF/ICSI). This treatment is a lot cheaper than IVF, does not affect the partner and may actually improve sperm quality, which IVF cannot do.
Approximately 10% infertile men have an infection in the genitourinary tract. An underlying infection may have no symptoms at all and it may have been present for many years remaining undetected. If a man experiences any symptoms with regard to urination or any pain or discomfort at ejaculation or at urination, they should see their GP who can then refer them to a urologist for further investigation if they think it is necessary. These types of symptoms may indicate an infection or inflammation of the prostate, otherwise known as prostatitis. This is quite a common condition, affecting about 50% of men at some time in their life. Although it is more common in older men, younger men can experience this as well and it may have a significant impact on sperm quality. Infections may be treated with antibiotics, but in some cases, the effects are irreversible, especially with infections such as mumps which may make men completely sterile. It is worthwhile getting tested for infections as they can affect sperm quality, cause a delay to conception and increase the risk of miscarriage.
A reduction in sperm count may indicate a hormone imbalance, and a simple blood test can confirm this. Because the balance of the different hormones is so important, any disruption in hormone levels is going to affect sperm development and what that means is that sperm numbers are going to go down. Hormone imbalances can have a drastic effect on sperm count and is probably the leading cause of no sperm (azoospermia). Altered hormone levels can also lead to a decrease in libido and impotence, loss of secondary sex characteristics, and small testicles. Hormone imbalances may be due to a defect that you are born with, growths in the glands, or testicular damage. Hormones can also be affected by exposure to environmental toxins like pesticides or occupational hazards, smoking, excessive alcohol intake and taking supplements to build muscle. Overly intensive exercise also produces high levels of adrenal hormones which lowers testosterone resulting in poor sperm and infertility. Obesity is another major cause of infertility due to its effects on hormone balance. The reason for this is that fat cells have an amazing ability to convert testosterone into the female hormone estrogen that results in a reduced sperm count and decreased libido.
The question is can hormone imbalances be treated? There are simple things that can be done to help, such as stopping smoking and reducing alcohol intake, monitoring exercise regimes, not taking steroids and reducing weight. But for conditions that are not lifestyle choices, hormone replacement therapy can sometimes been used effectively, and certain conditions can be managed with drugs so that fertility maybe regained. However, this is not suitable treatment for everyone with azoospermia, and success is limited. In this case, the only other option would be to consider looking for small numbers of sperm directly in the testes using a surgical procedure known as testicular sperm exploration (TESE). These sperm can then be used with assisted conception treatment with ICSI.
While semen analysis is a great starting point for fertility investigation, it only gives indirect information about the causes of infertility described above and fails to tell us anything about the ability of the sperm to fertilise the egg or whether the sperm are genetically healthy. This means that even if all of the semen parameters are completely fine, there may be genetic damage or problems with the fertilization process that will result in fertility problems. This is often called unexplained infertility. If a man is diagnosed with unexplained infertility, it may be an idea to check for sperm genetic damage. However it is important to understand that while it is possible to test for genetic damage to sperm, the tests are limited because they cannot check for every type of genetic disorder. The most common test for sperm genetic damage is a test for DNA fragmentation. This looks for the percentage of sperm that have broken DNA. In all samples, there will be a small percentage of sperm with DNA fragmentation, but there is a threshold limit above which it becomes a problem for fertility. Sperm DNA damage does not seem to affect fertilisation, but it will start to cause a problem once the embryo gets to around day three of its life, when the male genetic contribution kicks in. This may cause a delay in embryo development, it may cause failed implantation of the embryo and increase the chances of a miscarriage in the first 12 weeks. The latest European guidelines for recurrent miscarriage (ESHRE 2017) recommend this test for male partners, irrespective of whether sperm parameters are normal.
In a small percentage of cases, the cause of male infertility may be a congenital defect. These conditions, such as chromosome translocations, Y-deletion and Klinefelters, are associated with a very low sperm count or an absence of sperm altogether. So if a man has limited numbers of sperm, he should be tested for chromosomal abnormalities. In a few of these cases, hormone treatment can be used to improve sperm quality. Alternatively, sperm may be retrieved directly from the testes, but the chances of finding sperm are low.
The single most damaging marker of poor sperm quality, function and DNA health is oxidative stress. Oxidative stress is caused by the over production of highly reactive oxygen species which causes a reduction in motility and vitality and interferes with fertilisation. Oxidative stress is also the leading known cause of sperm DNA fragmentation. Therefore measuring oxidative stress in semen is extremely valuable, because it interferes with so many processes required for normal sperm function.
Oxidative stress and DNA damage may be counteracted by taking fertility supplements which act as antioxidants, however, there is no point in taking these supplements if you have not also addressed the causes of the problem. Oxidative stress and sperm DNA damage is caused primarily by infection or inflammation, or heat stress to the testicles, including varicocoele. It is also caused by smoking, exposure to environmental or occupational toxins and poor diet, such as eating lots of fried or processed foods. Treating infection, varicocoele repair and altering your diet can all significantly reduce oxidative stress and reduce DNA damage, and hence improve your fertility.
Overall, while treatment for male infertility is limited, there are many investigations, treatments and lifestyle adjustments that can be made to improve fertility to enable a man to have a child through natural conception. It is crucial that men are investigated thoroughly and that they are seen by the appropriate doctor – in other words a urologist who specialises in male infertility. The urologist will take a full medical history, perform a physical exam and recommend the appropriate investigations and treatment for infertility. An immediate referral to see a gynaecologist at a fertility clinic is not appropriate. Men should only be referred to assisted conception clinics for fertility treatment, not for investigation, diagnosis and improvement of male fertility, because it will not happen. While in some cases, natural conception may not be an option under any circumstances, going to a fertility clinic for IVF treatment should always be the option of last resort. It is important to understand that having treatment with sperm that are compromised as a result of varicocoele, underlying infection, poor lifestyle etc. will lead to an increased risk of a compromised embryo and an increased risk of the treatment failing. When couples have put so much effort into IVF treatment it is essential that they give it the best chance of working, so it makes sense to try to optimize the quality of the sperm before going ahead with assisted conception treatment.
Contrary to popular myths put forward that there is absolutely nothing you can do about male infertility, in many cases, there is plenty that can be done and it begins with appropriate investigation and diagnosis of the problem.