When pregnancy doesn’t occur despite regular, unprotected intercourse, the focus may shift to a woman’s fertility status, but around 40% of all cases of infertility originate with the male partner, so it’s important that both partners have a full fertility examination if they have been unsuccessful in conceiving a child.
There are several investigations to determine male fertility:
Urine and blood tests can be done to check whether the man has Chlamydia or another sexually transmitted infection that may reduce fertility or increase the chance of miscarriage in his partner.
Hormone Testing – Blood tests are available to check various hormone levels that regulate the reproductive system, such as testosterone. These hormones have an important role to play in the production of healthy sperm.
Ultrasound – An ultrasound scan of the scrotum can identify any abnormalities such as cysts, a testicular tumour or a varicocele (small veins) that can make conception difficult. Having the scan may be a little uncomfortable but is not normally painful.
Tissue Biopsy - Depending on the result of a scrotal ultrasound scan, a testicular biopsy may be necessary. A small sample of tissue is removed via a needle for examination. This can confirm benign growths (non-cancerous tumours), cancer and infections. It can also show if sperm production is normal.
Trans-Rectal Ultrasound – This type of ultrasound uses a small probe which is inserted into the rectal passage so the seminal vesicles (tubes that carry sperm) can be observed for any blockages or infection that might prevent the transportation of sperm to the testicles.
Semen Analysis – A sample of the man’s sperm can be checked for count (the number of sperm present in the ejaculate), morphology (shape) and motility (movement). Low sperm counts, abnormally shaped sperm and sperm that don’t swim correctly can affect the likelihood of conception and the ability of the sperm to fertilise an egg.
Urine Analysis (Post-Ejaculation) – A sample of urine can be taken after ejaculation to check for the presence of sperm in the urine. This means that sperm goes into the bladder after orgasm instead of being expelled through the penis. This is called retrograde ejaculation.
Genetic Testing – Some genetic disorders can make a person infertile or sub-fertile, for example, Klinefelter’s Syndrome (XXY) in which they inherit an extra X chromosome. Men with Klinefelter’s are almost always sterile but some men don’t know they have the disorder until they try to start a family and encounter problems.
Lifestyle advice is given to every man attending the clinic for a fertility work-up as there are entirely reversible factors that can affect his ability to become a father, including:
Smoking and Alcohol Consumption – Cigarette smoking and drinking alcohol decreases the quality of sperm and makes it more difficult to conceive a child. Sperm with damaged DNA can cause miscarriage in the female partner as well as a higher incidence of birth defects.
Exercise - Men should make sure they exercise regularly if they and their partner are trying to conceive. However, they shouldn’t overdo it as very vigorous exercise can affect sperm count.
Sexual frequency, diet, illnesses and medication usage is also discussed as part of a full patient history.