Causes & Treatment
Calling all Fathers-in-Waiting – Everything you need to know about male infertility by Clinica Tambre
TRB team, in partnership with Clinica Tambre | 20 Jun 2020
With today marking Father’s Day in the UK (an extremely difficult time for all trying to conceive), we at TRB want to focus on the patient fathers-in-waiting. With this in mind, we’ve taken your rather brilliant questions and put them to our partner fertility clinic in Madrid, Spain – Clinica Tambre.
Read below everything you’ve wanted to know regarding male (in)fertility, from the fertility specialists themselves. If you’d like to find out anything more, feel free to message us or Clinica Tambre directly, for fertility help and advice.
Male Infertility Causes and Signs
How common is male infertility and what are male infertility factors?
Answered by Dr. Marta Zermiani
Male factor is estimated to be present in about 50% of infertility cases, with sole responsibility in 30% of cases and a co-contributing female factor in 20% of cases.
Male infertility can be caused by a wide range of conditions: anatomical or genetic abnormalities, systemic or neurological diseases, infections, trauma, iatrogenic injury, gonadotoxins and development of sperm antibodies. In 30–40% of male infertility cases, no cause is identified.
What are the male infertility signs?
Answered by Dr. Marta Zermiani
Infertility is typically defined as the inability to conceive after at least one year of regular, unprotected sex.
A screening evaluation of the male partner is indicated when the couple fails to achieve pregnancy after 12 months of regular, unprotected sexual intercourse, when trying to conceive. This period is reduced to six months if the female partner is aged over 35 years.
What is Azoospermia?
Answered by Rachele Pandolfi & Carolina Andrés
Azoospermia is the condition of the complete absence of sperm in the ejaculate. In infertile males, approximately 15% display azoospermia. Azoospermia can be subdivided into two broad categories, obstructive azoospermia (OA) and non-obstructive azoospermia (NOA).
OA is the result of a blockage within the excurrent duct system that prevents sperm from passing into the semen. For example, mutations in CFTR result in congenital bilateral absence of the vas deferens in males homozygous for these mutations.
NOA can result from primary, secondary, or incomplete testicular failure. The causes of azoospermia can be hormonal problems, certain genetic conditions, a previous vasectomy or other surgeries, among other conditions. Certain cancer treatments can also cause it.
Among males with azoospermia, 60% is due to OA and 40% due to NOA. Between OA and NOA, NOA presents the most problems in conception rates using in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) because NOA is more often associated with spermatogenesis failure leading to production of few or no sperm. Azoospermia can cause sterility (inability to have children). There are other routes to parenthood if this is the case, such as the use of donor sperm.
Male Infertility and Obesity
Does age affect male infertility? What happens to sperm when men get older?
When men are in their 60’s and older, they may see a reduction in their sperm quality and concentration and they are also more likely to have children with autism.
What about male infertility and obesity?
Answered by Dr. Marta Zermiani
Obesity is associated with male infertility, most likely because of hormonal changes, secondary to excess adipose tissue. There are higher rates of azoospermia and oligospermia among obese men compared with men of normal weight. Additionally, couples made up of an overweight or obese man, with a female partner of normal BMI take increased time to conceive compared with couples with male partners of a normal weight.
Male Infertility Diet
Can alcohol consumption / smoking affect sperm count?
Answered by Rachele Pandolfi & Carolina Andrés
Much has been published about smoking and alcohol intake influencing male fertility, sperm parameters and reproductive outcome. A number of studies have reported an association between tobacco smoking and male infertility and/or suboptimal sperm production.
Heavy smoking was associated with decreased sperm counts, and alcohol consumption was associated with increased numbers of morphologically abnormal sperm. Studies show heavy, consistent drinking or binge drinking (five or more drinks for men in a two-hour timeframe) , have negative effects on sperm.
In men, heavy drinking affects fertility by:
- Lowering testosterone levels, follicle-stimulating hormone, and luteinizing hormone, and raising estrogen levels, which reduce sperm production
- Shrinking the testes, which can cause impotence or infertility
- Changing gonadotropin release which impacts sperm production
- Causing early ejaculation or decreased ejaculation
- Changing the shape, size, and movement of healthy sperm
Can Male Infertility be Reversed / Treated?
The good news is that male infertility can sometimes be reversed. One study shows it takes three months for the return of healthy sperm production, once alcohol consumption stops.
A review of observational studies on smoking and semen parameters found that 20 of the 25 studies reported an increased risk of lower sperm concentration in smokers compared to non-smokers. On average, sperm concentration was 13% lower in smokers compared to non-smokers. Smoking men also had a lower average proportion of sperm that were motile (moving or swimming) and morphologically normal (sperm with a correct body shape), compared to non-smoking men.
Men who are trying unsuccessfully to conceive, and those who wish to protect the health of their sperm for the future, should therefore avoid a range of drugs, including alcohol and tobacco.
On the other hand, some studies show that cigarette smoking and alcohol consumption do not appear to significantly affect sperm parameters, such as volume, sperm count, motility and morphology or pregnancy outcome in our study population. However, there is no conclusive agreement about the effects of cigarette smoking and alcohol use on these outcomes and thus no generally accepted guidelines.
Are there any foods that increase male fertility?
Yes, all antioxidant food can increase the chances of having a baby: vegetables, fruits, nuts, fish, berries…
What about male supplements for fertility?
Yes, antioxidants, vitamins including zinc, selenium, vitamin D, CoenzimQ10, melatonin to improve simple fragmentation… and also turmeric to reduce double fragmentation in sperm.
Can male infertility be treated with Chinese Medicine. E.g. fertility acupuncture and homeopathic medicine? Is it safe?
Complementary and alternative medicines are sometimes used by individuals who desire to improve the outcomes of their fertility treatment and/or mental health during fertility treatment.
The quality of the scientific evidence across these methods is poor. The advantage of these alternative techniques is that they offer fewer side effects, but there is a need for more research to determine their effectiveness in relation to fertility treatment.
Male Factor Treatments
What male infertility treatments are available?
Answered by Dr. Marta Zermiani
- Correction of varicocele is indicated in patients with a clinically detectable varicocele and abnormal semen analysis, as it improves pregnancy rates. Surgery is also indicated in cases of obstructive azoospermia.
- In patients with hormonal alterations, treatment with gonadotropin (hormonal treatment) is indicated.
- Cryopreservation of semen is recommended for patients who desire future biological offspring and are about to undergo chemotherapy, radiotherapy or surgery that can potentially affect fertility.
Many couples will require in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI). IVF involves ovarian stimulation, oocyte retrieval, and fertilization outside of the body; ICSI involves injecting one sperm into the oocyte to promote fertilization. In approximately 40–50% of patients with non-obstructive azoospermia, sperm can be found with the use of microTESE (Microsurgical Testicular Sperm Extraction).
Success Rates
What are the success rates of male infertility treatments?
Answered by Rachele Pandolfi and Carolina Andrés
Before answering this question, it is important to take into account that success rates of treatments will be influenced by many factors, making it difficult to isolate the effect of the male factor, when looking at the final outcome.
In couples with male factor problems, their treatment of choice would be ICSI or sperm microinjection, normally due to the low sperm quality. According to the literature, it has been seen that if the effect of the oocyte is minimum (women under 37 years of age) 60% of the couples will have a baby within 4 cycles. In contrast, the success rates decrease to 20% in couples where the female partner is over 37 years old.
A big thanks to fertility clinic, Clinica Tambre and their knowledgable fertility specialists for answering all our readers’ questions. If you’d like to book a consult with any of their team for more fertility help and advice, then you can contact them here.
