What to expect when you want to be expecting
It takes two to tango.
You could be forgiven for thinking that infertility is all about women. Our society identifies reproduction as mainly a women’s health concern, and they usually shoulder the burden of infertility treatment. But infertility — the inability to conceive after trying for 12 months — affects couples, not individuals.
Men’s reproductive health gets less attention than women’s. That’s appropriate since females literally carry the load when it comes to pregnancy, childbirth and breastfeeding. But men are more than just sperm donors. A father’s health influences his partner’s pregnancy, and his child’s development and lifelong health and wellbeing. It also has a big impact on a couple’s ability to conceive.
Male infertility contributes to one in four cases of IVF in Australia but could be a factor in up to 50% of all infertile couples. For three quarters of those IVF cycles, the cause of the male fertility problem is unknown. That means that thousands of Australian couples every year have IVF treatments because of unexplained problems with the male partner’s fertility.
Why male infertility matters
There are a couple of problems with overlooking men’s contributions to a couple’s infertility. There are genetic, anatomical and hormonal problems that affect men’s fertility that are treatable. By not investigating male infertility, we not only miss an opportunity to restore men’s fertility but to also improve their overall health.
Overlooking men’s impact on a couple’s infertility can also result in potentially unnecessary and invasive treatments for female partners. Infertility treatment is one of very few occasions when a patient without a health problem (a fertile woman) may receive treatment for a health problem in another person (her partner). Hormonal treatments to stimulate a woman’s ovaries and surgical collection of eggs are not without risk. Unnecessary use of IVF might be avoided if we can better understand fertility problems in men.
Time for a change
Until now, investigation of male infertility for Australian infertile couples has been inconsistent because there has been no specific guidance about how to diagnose and treat male infertility. With the recent publication of the first Australian Clinical Guidelines for the Management of Male Infertility, all health professionals now have an evidence-based path to follow for investigating and treating male fertility problems. The guidelines also help couples to understand what they should expect when it comes to male partners if they have concerns about their fertility.
What you should do if you’re concerned about infertility
Your GP is the right person to go to for advice about all aspects of your sexual and reproductive health, including fertility. They should offer you an evaluation of your fertility, including questions about your reproductive history, an examination (yes, you’ll need drop your pants because examination of your scrotum is necessary) and a semen analysis. The semen analysis will be done in an accredited laboratory; you’ll need to arrange to provide a semen sample, which is usually done in a private room at the testing laboratory. If your semen analysis raises any concerns, you should have another one done after about six weeks for confirmation.
Fertility assessments should occur in male and female partners at the same time because findings for one partner may affect investigations or treatment of the other.
What you should expect from fertility investigation and treatment
After an examination by your GP and semen analysis, any abnormalities will be followed up, usually by a fertility specialist. Blood tests to measure hormone levels and genetic tests are usually done at this stage.
Around 1% of men have no sperm in their ejaculate, either because sperm production is very low or because of an obstruction somewhere along the reproductive tract. MRI or ultrasound imaging is recommended to separate these two causes, and surgery is recommended for obstruction in some cases. Hormonal treatments to stimulate sperm production might be used to treat some causes of very low sperm production.
Around one third of infertile men have a varicocele (a swelling of blood vessels in the scrotum), and if it is large enough it can affect sperm production, so surgery might be recommended.
In all cases, treatment of male fertility problems should be specifically targeted to the individual cause. Treating the underlying cause will also improve related health problems.
Ultimately, if a cause of infertility can’t be found, or if treatment is unsuccessful, assisted reproductive technologies can be used to help couples conceive. Even for men with very low sperm production or complete blockage of the reproductive tract, specialists can extract sperm surgically from the testes. Intracytoplasmic sperm injection (ICSI — injection of a single sperm into an egg under a microscope) — can make a baby with just one healthy sperm.
It’s only fair, and about time, for male and female partners to be considered equally when it comes to infertility. It’s best for their individual health, their shared fertility, and their future children.
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