Derek Lok looks at male infertility

What is andrology?

Andrology is to men, what gynaecology is to women.

It is the branch of medicine which deals with diseases and conditions specific to men - in particular those associated with infertility and sexual dysfunction.

The Andrology department at Genea deals with male patients, including partners of assisted conception patients, sperm donors and other men who may need a semen analysis or sperm freezing.

What is male infertility?

Infertility is defined as the failure to achieve a pregnancy after one year of regular (at least twice weekly) unprotected intercourse with the same female partner.

Male infertility is diagnosed after testing on both partners identifies a reproductive problem in the male. Causes include:

• not enough sperm
• sperm that do not swim well
• sperm that are misshapen

Approximately two thirds of infertile males have sperm production problems - with low numbers being made, the sperm not functioning properly or a combination of both problems.

A number of factors can disrupt the production of sperm including undescended testis, infections such as mumps, heat, sperm antibodies, drugs or radiation damage.

What percentage of fertility problems are related to men?

One in six couples in Australia face difficulty becoming pregnant and are considered infertile. In up to one third of infertile couples, the problem lies solely with the male partner (male infertility). Male infertility is the underlying reason for 40 per cent of infertile couples using assisted reproduction technologies.

In most cases, there are no obvious signs of a fertility problem. Intercourse, erections and ejaculation will usually happen without difficulty and the quantity and appearance of the ejaculated semen can appear normal.

How can you help to ensure good sperm health?

There are many simple and effective methods of ensuring sperm are as healthy as they can be and small changes may be sufficient to improve fertility or possibly even avoid the need for IVF treatment.

It is important to maintain good overall health to reduce the risk of male fertility and aid good reproductive health.

A lot of the lifestyle choices that contribute to the production of healthy sperm, are also beneficial to overall good health.

Here are some lifestyle considerations to keep in mind:

• Men with a higher body mass index (BMI) have a significantly higher risk of being infertile compared with men considered to be normal weight. 
• Over the age of 35, men have increased levels of sperm DNA damage, poorer testicular function and small increased risks of passing on birth defects and disease.
• Smoking is a well known cause of many health problems including cancer and heart disease and is also detrimental to sperm health. Because it takes three months for sperm to fully form, men should quit smoking at least three months prior to trying to conceive. 
• More than two standard alcoholic drinks per day may reduce the quality and quantity of sperm through changes in testicular function.
• Some prescribed medications, including steroids, antidepressants, some anti-inflammatories and blood pressure tablets, cytotoxic drugs used in cancer treatments and opiates, can affect sperm health. If you are undergoing medical treatment, speak with your doctor about the possible side effects and whether sperm storage should be considered prior to treatment.
• Illicit drugs such as anabolic steroids, marijuana, cocaine and heroin all affect sperm health by altering testosterone levels and impairing sex drive. They can also have an impact on testicular size and weight gain, which both impair sperm production.
• Nutritional intake, including intake of particular vitamins, supplements and micronutrients, has been shown to affect the quality and quantity of the sperm a man produces. Menevit and other dietary supplements are commonly used by patients to improve their health and that of their sperm.
• Emotional problems such as anxiety and depression can lead to decreased sex drive and impotence.
• Environmental Toxins and contaminants may impact sperm health. Reduce your exposure by
  
  • eating organic fruits and vegetables
  • avoiding use of pesticides
  • wearing a face mask/ventilator when working in an environment that exposes you to toxins
  • using natural personal care products
  • buying non-toxic household cleaning products
  • consulting with your doctor or naturopath about reducing toxins in your body
• Urinary tract infections are common and often go untreated. A bacterial infection may increase the number of white blood cells found in semen, can cause fever, swelling, blockages and occasionally permanent damage. Early treatment with a simple course of antibiotics will usually clear these types of infection.
• It is known that the scrotum area needs to be four degrees lower than body temperature and able to sweat to facilitate healthy sperm production. Tight trousers or underwear and synthetic materials prevent heat dissipation and may result in increased scrotal temperature. Cotton boxer shorts are a sensible option and avoiding taking regular hot baths or spas.

What services does Genea offer to men concerned about fertility?

The initial screening evaluation of the male partner includes a history and semen analyses. If abnormalities are revealed by either the history or analyses, further evaluation is needed.

A basic semen analysis involves checking for unusual amounts of debris (pieces of dead cells), suspected presence of bacteria, clumping of the sperm and for the presence of cells other than the sperm. The number, motility and shape of the sperm will also be determined.

Genea Andrology also offers in depth sperm function testing options such as a Trial Wash performed prior to infertility treatment, sperm DNA damage level testing and antisperm antibody testing.

Sperm storage facilities are also provided by Genea Andrology. Some reasons for considering banking a sperm sample include:

• major surgery or medical treatments
• exposure to a toxic environment
• cancer therapy
• having a vasectomy and there is a possibility that you may want to have children in the future
• a dangerous profession or pastime where there is risk of injury e.g. The armed forces.

You may also want to freeze sperm prior to undergoing assisted reproductive treatment as a backup in case you are unable to attend due to travel or other commitments or if you have experienced difficulty collecting a sample.

Visit your GP to obtain a referral to Genea Andrology, or if you are in Sydney, make an appointment with our GP, Dr Kerry Pilcher to discuss your fertility options.