Episode 9 - Male factor infertility: health, testing and treatment - Dr Kate Burston
Male factor infertility: a guide for GPs
Fertility assessment is often framed around the female partner, but male reproductive health deserves attention from the outset. A patient may feel uncomfortable discussing semen testing, medication use or previous surgery. Stigma and assumptions about masculinity can make it harder to ask for help, even when a couple has been trying to conceive for some time.
In this episode of Fertility in General Practice, Dr Ali Hodgkinson speaks with fertility specialist Dr Kate Burston about male factor infertility. They explore semen analysis, potentially reversible contributors, treatment after vasectomy and the role of GPs in taking a careful history before specialist referral.
Making sense of a semen analysis
A semen analysis provides information about sperm concentration, movement and appearance, alongside other features of the sample. Dr Burston explains why a result should be interpreted in context rather than as a stand-alone verdict on whether a person can conceive.
How the sample was collected matters. So do recent illnesses, medicines and other exposures. When a result is abnormal, a conversation about these factors can help guide further assessment. The episode also distinguishes a standard semen analysis from additional investigations such as sperm DNA fragmentation or anti-sperm antibody testing, which may be considered in particular clinical circumstances rather than automatically for everyone.
For patients, clear explanations can reduce the tendency to interpret one result as a permanent label. GPs can help them understand what has been measured, what remains uncertain and why further testing or specialist advice may be recommended.
A history that goes beyond fertility
Dr Burston discusses a broad range of possible contributors, including hormonal conditions, previous testicular surgery or trauma, genetic factors and problems with ejaculation. A relevant history can be as important as the laboratory report in deciding what to investigate next.
The conversation also covers prescribed medicines, over-the-counter products, recreational drugs and non-prescribed testosterone. Asking specifically about testosterone and anabolic steroids matters because patients may not volunteer their use or recognise the potential effect on sperm production. Any changes to treatment should be discussed with the relevant clinician rather than made without medical advice.
Lifestyle conversations without blame
Smoking, alcohol, physical activity, body weight and heat exposure all feature in the discussion. Occupational heat may be relevant, so asking about a patient's work can add useful context that would otherwise be missed.
These conversations work best when they are practical and respectful. The aim is to identify changes that may help reproductive and general health, not to suggest that patients caused their fertility difficulties. Dr Burston also discusses antioxidant supplements and the limits of the evidence. Improvements in a laboratory measure should not be confused with proof of a higher chance of a live birth.
Fertility options after vasectomy
Patients who want to conceive after a vasectomy may be surprised to learn that there is more than one potential pathway. Dr Burston discusses vasectomy reversal and surgical sperm retrieval with assisted reproduction.
The choice depends on factors such as the time since vasectomy, the female partner's age, other fertility concerns and the number of children the couple hopes to have. A reversal is not automatically the best option, and sperm retrieval is not a guarantee of successful treatment. Assessment of both partners helps the specialist team explain the likely benefits, limitations and practical implications of each approach.
When to seek specialist advice
The episode encourages GPs to consider male and female factors together rather than investigating one partner only after the other has completed testing. An abnormal semen result, suspected hormonal or genetic issue, difficulty with ejaculation or a relevant surgical history may justify an earlier specialist discussion.
Referral information is most useful when it includes existing results, collection details, relevant medicines and exposures, previous operations and the couple's fertility history. GPs remain important sources of support while investigations and treatment are underway, particularly when test results affect a patient's confidence or emotional wellbeing.
Listen to the episode
Listen to Dr Kate Burston and Dr Ali Hodgkinson discuss a thoughtful approach to male fertility assessment, from the first conversation to specialist care. The episode helps bring male reproductive health into the wider fertility picture and offers practical points for everyday general practice.
About Dr Kate Burston
Dr Kate Burston is a CREI-qualified fertility specialist at Genea Newcastle, caring for patients across the Hunter and Mid-North Coast. She has a particular interest in male fertility alongside female fertility, fertility preservation, reproductive surgery and recurrent pregnancy loss. Her approach combines thorough investigation with clear communication and compassionate support, helping individuals and couples understand their options and participate in decisions about their care.
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