Male fertility: your questions answered

22 September 2017

Mr Steve Bromage, Consultant Urologist

There are two main ways that men experience infertility. This is either through a blockage (such as following a vasectomy) or through a problem with sperm production. When a couple is having problems conceiving, the focus is often on the female, yet the man’s fertility may contribute to over 40% of these cases.

Even a normal semen analysis does not rule out problems with the male reproductive system as there may be other important factors that are not tested in a semen analysis such as damage to the sperm DNA (there are alternative tests to look at this).

FAQ on fertility

Do vasectomy reversals work?

The vast majority of the time they do. There are factors that play a role in this, such as time from vasectomy. However, even after 20 years following a vasectomy the chances of getting sperm in the ejaculate are still over 50%, which compares to 95% if less than 5 years after vasectomy.  The best results are achieved using a microscopic approach to join the 2 ends together. The other alternative to vasectomy reversal is treatment similar to IVF (in vito fertilisation) and it is important that a couple sees an expert in male infertility to go through the pros and cons of these options.

What are the causes of male infertility?

A blockage can be caused by a previous vasectomy, previous infection or other less common causes such as being born without parts of the tubing system that carries sperm away from the testes.

A problem with production can be due to genetics, medications, trauma, infections, a varicose vein around the testis or other toxins. Testosterone supplementation (including anabolic steroids) can switch off sperm production and this can be a permanent problem if it is not appreciated and dealt with.

What tests should a man have when they have no sperm in their semen?

It is important that he is assessed by a fertility expert who will recommend blood tests, and possibly an ultrasound depending on what is found with the history and examination findings. The blood tests are usually to look for hormone and genetic abnormalities.

How is sperm surgically retrieved?

If there is no sperm in the ejaculate, it is still possible that sperm is still being produced and the only way of determining this is a procedure to extract sperm from the testes or structure surround them called the epididymis. This is a straight forward procedure that is best performed by a male fertility expert and can be done under local anaesthetic, sedation or general anaesthetic. Sperm can be extracted with a needle in straight forward cases, but can require testicular biopsies through a small cut in the scrotum. 

Steve Bromage is a consultant urologist specialising in renal cancer and male factor infertility. For more information or to book an appointment with Mr Bromage, please call 0161 447 6700.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.


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