08 November 2018
As part of our men's health campaign, Mr Jas Kalsi, one of our consultant urologists specialising in andrology, discusses male infertility and how it can be treated:
Did you know, male causes account for roughly half of all infertility cases?
Yet fertility has historically been perceived both in the population at large and within medical practice as largely a female matter. While women have had gynaecologists, specialists trained in female reproduction, there is now finally an equivalent for men, known as andrologists, who will fully evaluate and treat the male partner.
There has recently been increased attention in the media about the lack of care and services for men with fertility problems including articles in The Guardian and on the Victoria Derbyshire show on the BBC.
A comprehensive study published last year suggests that sperm counts among western men has more than halved in the last 40 years. And according to experts in the field, as many as one in five young men have low sperm counts, and about one in two are below the optimum.
Variocele - a leading cause of male infertility
One of the leading causes of male infertility is a condition called varicocele, which is caused by enlarged varicose veins in the testes. About 40% of infertile men have varicocele, although it doesn’t always impair fertility – 15% of fertile men also have varicocele. It creates an engorgement of blood that heats up the testes by as much as four degrees, which can cause significant damage to sperm.
A physical examination can identify varicocele, and it’s easily ruled out by an ultrasound scan. But very often men go undiagnosed, and ultrasound scans, which are standard in investigating female infertility, are very rarely employed on men. Instead, diagnostic work on men seldom goes beyond the standard semen analysis. Varicoceles can be very effectively treated using microsurgery (Microsurgical varicocele ligation) by experts such as Mr Kalsi at The Spire Thames Valley Hospital.
There is a fertility crisis developing, brought about because of the increasing age of parents and diminishing fertility. Men and their partners are waiting until they are older before they think about having children. The combination of an older woman and an older man means that their probability of success is reduced. Therefore, they are becoming more reliant on assisted conception.
The standard semen analysis is performed by our expert embryology lead, Claire Mooney. This gives good baseline information about the sperm count and motility (the ability of the sperm to move around). These are important factors, and a lack of either can lead to infertility. However, there is a false belief that if you have normal semen parameters, the man is fine. However, further tests such as an assessment of oxidative stress and DNA fragmentation tests can now be undertaken, which can show damage to sperm not picked up in semen analysis. Furthermore, up to 35% of patients with male infertility can carry underlying infections that are not detected in standard STI (sexually transmitted infection) screens. We believe strongly, that just as women are referred to gynecologists when being treated for fertility, so men should see consultant urologists specialising in andrology.
There is a reluctance to implement further testing in men because it’s deemed expensive. Yet women are subject to many expensive tests, and couples are sent off to have IVF, at a far higher financial cost, without a proper understanding of the male’s reproductive health.
See an expert today
Many men suffer in silence but are unaware that many of their friends and family are also having similar problems. The worst aspect of the whole process according to patients can be “the dreaded wait” between having the courage to come forward and finally getting to see an expert. At Spire Thames Valley, you can see an expert in male fertility quickly and in confidence. You can have all the required tests in a single day and these will be fully explained to you by an expert in male fertility. Please be rest assured that there are many things that can now be done to improve male fertility problems
Mr Jas Kalsi is a Consultant urologist specialising in andrology here at Spire Thames Valley Hospital. If you would like to book an appointment, learn more about any procedures or have any questions, simply call us on 01753 665 404 or email us here.