Abnormal Sperm Production

It is a common myth that female issues are usually that reason for pregnancy delay. Male fertility problems account for around 40% of the problems that couples experience when trying for a baby.

What are the common causes of male infertility issues?

The most common causes of male fertility issues are:

  • Azoospermia – where no sperm cells are produced
  • Oligospermia – where fewer normal sperm cells are produced

Sometimes, sperm cells are malformed or die before they can reach the egg. In rare cases genetic diseases, for example cystic fibrosis or a chromosomal abnormality, can cause male infertility.

Specific conditions affecting male infertility include:

Immunological infertility

Immunological infertility occurs when the immune system identifies part of the reproductive system as an ‘enemy’. In the male this involves antibodies being formed against the man’s own sperm, most often as a consequence of obstruction or infection. This can impact the ability of the sperm to reach the egg and fertilise it.

Queensland Fertility Group’s andrology laboratories can determine the degree of antibody binding in the semen. This allows our clinicians to recommend the appropriate treatment. Often, Intracytoplasmic Sperm Injection (ICSI) can be used in this case to help achieve pregnancy.

Retrograde ejaculation

Retrograde ejaculation occurs when semen, which would normally be ejaculated via the urethra, flows back into the urinary bladder. If a couple is experiencing infertility as a result of retrograde ejaculation and medications are not helping, sperm may be recovered from the urine or surgically retrieved from the testes, and depending on their quality, used in Intrauterine Insemination (IUI), or more likely, IVF or an IVF cycle with ICSI.

Occlusion

Some cases of male infertility are caused by blockages in – or an absence of - the vas deferens linking the testes with the penis. This can be due to injury, previous vasectomy or a congenital absence of the tubes leading from testes to penis. In these cases, sperm can be retrieved surgically from the testes and used for IVF or IVF with ICSI.

Idiopathic

There is no cause found for the majority of male infertility cases – up to a third of men have sperm of subnormal quality – from mild to severely affected cases. Queensland Fertility Group have many treatment strategies available for the different forms of male infertility.

What affects sperm quality?

Sperm quality can be affected by:

  • smoking
  • excessive alcohol
  • drug use, including prescription medication, steroids and recreational drugs
  • excess weight and high Body Mass Index (BMI)
  • frequent exposure to extreme heat (such as working in hot temperatures or regular saunas)
  • working in cramped conditions (for example, truck drivers)
  • age
  • acute viral illness
  • operations for undescended testes or hernias

If you have conceived a baby with a partner in the past, it is a good sign that your sperm are healthy and you should be able to do it again.

Contrary to popular opinion here is no scientific evidence that wearing tight clothes or bike shorts affects the quality of your sperm. Vitamins and supplements also have little direct impact on your sperm count - but they may help you stay healthy. Sports injuries to the groin will only affect sperm production in extremely severe cases.

Testing male fertility

Our andrology laboratories provide a full range of analytical services, including routine semen analysis, the detection of sperm antibodies, plus specific sperm functional tests such as sperm-egg interaction and the identification of sperm DNA damage.

Treating male fertility issues

ICSI

Intracytoplasmic Sperm Injection (ICSI), involves the direct injection of a single sperm into each egg to facilitate fertilisation. It is usually recommended for couples where male fertility is a problem, especially if it relates to to the number or quality of sperm produced. ICSI can also be used in cases where a man has had a vasectomy and sperm are removed surgically from the testes.

Vasectomy options

A vasectomy reversal is possible, but it does not guarantee that your sperm will be of sufficient quality to achieve unassisted fertilisation. Another option is to have IVF treatment using ICSI, using sperm retrieved directly from the testes using a needle. A single sperm is then chosen and injected directly into the egg to facilitate fertilisation. 

Download male fertility booklet

For more information about overcoming male infertility, download the booklet below or visit our Patient Information Booklets page.

In our Fertile Minds video, we explore the topic of low sperm counts, and what this means for your goals of having a family. A/Prof Anusch Yazdani is a fertility specialist, subspecialist in reproductive endocrinology and infertility, and Medical Director of Queensland Fertility Group.

No sperm in the semen analysis. Will I still be a father?

Transcript

No sperm in the semen analysis. Will I still be a father? - Fertile Minds Video

Hello, welcome to Fertile Minds. I'm Dr Anusch Yazdani and I'm a subspecialist in reproductive endocrinology and infertility and a medical director of the Queensland Fertility Group.

Today, I'll be speaking to you about low sperm counts and what this means for your goals of having a family. Now, infertility is the inability of a couple to achieve a pregnancy within 12 months of unprotected intercourse. And if we look at the causes, male problems make up almost half of the issues that we see.

Importantly, men may not know that they actually have a problem with their fertility. In the simplest way, the way that we assess your fertility is by doing a semen analysis. And the important things that we look at are the volume of semen, the concentration of sperm within the semen, the motility, which is how they swim and how they move. And then also the morphology and how they look.

Now, sperm abnormalities can happen in all of those categories. Now, not all of the causes of abnormal sperm though can be found in this test. Firstly, this is not a particularly an actual scenario, and so when you're collecting a sperm sample, it's not at all uncommon to have some abnormalities in there. And for that reason, we always recommend having a test done by a reliable lab and repeating the test if there are any abnormalities.

So when we find an abnormality, it's really important to find out the reason for why this has happened. That will usually involve an examination where we look at your development, examine the testicles and look for things like the presence of a varicose seal which is a varicose vein. But we also do some blood tests and sometimes it also means doing some imaging.

In all men, we recommend addressing your lifestyle, healthy eating, maintaining normal weight, not smoking, limiting your alcohol intake and exercising. Male preconception vitamins may also be of benefit.

The next step then depends on the cause of the abnormality. Now, in some situations we can actually improve your fertility both through injections or through tablets. But even if that's not possible, the really good news is that with new IVF techniques we really don't need very much sperm there at all. In fact, we can usually make it happen, even if there are just a dozen sperm swimming around as opposed to the hundreds of millions that we would normally expect. And in that situation again, by using a technique called ICSI, we would expect your chances to be really, really good and you have an excellent chance of having a pregnancy.

For those, where there are persistent abnormalities in sperm and where we cannot make this medically better, there are still some options there. Sometimes even if there's no sperm in the ejaculate, we may able to still retrieve sperm through surgery. If that is not possible, then there are still options available for you. And these would then include using donor sperm either from someone who's known to you or someone that the clinic can recruit for you or using donate embryos.

So in addition to the normal semen analysis, there are two other specific tests that we can do. One of them is called a sperm karyotype analysis, where we look at the number of abnormal sperm within the semen analysis. And not surprisingly not all the sperm in ejaculate is in fact normal. A number of them may be genetically abnormal and a small number of men will actually produce a very large number of abnormal sperm. In that situation, then there may be problems with conceiving and the options can sometimes be limited.

The second test that we can do, we'll look at DNA fragmentation. That DNA fragmentation refers to damage and it's oxidative damage within the sperm. Now this type of damage can arise for a whole lot of different factors. It may be due to medicines. It may be due to radiation. It may be due to foods or environmental chemical exposure. Unfortunately, we're seeing more and more of this in our current practices. Now this can be assessed by a special semen analysis just like the karyotype analysis and that will then provide some changes to how we manage. And so it may then mean increasing your vitamins or sometimes it again means having to retrieve the sperm surgically.

So what are your options? Well, the first step is to see your fertility specialist. They will then assess exactly what's going on. They will assess your partner and they can then provide you with the most appropriate options that are specific to you, including the cost, time to pregnancy and success rate.

We're here to help. Thanks for watching Fertile Minds. Don't forget to subscribe for more fascinating topics on both fertility and reproduction. Thank you.

*All opinions expressed on the Fertile Minds YouTube Channel belong to the individual doctors, scientists and specialists, not the Virtus Health group.

If you know or suspect abnormal sperm production could be contributing to fertility issues, a Queensland Fertility Group Fertility Specialist can help. Our Specialists are highly trained in all aspects of fertility, including the management and treatment of male factor fertility issues.

For more information or to make an appointment with a Fertility Specialist, call 1800 111 483 or send us an email.

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