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Male Factor Infertility

By Dr Jay Natalwala


Investigations and Treatment


In Australia, 1 in 5 couples have difficulties conceiving, leading many to seek medical advice. It is often the case that, in the absence of a clear reason for male factor infertility (e.g. a previous vasectomy), the woman will present alone for investigation. This seems to come from a widespread perception that subfertility is mostly the result of female causes.


The reality, however, is quite different. There is a male factor cause in approximately 55% of heterosexual couples who present with subfertility. 


Common causes of male subfertility:


  • One pertinent factor in Western Australia is a timing issue, due to fly in fly out (FIFO) work commitments. The ‘window for conception’ at ovulation is only one day, so timing is very important.


  • Male fertility also declines with age, even though we usually only hear the about the female ‘biological clock’. This is important for men who have healthy children from a previous relationship to know, as they may still have suboptimal semen parameters and therefore require assistance in conceiving.


  • A previous history of testicular infection, groin operations and injury are also very important  as they can often lead to low sperm counts or raised sperm antibody levels, all of which can impact on the chances of natural conception Investigation of these men involves a semen-analysis as well as other adjunct tests such as DNA fragmentation and anti-sperm antibody levels.  These results can then be used to determine the best course of treatment.


Treatment:

Treatment options are wide and varied and do not always begin with in-vitro fertilisation. 


  • Semen freezing and intrauterine insemination (IUI) is often the best option for FIFO couples. 
  • For men with suboptimal semen parameters IUI is often performed to achieve a pregnancy. 
  • When semen counts are very low then IVF using intra-cytoplasmic sperm injection (ICSI) will achieve high success rates.


Male factor causes behind subfertility are common and need to be carefully assessed in couples trying to achieve a pregnancy. It is therefore important for both partners in a heterosexual couple to present for initial assessment so that the cause behind their delay in conception can be fully investigated and the best course of treatment determined.


- As seen in the West Australian