Some 80% of couples who have regular unprotected sex (every two to three days) will get pregnant within a year but an estimated 1 in 7 will have difficulty conceiving*. And while infertility is often thought to be a female problem, the Human Fertilisation & Embryology Authority reveals that in a third of cases it is down to the man.
Infertility in men has many causes.
A common one is low sperm count or quality. The semen may contain too few sperm, no sperm at all or else the sperm is shaped abnormally and is therefore not capable of swimming from the vagina into the fallopian tube to fertilise the egg.
Problems with sperm production and quality can be due to injury, overheating of the testicles, infections such as mumps, hormonal issues, genetic problems or due to chemical exposure.
Infertility can also result from obstructions in the man’s reproductive tract in the testicles. Inflamed testes for example can cause male infertility, as can scarring or blockages within the tube carrying the sperm (often due to a past bacterial infection).
The types of external factors that may contribute to infertility in men include: drug treatment, radiotherapy or surgery (for example to correct a hernia), existing medical conditions such as diabetes and lifestyle factors including: being overweight, taking illegal drugs, using anabolic steroids, drinking too much alcohol or working in a job that brings you in contact with chemicals or radiation. Erectile dysfunction (impotence) or problems ejaculating can also scupper your chances of having a child.
Occasionally couples fail to conceive because they are trying for a baby at the wrong time. This can be resolved by working out when the woman is ovulating (the period when she is most fertile). The woman is most fertile between 12 and 16 days before her next period. She can work this out using an ovulation test available from a pharmacy.
Around 10% of couples who present with fertility problems will be termed as having unexplained infertility. In many cases the problem may be a very prolonged delay in achieving a pregnancy rather than any factor preventing pregnancy.
How is male infertility treated?
If you think you are infertile your GP will be able to test your sperm for abnormalities. Your nurse or doctor will also test for sexually transmitted infections (STIs) such as chlamydia which can affect sperm function.
If your tests come back normal and your partner also appears to have no obvious fertility issues your doctor may suggest some lifestyle changes (see the self-help section below).
If the tests reveal a fertility issue you will get referred to a clinic for further help. Your semen will be analysed to check sperm numbers and quality and a sperm antibody test will be performed to check for protein molecules that may prevent sperm from fertilising an egg.
Treatment will depend on the cause. Sometimes medicines are prescribed to assist fertility. This is more common for female infertility but occasionally men are prescribed gonadotrophins which are medicines that can improve fertility in men.
If your doctor discovers a blockage in the epididymis (a coil like structure in the testicles) or another problem with the tube through which sperm is carried, you may require minor surgery, performed under a local anaesthetic. Any sperm retrieved during the procedure is then frozen ready for use.
For men with a low sperm count, decrease sperm mobility, erectile dysfunction or who prematurely ejaculate - intrauterine insemination (IUI) may be offered. This involves sperm being collected and washed in fluid to pick the fastest movers. The selected sperm is then passed through a tube directly into your partner’s womb at a time designed to coincide with ovulation.
In vitro fertilisation (IVF) is the test tube method. Fertilisation takes place outside the woman's body. Most clinics suppress the action of the woman's own fertility hormones using an injection or nasal spray. The ovaries are then stimulated with daily injections.
Once there is a mature egg follicle in the ovary an injection of the pregnancy hormone Human Chorionic Gonadotropin (HCG) is given.The eggs are removed from the ovary 36 to 40 hours later with a fine needle placed into the vagina. The eggs are fertilised with sperm in a laboratory before being returned to the womb.
- Intra-cytoplasmic sperm injection (ICSI)
This is used to treat male infertility or if IVF has failed. The procedure is similar to IVF but involves injecting a single sperm directly into an egg in order to fertilise it. The fertilised egg (embryo) is then transferred to the woman’s womb.
- Egg and Sperm donation
Donor sperm may be another option if your own infertility problems cannot be resolved.
Avoid wearing tight jeans or underpants as these keep the testicles too close to the body, raising their temperature which slows down the rate of sperm production.
When trying to conceive maintaining a healthy lifestyle is essential. Smoking, excessive alcohol-use and being overweight all negatively impact on fertility. You should therefore cut out any excesses and stick to a balanced diet which includes: fruit and vegetables (at least five 80g portions a day), fibres such as wholegrain bread, rice, potatoes and pasta, some milk and dairy products, some meat, fish, eggs beans and other non-dairy sources of protein and only a small amount of foods and drinks high in fats and/or sugar.
To maintain a healthy weight you should combine a good diet with regular exercise. You can do this by building up to 30 minutes of moderate intensity exercise on at least five days of the week.
You should also try to keep stress in check, as being tense and wound-up can lower libido and may also limit sperm production. There are many different methods to manage stress including relaxation techniques such as yoga and meditation and regular exercise such as jogging, swimming and walking. Try to factor in at least an hour a day for relaxation, combined with a full night of sleep.
There are some supplements that are believed to increase sperm count. Maca (Lepidium meyenii) a plant grown in Peru, has been shown in some studies to raise sperm count in men. However, more research is needed.
Some nutritionists say taking 15mg of zinc daily can help keep sperm healthy. Rich sources of zinc include meat, oysters, grains and pulses. If you want to take zinc supplements take no more than 30mg a day and combine this with a copper supplement (usually 1.5mg).
Switch to organic foods as some pesticides have been linked to falling fertility levels. Likewise you may want to switch from tap to bottled water as some studies have found traces of the female hormone oestrogen in samples of tap water.