Infertility is often attributed to the female partner. Many do not realise that the male partner contributes equally to the problem. In my daily fertility clinic, couples ask a variety of fertility questions. Today, I would like to share some of the more common male infertility questions that come up.
I can ejaculate regularly during sex, can I still be infertile?
The answer is yes. Your semen or ejaculate comprises a mixture of fluids from the seminal vesicles and prostate, as well as the sperm cells. Sperm cells, which are produced in the testicles, travel through a tube called the vas deferens and mix with fluids from the seminal vesicles and prostate before being ejaculated.
Thus, the presence of semen does not equate to the presence of sperm cells. Semen can be of normal volume and consistency even without the presence of sperm cells.
Do I have a low sperm count because my semen volume is low?
This is another common misconception. Semen volume does not correlate to the sperm cell concentration in your semen.
Semen volume can be low for various other reasons. It can be as simple as a short abstinence period before the sperm test or incomplete ejaculation to more serious reasons like retrograde ejaculation and ejaculatory duct obstruction.
Even in a man with low semen volume, the sperm concentration can still be within normal range, i.e. more than 15 million sperm in each millilitre (ml) of semen.
My erection is weak, can I be infertile?
This is a very common question and I can understand why. A poor erection can directly lead to “infertility” due to the inability to deposit semen in the vagina. Thus, it is natural for every man to assume that a poor erection leads to infertility. This is a false alarm.
If erectile dysfunction (ED) is the main issue, there are simple fertility treatments such as intravaginal sperm insemination (IVI) or intrauterine insemination (IUI), that can overcome the issue of semen deposition into the vagina or the womb.
However, I urge men to seek the consultation of a fertility specialist or an urologist to find the root cause of their erection issue. While fertility treatment can give them an immediate solution to getting pregnant, the couple needs to find a long-term solution that will enable them to get pregnant naturally in future, if they so wish.
I was diagnosed with azoospermia, what can I do?
Azoospermia (no sperm cells seen in the ejaculate or semen) is not the end of the world. The first step is to see a male infertility doctor, in order to determine the most likely cause for the azoospermia. This could be due to either a problem with sperm production or a blockage of sperm transport.
Most of the time, the cause is more likely to be related to a problem with production, rather than blockage. In this situation, several blood tests will be done to assess your sperm production capability, together with assessment of your testicle size. In some situation, a testicular ultrasound will be done.
Hormonal treatment can be started for a few months to stimulate sperm production. If this fails, a minor surgery is needed to retrieve sperm from the testicles. This procedure is known as surgical sperm retrieval.
Besides hormonal treatment, supplements to improve both quantity and quality of sperm will be recommended. Once sperm cells are obtained, either via ejaculation or surgery, assisted reproductive techniques can be used to make the couple pregnant.
Is IVF (in-vitro fertilisation) the only treatment in male infertility?
In most cases, the answer is yes. This is because, even if hormonal treatment works, the amount of sperm found is usually minimal. Furthermore, the effect of hormonal treatment may not last forever. Thus, IVF treatment is more appropriate.
However, there are men with azoospermia who, with hormonal treatment, manage to make enough sperm and successfully became parents with IUI. Therefore, the treatment options are determined based on the amount of sperm cells available, taking into account the couple’s fertility history.
These are some of the most common questions asked in my male fertility clinic. My advice to couples diagnosed with male infertility is to come forward earlier, rather than later, to seek help.
Female partners play an important role in supporting their male partners to go through this challenging journey towards parenthood.