Male Infertility

Overview

Couples who want to have children but are unsuccessful after trying for 6 to 12 months should get evaluated. We offer evaluation and treatment of the male partner.

Diagnosis

The basic test for evaluation is a semen analysis. We can then check if the male partner has a problem that requires treatment. In addition, blood tests to check the male hormones may be necessary, as well as ultrasound of the testes.

Causes

Varicocoele
This is a condition where the veins of the testes become enlarged and swollen due to blood being trapped within them as a result of gravity. This leads to over-heating and may impair the quality of the sperm.

Varicocoeles can be treated with surgery. The aim of surgery is to tie off the veins so that blood does not get trapped within them. This surgery is best performed with the aid of an operating microscope. In this way, all the veins can be tied off accurately with less risk of damage to the other structures.

Varicocoeles can also be treated with embolization. This is performed by a radiologist who inserts a catheter into the vein and injects material to block the veins.

Previous vasectomy:
A male partner who has a previous vasectomy for sterilisation would be infertile because the tubes that carry the semen from the testes to the penis (the vas deferens) have been tied off. He can become fertile again by going for a reversal of vasectomy. During the vas reversal, the healthy ends of the vas deferens are reconnected with the aid of the operating microscope.

Ejaculatory duct obstruction
Occasionally the ducts that bring the semen to the penis (ejaculatory ducts) can become blocked. The connection can be re-opened by a cutting the duct openings using a special instrument called the resectoscope. This surgery is known as transurethral resection of ejaculatory ducts.

No sperm in the semen sample (azoospermia):
Sometimes the testes do not produce enough sperm due to genetic abnormalities or damage. In other instances the tubes carrying the sperm from the testes have become blocked from disease or previous surgery.  In such cases, the urologist may harvest the sperm from the testes or epididymis. The sperm can then be processed and passed to the gynaecologist for artificial insemination.