Male infertility

Approximately 30% cases of infertility are due entirely to a male factor and an additional 30% involves both male and female factors. Infertility may be due to incorrect coital habits, male sexual dysfunction (erectile dysfunction or hypogonadism), abnormal sperm count, sperm motility and/or morphology, as well as ejaculatory dysfunction. History of undescended testis, certain drugs and surgical or trauma to the lower abdomen or genitalia can increase your risk of infertility. A variety of genetic syndromes such as Klinefelter’s syndrome and androgen abnormalities can also be associated with male infertility and have potential significant health risks.

When you and your partner have been trying to conceive for more than 18 months and are currently unsuccessful, a visit to your urologist and/or IVF specialist is potentially beneficial. A comprehensive history, physical examination and semen analysis should be conducted first. This is then followed by more specialized tests such as hormonal profile and scrotal ultrasound if appropriate. Your urologist with subspecialty training in male infertility will direct you to the most appropriate treatment options based on the clinical findings.

All attempts should be made to maximise your semen parameters to ensure natural conception prior to IVF treatment. It is imperative that you choose your specialist that is properly trained in the field of male reproductive medicine/surgery.

Treatment options for male infertility

Depending on the causative factors for your male infertility, different therapeutic options are available. For fertility purpose, microscopic surgery is considered the standard of care due to highest paternity (best chance in improving sperm parameters and pregnancy rate) and lowest complication rates.

  1. Microscopic vas reversal (approximation of the tube for sperm passage under microscopic magnification and instruments) following vasectomy
  2. Microsopic varicocele repair (ligation of dilated veins near the testis under microscopic magnification and instruments)
  3. Endoscopic transurethral resection of ejaculatory duct (telescopic resection of blockage in your sperm passage)
  4. MicroTESE (localization and extraction of sperm from the testis under microscopic magnification) and other various sperm retrieval techniques (PESA, TESA and TESE)
  5. Other methods to optimise your semen parameters and treat underlying erectile dysfunction, hypogonadism or ejaculatory dysfunction.