What issues in their past might make a man infertile?
Here are some past concerns that may cause male infertility now:
Here are some past concerns that may cause male infertility now:
Undescended testes at birth
Testes like to be a lot cooler than core body temperature. If your testes did not descend normally when you were a baby, especially if surgical correction was delayed, your sperm production may not ever recover. Many men born with undescended testes can make enough sperm to conceive through IVF and ICSI, but cannot conceive naturally without help.
If you have a history of undescended testes and are having trouble making a baby, a sperm test is highly recommended as you may have a very low sperm count.
Karyotype imbalances in your sperm
Chromosome translocations and inversions can be silently carried by a male or female partner, causing either infertility or recurrent pregnancy loss (miscarriage). This is a type of genetic problem which can occur in an individual at random and can also pass in families.
Your DNA pattern may be balanced in you, but unusually organised. This means when you make sperm (or eggs) which ultimately only inherit half of your DNA, many may not receive an exact 50%. This makes the sperm or eggs unbalanced.
Klinefelter Syndrome
One common cause of male factor infertility is Klinefelter syndrome, where a man has an extra copy of the X chromosome. Klinefelter syndrome is often associated either with an ultra low sperm count or the complete absence of sperm in a man's ejaculate (azoospermia).
Men with Klinefelter syndrome often have very volume small testes. Sometimes sperm can be retrieved surgically for use in IVF when med with Klinefelter's syndrome present with azoospermia (no sperm released with ejaculation of semen)
Sexually transmitted infections (STIs)
A previous STI like chlamydia or gonorrhoea can result in blockages in the “pipes” of the testes and male reproductive tract, meaning sperm cannot escape the body. This will be picked up in a semen analysis showing no sperm, in a man with an otherwise normal testicular volume on examination and normal hormones on a blood test (obstructive azoospermia).
Testicular or other cancers
If you have had a cancer, especially if you have had chemotherapy, you may experience a complication of infertility. If you have had a recent cancer diagnosis, hopefully you may have been offered the opportunity to freeze sperm for the future. This may not have been an option if you had cancer before puberty.
Testicular surgery, hernia surgery or groin injury
Surgery around the groin area can provoke antibody formation causing an autoimmune response attacking sperm. Surgery can also cause injury to the spermatic ducts which carry sperm out of the body. Both these problems can cause male factor infertility.
Cystic Fibrosis and Congenital Bilateral Absence of the Vas Deferens
Men who are carriers of either one of two copies of a gene mutation of the CFTR gene can be born with congenital bilateral absence of the vas deferens. The vas deferens is the tube that carries sperm from the testes to the ejaculate. Men who have cystic fibrosis or who are recessive carriers for this condition can have a zero sperm count for this reason (obstructive azoospermia).
Sperm can be retrieved for In Vitro Fertilization (IVF) using Intracytoplasmic Sperm Injection (ICSI) via fine needle testicular sperm extraction retrieval (TESE).
Vasectomy
Sometimes men seek the permanent surgical contraceptive method of vasectomy (bisection of the vas deferens) but later change their mind. Depending on the timing of their vasectomy (longer ago is much harder to surgically reverse), IVF may be the best way to help overcome this acquired form of male infertility.
Sometimes men who have had a vasectomy develop anti-sperm antibodies meaning that even if sperm can be returned to the ejaculate, it may no longer be able to successful fertilise an egg due to autoimmune problems affecting sperm function. Men in this position can still use their sperm to make a baby through IVF and ICSI.
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Ellechemy intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.