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Getting Help For Male Fertility Problems

Sometimes it can be more difficult than you hope to become pregnant. In fact, infertility actually affects around one in five couples of reproductive age. It is also a common misconception that male infertility is only a problem for older men, but infertility within men of all ages is increasing, due to environmental, nutritional and lifestyle factors.

Male Fertility Problems

With most couples immediately looking at IVF as a first resort, it is important to understand that there are many other options to explore before this emotionally challenging step. At the Hammersmith Hospital site in London, Imperial Private Healthcare are able to look carefully at all the potential fertility issues in a couple, and when the diagnosis shows that there are male fertility problems, they can offer a multifaceted approach to finding a solution.

jonathan-ramsey-consultant-urologist

Mr Jonathan Ramsay
Consultant Urologist

Hammersmith Hospital is the only centre that considers the male endocrine situation simultaneously with his reproductive system. It is here that Consultant Urologist Mr Jonathan Ramsay, a UK leading expert on male endocrinology, leads the male fertility service, in conjunction with Consultant Endocrinologist, Dr Channa Jayasena.

We met with Jonathan to find out just what help is available for men suffering with infertility.

Jonathan has noticed a clear increase in the number of patients coming to him with male fertility problems. He attributes this to a combination of diet and environmental factors, but also highlights that there are three other public health issues that are causing real concern for male fertility: obesity, diabetes, and sexually transmitted diseases.

"In the first instance, you should aim to make lifestyle changes in order to improve the quality of your sperm. ‘Improving lifestyle’, in my experience, nearly always improves a man’s fertility as we measure it," explains Jonathan.

 A healthy man is much more likely to have healthy sperm.

If you have already made changes to your lifestyle, which may include losing weight, getting active, adopting a healthy diet, reducing stress and lowering alcohol intake, yet you are still unable to conceive, then help is available. The next step is speaking with a specialist like Mr Jonathan Ramsay and having your sperm sample analysed.

Once your sperm sample is in the laboratory, the diagnostic process begins. The diagnostic process will analyse the following elements before a diagnosis can be reached:

Sperm Analysis: sperm analysis will initially check the volume and viscosity of the sample, as well as the pH (how acid or alkaline the sample is).

Microscopic evaluation will then be carried out in order to check sperm count, motility (movement), morphology (shape), and vitality (living sperm). In order to be sure that any abnormalities are a consistent problem, more than one sample is likely to be analysed.

Sperm Analysis

Sperm count: this is measured as the amount of sperm per millilitre. If you have a low sperm count, this does not necessarily mean you are not able to fertilise an egg, however, it does mean that the chances of doing so are less than normal.

Motility: this is the movement of the sperm, which is important for natural fertilisation. The most positive of the four grades of motility is progressive motility which is a positive, progressive, rapid action, which the sperm uses to move forwards from the cervix to the fallopian tubes. The sperm that come under the progressive motility umbrella are the most likely to fertilise an egg. Normal motility is considered 40% or more for total motility, and 32% or more for progressive motility. Poor motility (asthenozoospermia), means there is less chance of conceiving naturally.

Morphology: this is the shape of the sperm. Morphology is measured based on strict criteria which looks at the percentage of sperm with defects. A percentage of 4% or more sperm without defect is considered normal. Mr Ramsay says: ‘motility and morphology can be affected by treatable causes like infection, inflammation and common abnormalities of the male genital tract, such as a varicocele (or a collection of veins in the scrotal sac), which increase the temperature in the testicle’, smoking, and both prescribed and recreational drugs, can all severely impair sperm quality.

Vitality: this is the proportion of sperm that are dead or alive. It is determined by adding dye to the sample– dead sperm will be stained blue. 50% or more living sperm is considered normal.

Antisperm antibodies: these are produced by the immune system in response to trauma or inflammatory processes that have affected the male genital tract. They may indicate a cause of secondary infertility. The mixed antiglobulin reaction (MAR) test is designed to pick up on these antibodies, but is only sometimes included in some standard sperm analyses. Mr Ramsay comments: ‘the presence of antibodies suggests that something has happened to the man, some trauma or infection, but in fact this underlying cause may actually be treatable’. Essentially, if that problem can ultimately be treated, it is possible that the infertility can be reversed too.

If your semen analysis shows that you have no sperm (zero sperm count), don’t give up hope. Mr Ramsay explains that there are two causes of no sperm: Obstructive Azoospermia (OA) and Non-Obstructive Azoospermia (NOA). For men with NOA, there may still be sperm in the testicles. This can be extracted using a procedure called microdissection testicular sperm extraction (mTESE). This procedure can be effective in as many as 50% of cases. Dr Paul Turek, a member of the American Board of Urology, suggests that undergoing testicular mapping will give a clearer idea of whether mTESE is more likely to be successful. This procedure, known as FNA mapping (or fine needle aspiration), is available through Imperial Private Healthcare.

In obstructive azoospermia (OA), there is a blockage in the genital tract, between the testicles and the urethral tube in the penis. Surgical sperm retrieval is nearly always possible in these cases, and sometimes reconstructive microsurgical techniques can overcome the blockage.

Psychological Aspect

The psychological effect and emotional strain of being told you are infertile can be challenging, and difficult to come to terms with. Feelings of emasculation and failure are not uncommon, but did you know that you don’t need many ‘normal’ sperm to have normal fertility? Men overproduce sperm at a great rate – in fact, a young man may produce 1 million sperm per hour!, and in a ‘normal’ specimen it is common that there may be more abnormal sperm than normal. "You must never, in my opinion, whilst there are sperm, tell somebody there is no hope of natural conception", comments Mr Ramsay. "The consequences of that is that they will put all their faith in IVF, which can be gruelling and expensive There are often less drastic options to consider first, and, even if the ultimate solution ends up being IVF, trying some of the alternative treatments first can help to increase the likelihood of success through IVF anyway. If we want to treat couples and reduce psychological damage, then we need to be careful to make an accurate diagnosis, and then to treat them as thoroughly and compassionately as possible."

Male Infertility Treatments

So what happens if the results come back showing that there is an underlying problem?

Medical, hormonal, and surgical options are all available to help increase chances of parenthood. According to Mr Ramsay, ‘At Imperial Private Healthcare we would hope to improve the situation for 30% of most men with fertility issues, therefore, reducing their need for IVF or to improve the situation so that IVF cycles may be more effective.’ Imperial Private Healthcare is unique because, instead of focussing on a single area, it takes a holistic view of the couple and then a multidisciplinary approach to both the man and/or the woman, depending on the diagnosis of the problem. For the man, the team consider male urological conditions, combined with male reproductive endocrinology. It also has a diagnostic andrology laboratory, which works in association with an on-site fertility lab. Careful investigation into all possible solutions is undertaken to give each patient the best possible chance at fertilisation.

Male Infertility Treatments

By combining so many different areas of research and such a wide range of experts across fertility, Imperial Private Healthcare is a fertility clinic that is particularly appropriate for couples who have failed due to the male factor. It, in effect, is a fertility unit for men.

We would like to thank Mr Jonathan Ramsay at Imperial Private Healthcare for providing the specialist knowledge for this article.

Mr Jonathan Ramsay and Dr Channa Jayasena can be contacted via private.healthcare@imperial.nhs.uk

For more information please visit http://imperialprivatehealthcare.co.uk/our-services/infertility-services/

If you are interested in speaking to a private fertility consultant, please see our list of leading IVF clinics both within the UK and abroad. These carefully selected clinics can provide you with any and all information you may need in beginning your journey towards parenthood.

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