guest article - Prof Sheryl Homa - getting the full picture

About one in twelve men experience infertility which can have a devastating effect on their lives. We all hear about diet and lifestyle and its role in general health as well as in fertility, but like female infertility, male infertility is also defined as a disease of the reproductive system. It is therefore very important to be fully investigated if your partner is struggling to conceive, so that the causes of the problem can be identified.

There are many tests that you can have to investigate male infertility and the first port of call should always be a semen analysis.  A comprehensive test will provide a lot of information about the quality of the sperm and the fluid that the sperm are in. The fluid comes from your male accessory glands, which are your prostate and your seminal vesicles. Both the sperm quality and the fluid can affect your fertility if the values are outside of the normal range. It is very important to have a semen analysis carried out in a dedicated Andrology laboratory that is fully accredited to UK and international standards. This guarantees that the results are accurate, reliable, and comprehensive.

Please be aware that a fertility clinic that is licensed by the Human Fertilisation & Embryology Authority (HFEA) is not necessarily accredited by the United Kingdom Accreditation Service (UKAS) for diagnostic testing.  Many NHS laboratories are fully accredited, but there are only a very limited number of laboratories that are UKAS accredited in the private sector. At-home sperm tests are not recommended by the professional bodies, as they provide very little information and are often unreliable. This may cause you to worry unnecessarily or give you a false sense of security that all is well.  

While an accredited semen analysis can give you quite a lot of information about your fertility potential, it is not a guarantee that you are infertile if you have poor parameters, or indeed that you are fertile if your parameters are in the normal range, as up to 30% infertility is unexplained. This is partly because a semen analysis does not provide any information about the genetic quality of the sperm, which is essential for normal embryo development. Furthermore, it provides no information about the ability of the sperm to fertilise the egg once it gets there. However, there are many other advanced tests you can have to investigate sperm function, including sperm DNA fragmentation and oxidative stress, and again it is important that these tests are accredited.

If your test reveals issues with your semen parameters, then further tests should be advised to investigate the cause. All too often, a GP will immediately refer men with poor semen parameters for IVF Treatment. But this does nothing to determine the cause of your infertility and certainly does not treat your infertility. Furthermore, using abnormal sperm for fertility treatment reduces the chances of a successful outcome. An abnormal semen analysis result indicates that you have an underlying problem, and this should be investigated so that you can be advised the appropriate treatment. If it is possible to treat the cause, this should not only result in an improvement in your semen quality, but it should also increase your chances of a natural conception as well as with assisted conception.

Your semen parameters are often reflective of your general health, so it is a good idea to get a general health check from your doctor. Sperm and egg development are regulated by your reproductive hormones, and just as women are always advised to get their hormones checked when they are experiencing infertility, so should the men.  A common cause of male and female infertility is underlying infection of the reproductive system and/or the urinary tract. This is often due to an imbalance in the collection of microorganisms that usually live in you reproductive system (your microbiome), rather than a sexually transmitted disease. Most of the tests for infection offered through the GP are not particularly comprehensive, so some infections can be missed.  Another test that women have, is an ultrasound scan to check the status of their ovaries and womb. Obviously if there is a problem with sperm production, there may be some irregularities in your testes since that is where sperm are made, so it may be helpful to have a testicular ultrasound.

In some cases, the cause of infertility is genetic. Genetic causes are often difficult to determine, especially as there are different types of genetic abnormalities that require different tests to identify them. So, a full blood chromosome test (karyotype) will not pick up individual gene mutations such as cystic fibrosis which will require a separate screen. There are some exciting new developments in genetic screening for individual mutations that are known to affect specific stages of sperm development and function, but these tests are only offered in specialised laboratories and are relatively expensive. The problem with genetic testing is that there are likely to be many genes that may cause infertility that have yet to be identified, so a negative result does not confirm that the cause of your infertility is not genetic.  

While it is tempting to run to your nearest laboratory and ask for every test under the sun to investigate your infertility, you should be aware that not every test is necessary for you. It very much depends on your personal circumstances, your medical history and symptoms. This is why it is essential that if you are experiencing difficulties starting a family, whatever your situation, you should seek advice from an expert in the field of male infertility. Ideally this should be a Uro-andrologist (not a gyanecologist!).  These are urologists who have a special interest in male infertility and can arrange appropriate testing for you.  Unfortunately, we see many men wasting money on tests that are unnecessary and are often missing out the tests that they do need. Furthermore, it is essential that you have a professional to explain the results to you and who can advise the next steps for treatment.

In summary, we would recommend the following:

  • Arrange a semen analysis at an accredited laboratory
  • If the results are poor, arrange an appointment with a male fertility specialist to discuss your next steps
  • If the results are within the normal range, and you are still struggling to conceive after 12 months of unprotected intercourse, arrange an appointment with a male fertility specialist to discuss further investigations
  • If you have symptoms including testicular discomfort, urological issues or generally feeling unwell, please see your doctor immediately