Treating Male Infertility

Sperm tests 

Sperm testing is a key part of any fertility investigation, and this is usually one of the first tests carried out along with the blood tests. The man produces a sample of semen by masturbation, which is collected in a small pot for analysis in a laboratory. The sample may have to be produced at the hospital, and most fertility clinics have special rooms for this purpose. The idea of performing to order in a back room at the clinic with a few erotic magazines for company can be deeply unappealing, and some men find the whole experience difficult. If you live near the clinic it may be possible to produce a sample at home and bring it in to the laboratory. If you do get the go-ahead to do this, you must get the sample back as quickly as you can, ideally within a couple of hours, and you shouldn't let it get too cold.
 

Treating Male Infertility

It is usually recommended that you don't have intercourse for a few days before giving a sperm sample, which leads some men to assume they will have a much higher sperm count if they abstain from sex for longer than this. In fact, although abstaining for weeks may produce a higher volume of seminal fluid, there is often a decreased percentage of live, active sperm, so this isn't advisable.

The sperm test involves a number of checks to make sore the sample is normal and full of healthy sperm. The volume of fluid is checked, and it is examined to see how quickly it liquefies, which normally happens fairly soon after it has been ejaculated. The sample is examined under a microscope to see how many sperm are present (the sperm concentration) and to make sure the sperm are swimming fast enough and going forwards rather than moving erratically or just twitching about (this is known as the motility). 

The sperm should not be stuck together (agglutination) as this can suggest there are antisperm antibodies present. The shape of the sperm (sperm morphology) will also be observed, as they sometimes have abnormally shaped heads or tails. The number of white blood cells may be checked, as high levels can indicate infection. Sometimes a sperm antibody test is also carried out, which checks for antibodies that can affect the way the sperm function and prevent them fertilizing an egg.
 
Sperm counts can vary considerably, and a normally fertile man may produce a sample with a low count at certain times, so it is worth repeating the sperm test if the results do suggest there could be a problem. Sperm production is a slow process, which takes about three months, and illness, medication or excess alcohol consumption during this period may affect the count.

Chlamydia screening
 
Chlamydia, a sexually transmitted disease, can cause fertility problems if it is not diagnosed. Chlamydia testing is simple and usually just involves taking a urine sample or a swab. If the results are positive, you and your partner will be prescribed a course of antibiotics. As chlamydia has no symptoms it can affect your fertility without your knowledge and if it has already caused damage to your fallopian tubes, the antibiotics will not be able to reverse this.
 
Ultrasound scans
 
A relatively unobtrusive way of looking at the ovaries, ultrasound scans can show how follicles are developing and whether there are any cysts that could suggest polycystic ovaries. An ultrasound scan can also give a view of the womb itself, and it is possible to check the lining to make sure it seems to be about the right thickness for the stage of the menstrual cycle.
 
Unlike pregnancy scans where the ultrasound probe is used externally on the stomach, most of the scans carried out during infertility investigations are done internally (known as transvaginal ultrasound scans), as this gives a clearer view of your reproductive organs. The scan works by using sound waves that send out echoes as they bounce off your body and these are used to give a picture.

 
At first, a transvaginal scan may feel rather odd and undignified, but they are painless and quite straight forward.
You will need to take off the clothes you are wearing on the bottom half of your body, and lie on a bed. The doctor then inserts the ultrasound probe into your vagina, and can look at your ovaries and follicles on a small screen.
 
'I had one of those internal ultrasound scans, and they detected polycystic ovaries straight away. I've had several scans now, and they're absolutely fine. I found the first one really informative as well, because they showed me exactly what was wrong. They pointed out the cysts on my ovaries, so I actually found it very helpful for me to understand" Lucy, 27. To find out more, you can check out Treating Male Infertility.

 

Infertility Diagnostic Tests

Fertility Tests 

When women first start the process of fertility testing, all any of us really want to know is whether there is anything wrong, and whether we will be able to have a baby. Unfortunately, fertility tests don't always give the clear-cut answers we are looking for. Although they can pinpoint particular problems, the results are sometimes rather ambiguous, and you can go through a whole battery of tests and still emerge none the wiser as to why you aren't getting pregnant.
 

Infertility Diagnostic Tests

The other main problem with fertility tests is that they seem to take so long. Testing is a matter of elimination, so doctors will start with the most straightforward test and work their way through the others until they find a clue as to what may be causing problems. There are often long gaps in between tests where you are waiting for results, and then waiting for the next appointment.

It can be very frustrating, especially if you are starting to worry about your age and feeling that your biological clock is ticking away, and your fertility is declining, while you wait. Paying for tests privately can sometimes speed up the process and reduce waiting time for appointments, but it can still take a while if the results prove inconclusive and you have to work your way through a number of different procedures.

'I expected that you would go straight to the doctor and they would tell you what was wrong with you. I didn't know a lot about infertility and how they go about diagnosing it I didn't realize how long it took to get to the bottom of what the problem was" Rachel, 35
 
Medical history 

Your doctor will probably want to begin any assessment of your fertility by looking at your medical history. Your age, weight and menstrual cycle pattern may be relevant, and details of any previous surgery or sexually transmitted diseases can help form a picture of potential problem areas. Your doctor may also want to do an internal pelvic examination at this stage, and a cervical smear.

Your partner's medical history is important too, and your doctor needs to consider the two of you as a couple in order to work out where any problems could lie. Your partner should have a physical examination, as this can highlight any problems with the testicles or the tubes leading away from the testicles, which carry the sperm.

Blood tests 
 
The first test you are likely to have is a blood test to check your hormone levels. These tests have to be carried out at the right point in your cycle. Doctors usually do a progesterone test to make sure you have ovulated, as progesterone is produced by the ovaries after an egg has been released and good progesterone levels indicate that you are ovulating normally. The progesterone test is done on day 21 of a regular 28-day cycle. If your cycle is shorter or longer, it is important to make sure that the timing is adjusted, as the results won't be accurate if the test is done at the wrong time. If you have irregular periods, it is going to be much harder to work out when you are ovulating, and you may have to have a series of blood tests to check your progesterone levels.
 
You should also have a test for the hormones that stimulate the ovaries to produce eggs. These are follicle stimulating hormone (FSH) and luteinising hormone (LH), and this test is normally done on day two or three of your cycle. High levels of FSH and LH indicate that your ovarian reserve (the number and quality of eggs remaining in the ovaries) is low, and this can make it harder for you to get pregnant.

If your periods are irregular, you may have a blood test to check your prolactin levels, as high levels of this hormone can affect your menstrual cycle. If doctors think thyroid disease is a possibility you may be tested for this too, as an underactive thyroid can affect egg quality an increase the risk of infertility and miscarriage.

Your doctor may also want to make sure that you are immune to rubella (German measles). Although German measles is not usually a serious illness, it can damage a baby during early pregnancy, and if you are not immune you will be told to avoid risking pregnancy until you have been immunized.

Sometimes your family doctor will be happy to carry out some of these basic blood tests before referring you to a specialist, whereas other doctors may prefer to refer you straight away. To find out more, you can check out Infertility Diagnostic Tests.

Unexplained Secondary Infertility

Unexplained infertility 

Many couples never find out why they can't conceive, as no cause is found for their problems despite extensive tests. In some cases, it is thought that this could be down to age, despite apparently normal test results, but in most eases it is just a matter of doctors not being able to get to the root of the problem. Sixty per cent of those with unexplained infertility will conceive naturally within three years, but that still leaves many others with no idea why they can't have children.

Unexplained Secondary Infertility

Unexplained infertility can be a difficult diagnosis to live with, and some women find it hard not to blame themselves, wondering whether it is something they have done in the past which has caused the problem, or even something they are still doing unawares. Not knowing what you are up against can make the whole experience particularly difficult.

'I have unexplained infertility, which is not reassuring at all. All it means is that they haven't found anything with the tests they have these days. I think unexplained infertility is a bit of a cop out. You think, is it me? Is it my problem I'm not conceiving because I'm stressing out so much? Is it the food l'm eating? Is it because I'rn 37?' Lana, 37

Secondary infertility

Women who have already been pregnant don't expect to have problems conceiving again, but in fact as many as a third of the patients at fertility clinics will have had a child, or a pregnancy, in the past. This is known as secondary infertility.

Some conditions which affect fertility can develop after a first pregnancy, such as endometriosis, hormone imbalances or sperm problems. An untreated infection after a previous delivery can leave scar tissue, or block the fallopian tubes. Women who have had a caesarean section, especially during the later stages of labor, are at slightly greater risk. Sometimes secondary infertility is simply down to age. If a couple have relatively minor fertility problems and start trying for a first child when they are fairly young, they may still manage to conceive, but if the minor problems are combined with age, it can make all the difference. In some cases, secondary infertility will remain unexplained.

It is important not to assume you cannot possibly have a fertility problem just because you've already conceived before. If you've been trying unsuccessfully for another baby for more than a year, it is worth having some basic tests carried out.

Possible causes from your male partner 

Most male fertility problems involve sperm. There may be a low sperm count (not enough sperm in the semen), there may be problems with sperm motility (the sperm aren't moving properly) or with sperm morphology (the sperm may be abnormal). Having a varicocele in the testicles, which is a bit like a varicose vein, can damage sperm, as it affects the blood flow. Some sperm problems are hormonal and some may be genetic, whereas others are caused by infection, but quite often there is no obvious cause for the problem.
 
Sometimes there is agglutination in the semen sample, which means the sperm are stuck together in clumps and can't fertilize an egg. This is often caused by anti-sperm antibodies in the blood, which may be the result of injury or surgery.
 
In some cases, there are simply no sperm in the semen sample at all. This is usually due to some kind of blockage, but can also happen when a man doesn't have a tube linking his testicles to his penis (the vas deferens), when the muscles that pump the sperm out aren't working properly or because no sperm are produced in the testicles.

 
It is important to remember that smoking, excess alcohol and recreational drugs can all affect sperm production, and male fertility problems can be caused by these lifestyle factors.
 
'My partner has poor sperm morphology. There were a very tiny percentage of normal sperm, and all the rest were not normal. I think sometimes he felt slightly guilty about it. I would have much preferred it if it had been me. That would have made it a lot easier. But it wasn't. It's nobody's fault, it's just one of those things that happen.' Anna, 33. To find out more, you can check out Unexplained Secondary Infertility.

 

Causes Of Infertility In Women

Hydrosalpinx

Sometimes one of the fallopian tubes becomes completely blocked and it can swell and fill up with watery fluid.
This is known as a hydrosalpinx, and is usually caused by previous infection or surgery. The fluid tends to collect at the end of the tube that is closest to the ovary. Women who have a hydrosalpinx may experience very severe pelvic pain, but it is possible to have no symptoms at all.

Causes Of Infertility In Women

Sometimes only one tube is affected, but it can occur in both at the same time (bilateral hydrosalpinges). If both tubes are completely blocked, the only way to get pregnant is with IVF. There is evidence that a hydrosalpinx can reduce embryo implantation rates and increase the risk of miscarriage. For this reason, women who have hydrosalpinges often have their fallopian tubes removed before starting IVF.
 
'The consultant said our only chance of having a baby was through IVF, but that our chances of IVF working were halved because I had bilateral hydrosalpinges. We were distraught. He said l would have to have my tubes removed, I knew they didn't work, so I thought I might as well do it right away, but there is a stigma to being sterilized at 31.' Mikaela, 32

Physical problems with the womb or ovaries 
 
There can be physical problems with the ovaries or the womb that make it difficult for a woman to conceive. Sometimes the outer surface of the ovaries may be scarred, usually after some kind of surgery, and this makes it difficult for follicles to develop normally. The womb is sometimes oddly shaped, and depending on how serious this is, it can lead to infertility and miscarriage.
 
Asherman's syndrome
 
The name Asherman's syndrome is given to a rare condition where scar tissue is found inside the womb. It sometimes causes the front and back walls of the womb to stick together, although in milder cases the scarring is found in just a small portion of the womb. It can be the result of a D and C (dilatation and curettage) or an ERPC (evacuation of the retained products of conception), which involve clearing the womb after a miscarriage, to remove a retained placenta or to terminate a pregnancy. Scarring can also be caused by a caesarean section or other surgery, or by infection.
 
The symptoms of Asherman's are usually changes to the menstrual cycle, which may become shorter or lighter than before, and sometimes stops altogether. Some women feel period pain but don't bleed. This can be a sign that although menstruation is taking place, the blood can't get out of the womb because the cervix is blocked by scar tissue.

'I had a retained placenta when I had my daughter, and I was told I had to have emergency surgery, but after the ERPC, I had more and more problems. The pain I was having was quite incredible and I didn't have a bleed. They finally referred me to a consultant and we had tests that showed my cervix was completely closed up, and I had 90-95 per cent obliteration of the uterine cavity.' Abbi, 31  

Problems with cervical mucus

Usually cervical mucus reaches a special consistency around the time of ovulation, which makes it easier for sperm to swim through it into the womb. If this doesn't happen and the mucus is thick or very scanty, it may be impossible for the sperm to swim through it and get into the womb. This is now considered to be a very rare cause of infertility.
 
Immune problems 

There is growing interest in reproductive immunology, which is concerned with looking at whether a woman's system may reject sperm or embryos, and prevent the implantation of a fertilized egg. Usually, your body rejects any kind of unrecognized material that starts growing inside it, but when you get pregnant, special blocking antibodies stop your immune system attacking the foetus. 

Some doctors believe that sometimes this blocking system fails, that the body may reject sperm or embryos, or start producing too many natural killer cells that attack growing cells in the body. Reproductive immunology is still a controversial area, and although some clinics now offer tests, others believe they are of limited use and question the validity of both the tests and the treatments offered, as most are not scientifically proven and are often expensive. To find out more, you can check out Causes Of Infertility In Women.