November 5, 2018

Male Fertility Focus #FertilityFellas

Male causes account for roughly half of all infertility cases, yet fertility has historically been perceived both in the popular imagination and within medical practice as largely a female matter. While women have had gynaecologists, specialists trained in female reproduction. There is now finally an equivalent for men called andrologists such as Mr Kalsi who will fully evaluate and treat the male partner.

In this blog Mr Kalsi gives his opinion on male fertility and investigations.

There has recently been increased attention in the media about the lack of care and services for men with fertility problems including articles in The Guardian and on the Victoria Derbyshire show on the BBC.

Furthermore, Men and their partners are waiting until they are older before they think about having children. The combination of an older woman and an older man means that their probability of success is reduced. Therefore they are more reliant on assisted conception.

Even experts who have worked in in IVF laboratories have recently reported how shocked they were at how little attention was given to male infertility. One such expert was quoted to say “I think that far too many men who have poor sperm quality are sent off to IVF units without having proper investigation. They could be managed in other ways.”

One of the leading causes of male infertility is a complaint called varicocele, which is caused by enlarged varicose veins in the testes. About 40% of infertile men have varicocele, although it doesn’t always impair fertility – 15% of fertile men also have varicocele. It creates an engorgement of blood that heats up the testes as much as four degrees, which can cause significant damage to sperm.

A physical examination can identify varicocele, and it’s easily ruled out by an ultrasound scan. But very often men go undiagnosed, and ultrasound scans, which are standard in investigating female infertility, are very rarely employed on men. Instead, diagnostic work on men seldom goes beyond the standard semen analysis. The condition can be effectively treated using state of the art microsurgery (microsurgical varicocele ligation) which is performed by expert andrologists such as Mr Jas Kalsi.

Moreover, a standard semen analysis gives limited information – essentially, the sperm count and motility (the ability of the sperm to move around). These are important factors, and a lack of either can lead to infertility. There is a great misconception about the value of semen analysis. There is a false belief that if you have normal semen parameters, the man is fine. However further tests such as assessment of oxidative stress and DNA fragmentation tests, which can show damage to sperm not picked up in semen analysis, should be much more widely used. These tests are now available and can be very helpful.

Just as women are referred to gynaecologists when being treated for fertility, so men should see consultant urologists specialising in andrology.

There is a reluctance to implement further testing on men. However, women are subject to many tests and couples are often sent off to IVF without a proper understanding of the male’s reproductive health.

If you would like more information, to book any male fertility tests, or to arrange an appointment to see Mr Kalsi please contact our patient services team.