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Male Infertility or Subfertility

Our expert team in male infertility and subfertility follow a clear protocol to reach the diagnosis and solve the problem in very high success rate. 

Infertility is the failure of a sexually active couple to achieve conception in one year. It is better described as  'subfertility' as many causes of failure to conceive are relative and can be treated. 

Causes of infertility or subfertility

  1. Congenital or acquired urogenital anomalies
  2. Urogenital tract infections
  3. Increased scrotal temperature (a consequence of varicocele)
  4. Endocrine  disturbances
  5. Genetic abnormalities
  6. Immunological factors 

In 30% of cases, no male infertility associated factor is found which may be explained by many environmental factors. 

 
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 What are the prognostic factors that can give expectations for the patients?

The duration of infertility; primary or secondary infertility; results of semen analysis; and the age with the fertility status of the female partner.

The cumulative pregnancy rate in infertile couples with 2 years of follow-up and oligoathenospermia as the primary cause of infertility is 27%.

Female age is the most important single variable influencing outcome in assisted reproduction compared to a woman at 25 years old, the fertility potential is reduced to 50% at age 35, to 25% by 38 years and < 5% at over 40 years. 

History of infertility is very important to analyse the cause and treat accordingly. The following are important points to visit during the history session: 

  • Smoking and alcohol consumption
  • Length of infertility and attempts trying to conceive
  • History of contraception
  • History of family genetic disorders
  • Sexual history including erectile dysfunction, ejaculation problems
  • Psychological conditions
  • Previous medical and surgical history. Particularly ask about a past history of diabetes, mumps, prostitis, hernia repair, vasectomy, testicular torsion, sexually transmitted diseases
  • Previous history of chemotherapy or radiotherapy
  • Drug history as some medication would have direct or indirect hormonal effects and direct metabolic effects

The examination include the following:

  1. General examination of weight, height to asses the BMI and general vital signs.
  2. General body features examination (secondary sex characteristics and gynaecomastia)
  3. Full Andrology hormonal testing and examination
  4. Testicular examination for anatomical cause of the infertility

Semen analysis

In the male, semen analysis is the initial investigation. Feature including the following will be studied:

  • Semen volume (ML)
  • Total sperm number and concentration
  • Total and progressive sperm motility (%)
  • Vitality (live sperm)
  • Sperm morphology (normal sperm shape, %)

Repeat semen analysis tests can be undertaken to observe the progression after treatment.

Further andrological investigation may be required. 

Other Investigations

Other tests may be required depending on each case:

  • Hormone analysis: FSH level and testosterone are the main tests in case of impaired spermatogenesis. LH, prolactin and free testosterone may also be requested
  • Genetic tests in some cases
  • Ultrasound to the testis and inguinal area
  • Testicular biopsy is the ultimate diagnostic procedure to examine the histological testicular structure and the possibility of finding sperm. The sperm can be extracted in the same time and used in treatment.

Treatment of infertility or subfertility will be according to the finding of the examination and tests requested and guided by the cause.

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