MALE INFERTILITY - Andrology Australia

92 Pages·2015·1.35 MB·English

Male
Infertility
Contents
At A Glance 04
Male Reproduction 06
Male Infertility 17
Causes 20
Sperm Production Problems 25
- DATE REVIEWED: FEBRUARY 2018 (5TH EDITION)
© Healthy Male (Andrology Australia) 2004 Sperm Transport Problems 34
Looking After Your Fertility 36
Health information in this booklet describes MALE
INFERTILITY. Diagnosis and treatment options are described
to help men and their families understand the health problem, Diagnosis 42
make men aware of the available treatment options, and to
help make talking with their doctor easier.
Treatment 49
The information contained in this booklet is based on up-to-
date medical evidence. It has been provided for educational
purposes only. It is not intended to take the place of a clinical Having a Family 59
diagnosis or medical advice from a fully qualified health
professional. Healthy Male urges readers to seek the services
of a qualified health professional for any personal health Emotional Issues 74
concerns.
Although the information in this booklet has been carefully Support 80
reviewed, Healthy Male does not take any responsibility for
any person using the information or advice available in this
booklet. Information is given on the understanding that users Glossary 83
take responsibility for checking the relevance and accuracy of
the information.
Expert Reviewers 87
Healthy Male is supported by funding from the Australian
Government Department of Health and is administered by
Monash University.
At A Glance
How is male infertility What is ICSI
diagnosed? (intracytoplasmic
sperm injection)?
If a couple has been trying for a
pregnancy without success, they ICSI is a form of ART where a
should go to their local doctor, single sperm is placed directly
family planning clinic or women’s into each egg by piercing the
health clinic, and have some outer covering of the egg. ICSI is
What is male infertility? tests. Both partners should be particularly helpful for men with
tested around the same time as poor sperm production. Sperm
the problem could be in either are collected from the semen or
Reproduction (making a baby) is a simple and natural
the male or the female partner. removed carefully from the testis or
experience for most couples. However, for some couples Testing should be done even if one epididymis.
partner has a child from another
it is very difficult to conceive.
relationship. ICSI can achieve pregnancies
even when only a few sperm are
Diagnosis can involve a medical produced. As with other forms of
Male infertility is diagnosed when, after testing both
history from the man and a physical IVF, after fertilisation the resulting
partners, reproductive problems have been found in examination, along with a semen embryos are placed back into the
analysis to check the number, woman’s uterus.
the male.
shape and movement of sperm in
the ejaculate. Especially if there
are abnormalities on the semen Does counselling help a man
analysis, some simple blood tests cope with infertility?
may also help in diagnosing male
Infertility can be distressing and
infertility.
many couples find it difficult to
How common is male without difficulty. The quantity
accept. Many men are reluctant
infertility? and appearance of the ejaculated
How is male infertility to seek psychological counselling,
semen generally appears normal
Infertility is a widespread problem. to the naked eye. Medical tests treated? fearing it is an admission of
For about one in five infertile are needed to find out if a man is weakness. However, couples often
couples the problem lies solely in infertile. One in eight infertile men has find counselling helpful.
a treatable condition, and after
the male partner and in another
treatment couples can become All infertility clinics provide
quarter, both partners have
pregnant naturally. In some cases, psychological counselling and
problems. What causes male infertility?
the doctor will recommend that the support, with counsellors specially
Male infertility is usually caused by couple seek assisted reproductive trained in managing fertility
What are the symptoms of problems that affect either sperm technology (ART) treatment, such problems.
production or sperm transport as in vitro fertilisation (IVF). ART
male infertility?
(blockage). Through medical testing, does not cure or treat the cause
In most cases, there are no the doctor may be able to find the of the male infertility, but these
obvious symptoms or signs of cause of the problem. treatments may help the couple
infertility. Intercourse, erections conceive, even if the man’s sperm
and ejaculation will usually happen count is very low.
04 05
Male Reproduction
Movement of
fibres in tail
creates motion
Mitochondrial
sheath around
neck region
A man’s fertility What are sperm? (provides energy)
and sexual
Sperm are the male reproductive cells. To have
characteristics
a child, genetic material from the sperm must
depend on the
combine with the genetic material from an egg, in
normal functioning
a process called fertilisation.
of the male
reproductive system
Healthy, fully developed sperm are very small Sperm head
(0.05 millimetres long) and cannot be seen by contains tightly
the human eye. Sperm are highly specialised cells Covering of sperm packed DNA
and are made up of three parts: a head, neck and head helps sperm (genetic material)
tail. In the head is a structure called the nucleus, stick to and
which contains 23 tightly packed chromosomes penetrate egg
(genetic material). The head is designed to
bind to and then penetrate (enter) the egg. The
neck of the sperm joins the head to the tail. The
Healthy, mature sperm
part of the tail nearest the neck contains the
mitochondria, which provides the energy for the
sperm to move. The tail moves in a whipping
motion to push the sperm towards the egg.
06 07
1
6
7
2 8 12
11
3
9
4
10
Male Reproduction
5
1 Bladder
2 Vas deferens
1 3 Urethra
6
What are the testes? 4 Penis
The testes (testis: singular) are a pair of egg 7 5 Scrotum
shaped glands that sit in the scrotum next to 2 8 12
6 Seminal Vesicle
the base of the penis on the outside of the body.
In adult men each testis is normally between 3 11 7 Rectum
15 and 35 millilitres (mL) in volume. The testes
8 Prostate gland
are needed for the male reproductive system to
function normally. 9 9 Epididymis
4 10 Testicle
The testes have two related but 10 11 Cowper’s gland
separate roles: 5 12 Ejaculatory duct
• to make sperm
1 Bladder
• to make testosterone.
The2 maVlea rse pdreofdeurcetnivse system
The testes develop inside the abdomen in the 3 Urethra
male fetus and then move down (descend) into
the scrotum before or just after birth. The descent Ho4w dPoen hisormones control the testes?
of the testes is important for fertility as a cooler The5 piStucirtoatruym gland and the hypothalamus,
temperature is needed to make sperm and for
loc6ateSde amti tnhael Vbeassiec loef the brain, control the
normal testicular function.
production of male hormones and sperm.
Rectum
Lut7einising hormone (LH) and follicle stimulating
The location of the testes in the scrotum keeps
the testes about 2°C below normal core body hor8moPnreo s(FtaStHe) galraen tdhe two important messenger
hormones made by the pituitary gland that act
temperature. This is the reason that in cold 9 Epididymis
on the testes.
weather the scrotum contracts and brings the
10 Testicle
testes closer to the body and in hotter weather,
The levels of LH and FSH in the blood rise during
the scrotum relaxes. 11 Cowper’s gland
the early stages of puberty and help the testes
to 1g2roEwj aacnudl amtoartyu rdeu. cLtH is needed for the Leydig
cells in the testes to make testosterone, the male
sex hormone.
08 09
Male Reproduction
Where are sperm made?
Sperm are made in the testes in many loops of
small, tightly packed tubes called seminiferous
tubules. These tubules have a total length of 150
metres. Between the seminiferous tubules lies
another type of cell, the Leydig cells, that make
Testosterone is important for the physical
the male sex hormone testosterone.
changes that happen during male puberty, such
as development of the penis and testes, and
for the features typical of adult men such as
facial and body hair and a masculine physique.
Testosterone and FSH from the pituitary gland
then act together on the seminiferous tubules
(sperm producing tubes) in the testes to make
sperm.
Lumen
Seminiferous tubule
Developing sperm
Supporting or
nurse cell (Sertoli cell)
Leydig cells
Lumen
Hypothalamus CrosSs-esmecintiiofen roofu as tteusbtiusle
Developing sperm
Pituitary
Supporting or
Testis
nurse cell (Sertoli cell)
Hypothalamus Leydig cells
Hormone links between the brain and the testes
Pituitary
Testis
10 11
Male Reproduction
The germ cells in the lining of the seminiferous
tubules divide over and over again to make sperm.
The process starts with the earliest germ cell,
called a spermatogonium. These dividing cells pass
through many stages and undergo a major change
in shape, from a round cell (spermatid) to the
familiar ‘tadpole-like’ sperm. Sperm developing in
How are sperm made?
the lining of the seminiferous tubules are supported
Spermatogenesis (sperm production) is a by larger cells called Sertoli cells.
continuous process with millions of sperm being
made each day after puberty. Within the testis, When mature, sperm are released into the lumen
sperm can be at different stages of development. It (the space in the middle) of the seminiferous
takes about 70 days to complete the development tubules to move out of the testes.
of sperm that are able to swim and fertilise an egg.
How do sperm move from the testes?
The epididymis is a highly coiled tube (duct)
that lies at the back of each testis and connects
the seminiferous tubules to the vas deferens, a
muscular tube about 30 cm long. When released
from the testis, the sperm spend two to 10 days
passing through the epididymis where they gain the
vital ability to swim strongly (become ‘motile’), and
to attach to and penetrate (enter) the egg.
Lumen
What is semen?
Seminiferous tubule Wall of tube
Developing sperm Spermatogonium Semen is the mixture of fluids from the testis and
other glands in the male reproductive tract. In fact,
Supporting or Spermatocytes
the sperm and the fluid from the testes make up
Lumen nurse cell (Sertoli cell) Round Spermatid only about two per cent of the volume of the semen
SLeummienniferous tubule Leydig cells Wall of tube Sertoli cell that is ejaculated.
Seminiferous tubule Wall of tube
Developing sperm Spermatogonium ‘Elongating’ Sperm move up the epididymis in this small amount
Developing sperm Spermatogonium spermatid with tail of fluid and then mix with larger amounts of fluid
Supporting or Spermatocytes
from the seminal vesicles (60% of the semen), the
nSuurpsep ocretliln (gS eorrt oli cell) RSopuenrdm Saptoecrmytaetsid Sperm released into prostate (30% of the semen) and other smaller
Lneuyrdsieg c ceelll l(sSertoli cell) SReorutonldi cSepllermatid hollow of tube (lumen) glands (8% of the semen), before ejaculation.
Leydig cells Sertoli cell
‘Elongating’
Cross-section of sperm producing tube (seminiferous
‘Elongating’
tubules)p ienr tmhea tteidst wisi sthho twainilg sperm development
spermatid with tail
Sperm released into
Sperm released into
hollow of tube (lumen)
hollow of tube (lumen)
12 13
Male Reproduction
What is fertilisation?
For pregnancy to happen, sperm must enter the
vagina at the fertile time of a woman’s menstrual
cycle. Sperm must then travel through the woman’s
uterus (sometimes called the ‘womb’) and into the
uterine tubes where they meet the egg. Fertilisation
What is ejaculation?
of the egg happens when moving sperm bind (stick)
Ejaculation is the release of semen from the penis to and then penetrate (enter) the egg.
at sexual climax (orgasm). When a man is sexually
stimulated, the brain sends signals to the genital
area through nerves in the spinal cord to make the How many sperm are needed to become
pelvic muscles contract. pregnant?
The ejaculate of fertile men contains tens of
At orgasm, waves of muscle contractions transport
millions of sperm. However, men with much lower
the sperm, with a small amount of fluid, from the
numbers of sperm can still achieve pregnancy. Men
epididymis through to the vas deferens. At the
who never have any sperm in their ejaculate are
back of the bladder, the vas deferens becomes the
sterile and cannot cause a pregnancy without some
ejaculatory ducts, which pass through the prostate
form of treatment.
gland to join the urethra.
The seminal vesicles and prostate contribute
extra fluid (the majority of the semen) to protect
the sperm. The passage of fluid along the urethra
is further helped by fluid made by the Cowper’s
glands. This mixture of sperm and fluid from the
testes and other glands (the semen) travels along
the urethra to the tip of the penis where it is
ejaculated (released).
The average volume of semen that is ejaculated
is about 2 to 5 mL. Given that the testes only make
about two per cent of the semen volume, when a
man has a vasectomy (cutting the vas deferens),
the change in the amount of semen ejaculated is
not noticeable, even though there are no sperm
present.
14 15
Male Reproduction Male Infertility
How can sperm production go wrong? What is male infertility?
The process of making sperm can be interrupted at Reproduction (making a baby) is a simple and
various stages for a number of reasons: natural experience for most couples. However, for
some couples it is very difficult to conceive.
• absence of germ cells (called Sertoli cell-only
syndrome): the testis may completely lack A man’s fertility generally relies on the quantity
the germ cells that normally divide to become and quality of his sperm. If the number of sperm
sperm. This is a severe problem. If every tubule a man ejaculates is low or if the sperm are of a
shows this pattern the man will be sterile as poor quality, it will be difficult, and sometimes
there are no sperm in the semen or in the impossible, for him to cause a pregnancy.
testes
Male infertility is diagnosed when, after testing
• maturation or germ cell arrest: sometimes both partners, reproductive problems have been
germ cells stop developing and do not become found in the male.
mature sperm
Many men will still be able to father children
• hypospermatogenesis: when the number of naturally even though they may have a lowered
sperm made in the testes is lower than normal, sperm count.
smaller numbers, or sometimes no sperm,
make it through into the ejaculated fluid.
How common is male infertility?
Some men have a mixture of patterns of sperm
Infertility is a widespread problem. For about one
production in the same testis. This means that
in five infertile couples the problem lies solely in
although one area of the testis is not producing
the male partner and in another quarter, both
sperm, another area may have normal sperm
partners have problems. In about one in seven
production. This is generally found during a special
infertile couples, the cause of the problem cannot
operation (called microsurgical testicular sperm
be found (idiopathic infertility).
extraction or ‘micro-TESE’) for men who have a
condition called ‘non-obstructive azoospermia’.
16 17
Male Infertility Male Infertility
This means that in almost half of infertile When should we see a doctor for
couples, there is a problem in the male alone or fertility problems?
both male and female partners. It is estimated
that one in 20 men has some kind of fertility If you and your partner are not using any form of
problem with low numbers of sperm in his contraception, and the woman does not become
ejaculate. However, only about one in every 100 pregnant after a year of regular (at least twice
men has no sperm in his ejaculate. weekly) sexual intercourse, you should both see a
doctor and have some tests.
There are several ways to help improve the
chance of successful pregnancy but the most
27%Both male & female problems
important is for the woman to monitor her cycle
and that intercourse happens regularly around
? 15%No known cause for infertility the time she is ovulating. There are different ways
for a woman to monitor her cycle, usually with a
‘kit’ that can be bought at a pharmacy.
38%Female problems only
You can ask a doctor questions about the timing
20%Male problems only of sexual intercourse and other facts about the
reproductive system. Some basic answers can
0 20 40 60 80 100 help couples and lower their stress and anxiety.
Some couples will be worried that things are ‘not
working’ after only a few months, and they may
Proportion of couples with infertility due to male find it helpful to talk about their concerns with a
or female problems
doctor.
For couples with known reproductive problems, or
What are the symptoms of male
if the female partner is older than 35 years, it may
infertility? be best to seek medical help before 12 months of
trying to conceive.
In most cases, there are no obvious symptoms
or signs of infertility. Intercourse, erections and
ejaculation will usually happen without
difficulty. The quantity and appearance of the
ejaculated semen generally appears normal to
the naked eye. Medical tests are needed to find
out if a man is infertile.
18 19