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What men need to know about fertility issues

When couples struggle to conceive, there's an equal chance the problem lies with the man.

07 September 2016
by Glynis Horning

If you’ve been trying for a baby for 12 months without success, both of you should see a doctor – because in about 35% of cases, infertility comes from the woman’s side, but in another 35%, it’s from the man’s. In 20% of cases both partners have a problem, and in 10% no cause is found.

“It’s ideal for couples to see a specialist early to avoid delays in receiving optimal treatment,” says Dr Paul le Roux, a reproductive medicine specialist at the Cape Fertility Clinic. “Many couples follow incorrect steps for years before receiving the right advice.” 

Male infertility has a range of possible causes. These are eight of the most common – discuss them with a doctor, urologist, and if needs be, a fertility specialist.

He smokes

A recent overview of studies showed cigarette smoking was associated with reduced sperm count and motility (the sperm’s ability to move), says Dr Sascha Edelstein, a specialist at HART Fertility Clinic in Cape Town.  Good news is if he quits smoking, the chances are that sperm problems will be corrected within about three months – “the time it takes new sperm to develop”.

He has health issues

Mumps can cause sterility, as can tuberculosis (TB), sexually transmitted infections (STIs) and Klinefelter’s syndrome (a genetic disorder). Medications can affect fertility too, including some used to treat hypertension (high blood pressure), infection, digestive disorders, diabetes, thyroid disease, cancer and depression. He should speak to his doctor about this.

He has problems with his scrotum

For example, varicoceles (varicose veins in the scrotum) affect about 10% of men and can impair sperm quality. “Varicoceles are a surgically correctable cause of male subfertility (reduced fertility),” says Edelstein. Infertility can also be caused by premature ejaculation, blockage of the ejaculatory duct, or retrograde ejaculation, where sperm enters the bladder instead of exiting the penis, Le Roux says. See a specialist.

He has problems with his sperm

Having too few sperm, poor sperm motility or abnormal sperm can prevent fertilisation. This can result from injury, disease, medication or hormonal imbalance.  Age may also be a factor – new studies show male fertility, too, declines with age from around 35, with a drop in sperm quality and quantity.

He eats badly

As with women, men’s fertility can be affected by being extremely underweight or overweight and by poor nutrition. Zinc (high in wheat germ and peanuts) is needed for healthy sperm, as are long-chain fatty acids (found in fish, nuts, avocado, meat and most oils). Studies suggest eating fatty fish like pilchards twice a week may improve sperm motility and concentration.

His testes are regularly exposed to excessive heat

Heat from tight clothes (especially underpants), frequent use of saunas or hot-tubs, constant use of a laptop, or carrying a cellphone in a pants’ pocket are thought by some to contribute to infertility by affecting sperm, but there is no conclusive evidence to date.

“Undescended testes (when a testicle that hasn't moved into its proper position) is linked to sperm problems,” says Le Roux, “but this is unlikely to be a heat effect, and is rather that an abnormal testes in fetal life does not go through the correct steps of descent from the peritoneal cavity to the scrotum.” Frequently only one testes is affected, says Edelstein, “in which case the other can compensate and provide adequate sperm production.”

He abuses substances

Excessive alcohol (more than three drinks a day), anabolic steroids and recreational drugs (including dagga) can all affect fertility.

Much can be done today to solve fertility problems. Talk to a fertility specialist about IVF (invitro-fertilisation) or ICSI (intra-cytoplasmic sperm injection), where a single healthy sperm can be selected and injected directly into an egg, then the embryo transferred into the uterus. “As a last resort, if there is an inability to retrieve sperm via the ejaculate or a testicular biopsy, donor sperm can be used,” says Le Roux.

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