Causes, Testing and Treatment Options at Aevitas Fertility Clinic

When a couple struggles to conceive, fertility is sometimes still viewed primarily as a female issue. In reality, male factor infertility can be an important contributor to difficulty conceiving, which is why evaluating both partners is an essential part of a fertility assessment.

The encouraging news is that many causes of male infertility can be identified, and advances in fertility treatment mean that even men with very low sperm counts or poor sperm quality may still have options for becoming biological fathers.

At Aevitas Fertility Clinic in Cape Town, we take a holistic approach to male infertility and men’s reproductive health. Our practice includes doctors with a particular focus on male infertility, working alongside urologists with expertise in male reproductive health where specialist assessment or treatment is required.

Fertility investigations consider both partners so that treatment can be based on the underlying factors affecting conception rather than assumptions about where the problem lies.

What Is Male Factor Infertility?

Male factor infertility refers to circumstances in which an issue involving sperm production, sperm quality, sperm delivery or another aspect of male reproductive health reduces the likelihood of achieving a pregnancy.

Male fertility is influenced by several characteristics of sperm, including sperm concentration, movement and shape.

A fertility problem may therefore involve too few sperm, sperm that do not move effectively, abnormal sperm morphology, or a combination of factors. In some cases, no sperm may be present in the ejaculate.

Importantly, male infertility may not cause any obvious symptoms. A man can feel completely healthy and still have an underlying fertility issue.

What Causes Male Infertility?

There is no single cause of male factor infertility.

Potential causes can include problems with sperm production, hormonal factors, genetic conditions, infections, previous illness or surgery, abnormalities affecting the reproductive tract, or a varicocele (enlarged veins in the scrotum).

Lifestyle and environmental factors may also affect sperm health. Age may also play a role. Although men can remain fertile much later in life than women, sperm quality and reproductive outcomes can change with increasing paternal age.

In some men, investigations do not identify a clear underlying cause.

How Is Male Infertility Tested?

One of the first investigations into male fertility is usually a semen analysis.

A semen analysis provides important information about sperm concentration, motility and morphology, helping fertility specialists assess whether sperm-related factors could be making conception more difficult.

Because sperm production can fluctuate, an abnormal result does not necessarily provide the complete picture on its own. Depending on the results and the man's medical history, further investigations may be recommended.

These could include additional semen testing, blood tests to assess hormone levels, physical examination, ultrasound or genetic investigations where appropriate.

The purpose is not simply to establish that there is a sperm problem, but to understand as much as possible about why it may be occurring and how it could influence treatment.

Can Male Factor Infertility Be Treated?

Treatment depends on what investigations reveal and may involve treating an underlying male reproductive health condition, assisted reproductive treatment, or a combination of approaches.

Aevitas follows a holistic approach to male infertility and works with urologists who have a particular focus on male reproductive health. Where appropriate, treatment may include procedures aimed at correcting an underlying problem, such as varicocele repair or microsurgery.

Lifestyle changes, treatment of hormonal or other medical conditions, and addressing potentially reversible factors may also form part of the treatment plan.

Where assisted reproductive treatment is required, options may include intrauterine insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

How Can ICSI Help With Male Infertility?

ICSI – intracytoplasmic sperm injection – has transformed treatment possibilities for many couples affected by male factor infertility.

With conventional IVF, eggs and sperm are placed together in the laboratory and fertilisation must still occur.

ICSI takes this process a step further. An embryologist selects an individual sperm and injects it directly into a mature egg to facilitate fertilisation.

This means ICSI may provide a treatment option even when sperm numbers are very low, sperm movement is poor or previous fertilisation has been unsuccessful.

ICSI does not guarantee fertilisation, pregnancy or a baby, and whether it is appropriate depends on the individual circumstances. However, it has significantly expanded the possibilities available to men who previously may have had very limited options for biological fatherhood.

What Happens If There Is No Sperm in the Semen?

Finding no sperm in a semen sample does not necessarily mean biological fatherhood is impossible.

Azoospermia can occur for different reasons. In some cases, sperm production is impaired. In others, sperm may be produced but prevented from reaching the ejaculate because of an obstruction.

Depending on the cause, specialist surgical sperm retrieval procedures may sometimes make it possible to retrieve sperm directly from the male reproductive system for use with IVF and ICSI.

One such procedure is microdissection testicular sperm extraction (MicroTESE). MicroTESE is a specialised microsurgical procedure that may be considered in selected men with non-obstructive azoospermia, where sperm production within the testes is severely reduced. Using an operating microscope, the urologist identifies and removes small areas of testicular tissue that appear most likely to contain sperm, which can then be examined in the laboratory.

MicroTESE is not appropriate in every case of azoospermia. The recommended approach depends on whether the cause is obstructive or non-obstructive, as well as hormonal, genetic and clinical findings. Assessment by a fertility specialist and, where indicated, a urologist with expertise in male infertility is therefore important before deciding on treatment.

This is why specialist assessment is particularly important following an azoospermia diagnosis. The next step depends on understanding the underlying cause rather than the semen analysis result alone.

What If Treatment with Your Own Sperm Is Not Possible?

There are circumstances in which using a man's own sperm may not be possible or may not offer an appropriate route to pregnancy.

In these cases, donor sperm can provide another family-building option.

The Aevitas Sperm Bank provides access to carefully selected and screened sperm donors for recipients who require donor sperm as part of fertility treatment.

Deciding to use donor sperm is a significant personal decision, and the Aevitas team can help patients understand the medical process and the options available to them.

When Should You Seek Help for Male Infertility?

If you have been trying to conceive without success, fertility assessment should not focus on one partner alone.

Male fertility testing can provide valuable answers early in the process and may prevent couples from spending months pursuing approaches that do not address the underlying reason pregnancy is not occurring.

If you are concerned about low sperm count, poor sperm motility, abnormal sperm morphology, azoospermia or male factor infertility, the first step is to investigate.

At Aevitas Fertility Clinic in Cape Town, our fertility specialists assess both partners, investigate potential causes of infertility and recommend a personalised treatment pathway based on the results.

Male infertility does not automatically mean the end of the possibility of biological fatherhood. Understanding the cause is the first step towards understanding your options.

Contact Aevitas Fertility Clinic to arrange a fertility consultation and learn more about male fertility testing, IVF and ICSI treatment.