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Management of Male Infertility

Combination of Male and Female Fertility Disorders

The female partners of men with low sperm count  or abnormal sperm often have disorders such as irregular ovulation, endometriosis or tubal blockages which contribute to the infertility.  As might be expected in infertile couples, problems with the woman are found more often when the man has a less severe disorder.  It cannot be overemphasised that both partners of the infertile couple must be investigated in detail.

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Fertility problems in the woman should be corrected where possible even though there is no effective treatment for the semen disorder.  Treatments commonly used such as ovulation induction with or without artificial insemination and IVF mainly involve the female.

Ineffectiveness of Treatment

Many treatments have been used in attempts to remedy reduced sperm output or function in the past.  Such treatments include: operations for varicoceles, nutritional supplements, traditional herbs, drugs which alter hormone levels and artificial insemination with husband’s semen.  None of these have been proved to increase pregnancy rates.

There are problems in assessing the success of treatment of infertile men.  First, semen test results are very variable from day to day within the one man so that an apparent increase in sperm number (for example, from 3 to 20 million per ml) may result from a chance fluctuation that has nothing to do with the treatment the man happens to be taking at the time. Second, the patients are subfertile, not sterile; pregnancies occur, but at a lower rate than normal.  Thus if a pregnancy occurs during treatment, it may not necessarily be due to the treatment.  To demonstrate that a treatment is effective, it must be shown that semen tests improve more often and pregnancy rates are higher than with similar men given no treatment.