Male infertility: causes, tests and treatment

Infertility is when a couple cannot get pregnant despite having regular unprotected sex (sex every 2 to 3 days without contraception), the NHS (the UK's National Health Service) says. MedlinePlus, from the US National Library of Medicine, says infertility is the term doctors use if a man has not been able to get a woman pregnant after at least one year of trying.

MedlinePlus says that about a third of the time infertility is because of a problem with the man, and a third of the time it is a problem with the woman; sometimes no cause can be found. The World Health Organization (WHO) says that in men, infertility is most commonly caused by problems in the ejection of semen (releasing semen), absence or low levels of sperm, or abnormal shape and movement of the sperm.

The NHS says it's always best for both partners to see the doctor, as fertility problems can affect either or both partners.

The NHS says you could have a low sperm count if you and your partner are having difficulty getting pregnant, and that you usually find out after having tests to check your fertility.

Some causes do have signs of their own. MedlinePlus says a varicocele can cause enlarged, twisted veins in the scrotum, a dull ache or discomfort, or a painless lump in a testicle, swelling of the scrotum or a bulge in the scrotum, though some men do not have symptoms. It says to contact your doctor if you discover a lump in a testicle, and that a varicocele that appears suddenly in an older man may be caused by a kidney tumour, so see a doctor about it.

When to see a doctor. The NHS advises seeing a doctor if you and your partner have been having regular sex without contraception for over 1 year and have not been able to get pregnant, or after 6 months if your partner is 36 or over. It says to see a doctor sooner if you have any other reason to be concerned about your fertility, for example if you've had treatment for cancer or you think you might have had a sexually transmitted infection (STI).

Treatment depends on the cause, and your doctor will advise what suits you. These are options the NHS and MedlinePlus describe:

• ICSI or IVF. If you have a low sperm count and you and your partner have not been able to get pregnant after trying for over 1 year (or 6 months if your partner is 36 or over), the NHS says treatment may include IVF (in vitro fertilisation) or ICSI (intracytoplasmic sperm injection): eggs are removed from the woman's ovaries and fertilised with the man's sperm in a laboratory, then put back into the womb. In ICSI, a single sperm is injected into the egg; in IVF, eggs and sperm are mixed in the laboratory. The HFEA says a doctor may recommend ICSI if you have a very low sperm count, or if your sperm are abnormally shaped or do not move normally.
• Medicines. The NHS says gonadotrophins, a type of hormone medicine, may improve fertility in men. It says some fertility medicines may cause side effects, such as nausea, vomiting, headaches and hot flushes: ask your doctor. NICE (the National Institute for Health and Care Excellence) has called for more research into how well gonadotrophins work for some men.
• Surgery. If the epididymis (a coil-like structure in the testicles that helps store and transport sperm) is blocked, the NHS says surgery can be used to correct the blockage. It says taking sperm out by an operation (surgical extraction of sperm) may be an option for men who have a blockage that prevents the release of sperm, were born without the tube that drains the sperm from the testicle, or have had a vasectomy or a failed vasectomy reversal.
• Treating a varicocele. MedlinePlus says a varicocele can be corrected with surgery, or by blocking the vein through a thin tube (embolisation), and that after surgery the sperm count will likely increase and fertility may improve. It says complications from treatment may include an atrophic testis (wasting of the testicle), a blood clot, infection, or injury to the scrotum or a nearby blood vessel. NICE has also called for more research into how well treatments for varicocele work for fertility problems.

IVF and ICSI have risks: read the risks and warning signs on each treatment's page.

Of these treatments, MCI offers IVF and ICSI. For the medicines and operations described above, ask your doctor where they are available.

MCI also offers IUI (intrauterine insemination). It is usually suggested when the fallopian tubes are open and the sperm is healthy. The IUI page explains who it may suit and when it is not likely to help, which includes male factor infertility (a fertility problem on the man's side). Your doctor will advise.

Our prices for patients in Pakistan, and for Pakistanis working in the Middle East:

• Free: first consultation, the woman's ultrasound scan, semen analysis and sperm freezing
• ICSI or IVF: Rs 80,000, from consultation to embryo transfer
• Medicines for an ICSI or IVF cycle: usually Rs 50,000 to 70,000, charged separately (mostly hormone injections that help the ovaries produce eggs; the dose depends on the tests)
• Second ICSI or IVF cycle: Rs 60,000, if the first does not succeed

Families who live in the UK, USA, Europe or Hong Kong and come to Mirpur pay £800 for ICSI or IVF, including medicines and embryo freezing. See families from abroad.

Ask about the cost of any other tests your doctor advises. Families on low incomes can ask about reduced fees at their consultation; we do not offer instalment plans. See all costs.