Guide for Men
Finding out you need help to have a child can be difficult to come to terms with as a man, because there’s always a natural assumption that when you try for a baby it will just happen.
But did you know that problems with sperm production account for around a third of infertility cases? It’s not as uncommon as you might think, it’s certainly not abnormal, and for the vast majority of cases we see here at Manchester Fertility it’s treatable.
We’ve helped many men become fathers – even those who have no sperm at all in their sample. We can also help men who have had previous vasectomy have the best chance of becoming a father again.
Why you may need our help
There are many reasons why a man may not be able to have a child naturally. These include:
- Not producing sperm in your sample – because of previous vasectomy or other causes
- A low sperm count – when you haven’t got as much sperm in your sample
- Poor sperm motility – your sperm isn’t moving in the right way to reach the egg
- Abnormal sperm shape – making it difficult for your sperm to attach to the egg to fertilise it
- Not able to achieve or sustain an erection – so sperm can’t be delivered to the egg
- Not able to ejaculate – as a consequence of diabetes or pelvic nerve damage
- Hormonal problems – which may influence the way your testicles work
- Previous medical or surgical treatment – which may have affected your fertility
What we offer
There are various different ways we can help you if you’ve been told you have a problem with your fertility. We usually need to make a full evaluation of all of the factors that might influence your - and your partner’s - fertility so we can say what we can do to help. This usually means one consultation with both of you present. We can then examine you, do some tests and then offer you options for treatment to try and help your partner have a baby.
Tests that may help include:
Semen analysis – to determine the true results of previous examinations, but in a registered infertility laboratory where the sample’s quality for use in an IVF-based technique can be looked at in detail.
Sperm DNA fragmentation and aneuploidy – to help understand the ability of your sperm to fertilise an egg. This is something that is usually used when there has been a failure of fertilisation in a previous IVF cycle.
SpermComet DNA Damage test – we are now offering SpermComet® – the very latest next generation of sperm DNA quality testing for men. This test provides us with unique information by measuring the amount of DNA damage in individual sperm.
Hormone tests – Blood tests help us to understand the way in which your testicles are working and any hormone imbalances that may influence sperm production.
Chromosomal tests – men with very low sperm counts, or an absence of sperm from their ejaculate, may have some abnormalities of their chromosomes, which may have an influence on their ability to father a child or even impact on their child’s fertility in the future. We can check for those chromosomal abnormalities that are known to have an effect on your fertility by blood tests.
Ultrasound scanning - This may be used if the specialist feels that there is a need to look at the structure of your testicle or to see if there is a blockage in the tubes that connect your testicle to the water pipe.
Treatments that may help include:
IVF – Traditional IVF, where your sperm is mixed with your partner’s egg in our laboratory, can be a good treatment for some cases of male infertility, such as when your sperm isn’t quite as mobile as it should be. Because the sperm doesn’t have to swim to the egg – it is put in direct contact with it – then, often, the egg can be fertilised. The egg develops into an embryo in our laboratory and it’s then transferred into your partner’s uterus, hopefully, to grow as in a natural pregnancy. If your partner undergoes IVF, you simply have to provide a sample of sperm on the day your partner’s eggs are retrieved.
ICSI – Intracytoplasmic Sperm Injection - This is a procedure done as part of an IVF treatment when there’s a particular problem with sperm shape, a low sperm count or problems with your sperm’s motility. It is always used when sperm has been surgically retrieved. Our embryologists examine your sperm sample and isolate a single, healthy, good quality sperm. This sperm is then injected directly into your partner’s egg to fertilise it, so ensuring that any problems with motility, attachment to the egg, or there not being enough sperm, are overcome. ICSI is a very effective treatment and we have consistent success rates at Manchester Fertility.
MERC – Multiple Ejaculate Recovery and cryopreservation of sperm - This is usually done when the sperm count is very low and multiple samples are taken and frozen either for use in an IVF and ICSI type treatment. Very occasionally, MERC samples may be used with intra-uterine insemination (IUI) where the sperm is inserted through the neck of your partner’s womb at the right time in her cycle.
SSR – Surgical Sperm Retrieval - Surgery is often needed to obtain sperm when none is present in your semen or you can’t ejaculate. In these circumstances, you’ll usually need what’s called surgical sperm retrieval (SSR). There are many different SSR techniques we offer, such as PESA (percutaneous sperm aspiration) and TESE (testicular sperm extraction). TeSE can be performed as a ‘closed’ procedure (cTeSE) through a 2mm incision in men who have had a previous vasectomy, or failed vasectomy reversal. Open TeSE (oTeSE) and micro-dissection testicular sperm extraction (mTESE) are used when there is no known, or obvious, obstructive cause for an absence of sperm in the ejaculate. Using these techniques we can maximise the chance of recovering viable sperm which is then, usually, frozen. A test thaw of a fraction of the retrieved material enables us to determine the likely quality of all remaining material, and gives you a realistic expectation of the sperm available to your partner before she embarks on IVF treatment. Samples may be frozen for up to 10 years and SSR usually gives us enough material for a number of IVF and ICSI treatments.
Reversal of Vasectomy – Reconstructive procedures to reverse vasectomy are a common part of our treatment range to try and help men to ejaculate sperm again. Outcomes do, however, need to be determined on an individual basis and considered alongside SSR as an alternative treatment option. We can offer synchronous sperm retrieval at the time of reconstruction and if you are considering a vasectomy reversal you may wish to think about having sperm retrieved surgically and stored at the same time. This means that you would not need to have another hospital procedure should the reversal fail.
Treatment with Donor Sperm – Donor sperm is used when sperm isn’t available from the man. It is usually used with intra-uterine insemination (IUI), where the donor sperm are inserted through the neck of your partner’s womb at the relevant time in her cycle. If your partner has problems with her tubes donated sperm can be used with IVF treatment and if she has problems with ovulation it can even be used with donated eggs.
Our Expertise, your chance to be a Father
Our male fertility team are leaders in their field. Steve Bromage, our consultant urological surgeon, is a nationally recognised leader in this field and specialises in the evaluation of male infertility problems, surgical sperm retrieval procedures (SSR) and reconstructive surgery for obstructive problems. Thanks to his considerable expertise, in collaboration with our team of specialist embryologists and reproductive medicine specialists, we’ve been able to help many men who thought they could never become fathers to have children of their own.
Of course physical treatment isn’t the only thing we offer to you. We know that finding out you may need help to be a father can take an emotional toll as well, something it can sometimes be hard to talk to your partner about.
You may feel guilty because you’ve not been able to give your partner a child naturally or because she has to take drugs and go through egg retrieval so your sperm can be used. Or you may simply find it hard to accept that there’s a problem. You’re not alone. Our counsellors have many years experience in helping men through treatment and you can talk to our counsellors anytime you need to, in confidence, at any point in your journey with us.
Don’t despair. In many cases, male factor infertility is treatable. So if you’re concerned about your fertility, visit your GP who can conduct simple non-invasive tests to identify any problems or contact us directly at Manchester Fertility so that we can progress things for you directly. You can then be seen by our specialist male fertility team at Manchester Fertility for further advice and treatment.
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Thanks to everyone at Manchester Fertility for everything.See more Laura and Melissa