It takes two - Infertility is not just a woman's journey. Can further fertility testing for men shed light on the "unexplained"?

When a couple has been trying to conceive for some time without success, they often begin fertility testing. The focus tends to be primarily on the woman, involving scans, blood tests, and sometimes more invasive procedures.

For men, testing typically involves a sperm analysis. If the results are “normal” or close to normal, but pregnancy still isn’t occurring, the couple is often diagnosed with unexplained infertility. In their eagerness to start a family, they are frequently advised to pursue assisted reproductive technologies (ART), such as IVF or ICSI, sometimes earlier than necessary.

The focus, once again, is on the woman, who undergoes an invasive IVF cycle that can be physically, emotionally, and mentally challenging.

However, could further testing for men shed light on this "unexplained" infertility?

Standard sperm analysis evaluates factors such as volume, colour, viscosity, liquefaction, pH, total sperm count, concentration, vitality, motility (both progressive and total), morphology, and the presence of leukocytes and anti-sperm antibodies.

Key parameters like morphology, motility, and DNA integrity are particularly important in determining the sperm’s ability to fertilise an egg. For example, progressive motility is crucial as it enables the sperm to swim toward the egg, while the sperm’s shape (morphology) affects its ability to penetrate the egg.

DNA fragmentation is another critical, but often overlooked test that assesses the genetic health of the sperm.

Since sperm contributes half of the genetic material needed to create new life, the integrity of this DNA is vital for normal embryo development. High levels of DNA fragmentation (30-50%) can contribute to poor embryo development, miscarriage, and genetic abnormalities.

While sperm morphology is an important indicator of fertility, DNA fragmentation is present in about 20% of sperm samples with “normal” morphology, which may explain difficulties with conception even in cases where standard semen analysis results seem unremarkable.

Factors such as smoking, alcohol consumption, infections, exposure to toxins, advanced paternal age, and stress can all contribute to DNA fragmentation, mainly through increased oxidative stress. The body’s natural defences—vitamins C, E, and glutathione—are designed to protect sperm from oxidative stress, but external factors can overwhelm these defences and lead to damage.

In addition to DNA fragmentation testing, routine andrology checkups involving ultrasounds and blood tests can provide further insights. For example, conditions like a varicocele (an enlarged vein in the scrotum) can increase the temperature of the testes, leading to oxidative stress and reduced sperm quality.

As you can see, there are many factors to consider before pursuing IVF. Sometimes, simple lifestyle changes can significantly improve sperm quality and DNA integrity, while in other cases, medical intervention may be necessary.

The emotional toll

Infertility is not just a woman's journey. When male factors are involved, men experience deep emotional responses as well. Many men struggle with feelings of inadequacy or identity loss, especially when medical treatments come into play. This can increase anxiety, depression, and stress, making an already difficult situation even harder to manage.

Unfortunately, many men face these emotions in silence, hesitant to express their feelings or seek support. This silence can lead to isolation and lower self-esteem. But it doesn't have to be this way.

By opening up the conversation around male infertility, we can create a more supportive environment where men feel comfortable sharing their experiences and seeking the help they deserve.

If you're feeling overwhelmed by the challenges of infertility, you don't have to go through it alone. At my clinic in Marylebone, I offer support to men through acupuncture and hypnotherapy. Let's start a conversation and find out more about how I can help you build resilience and confidence, empowering you to move forward on this journey with renewed strength. Reach out today—I'm here to support you.