Early testing of both the man and woman can be key to unlocking the full story behind a couple's fertility issues but it is still commonly assumed that infertility is a 'woman's issue.' As Fertility Network calls for more men to be fertility tested in a timely manner alongside the woman Hannah and Luke share their story.
When Hannah and partner Luke had been trying for a baby for 12 months without success Hannah went to see her GP. The couple didn’t consider that they would need a male fertility test.
“I knew that there was potentially a problem with me because I had irregular periods as a teenager and my periods took ten months to start again after I came off the pill,” she says. “We were really surprised when it turned out that Luke had fertility issues too.”
Tests revealed that Luke, aged 37, had a low sperm count which, coupled with Hannah’s subsequent diagnosis of polycystic ovaries, significantly lowered the couple’s chances of conceiving naturally.
Luke, who runs marathons in his spare time, says: “It was very hard to deal with as it was just something which had never crossed my mind. I remember feeling helpless and not knowing what I could do to change things.”
Male fertility tests need to be in parallel with female testing
One third of couples who are tested for infertility will discover that there are contributory factors on both sides. For Hannah and Luke the news hit them hard: “When we found out that we both had fertility issues it was pretty devastating,” admits Hannah, aged 35. “Seeing adverts for pregnancy tests and baby products on TV was just one small way we were reminded of our difficulties and it was a really hard time for us. We just had to get on with it really and keep ourselves busy. Luke tried a few of the tips suggested for improving sperm count such as wearing loose underwear, exercising and not drinking, but it didn’t help particularly.”
Hannah and Luke from Cambridgeshire were referred for IVF at Bourn Hall Clinic and at the time were eligible for one round of NHS-funded treatment before funding was withdrawn for NHS IVF in Cambridgeshire (it has since been reinstated).
The couple’s NHS-funded treatment was not successful. “I only produced three eggs and we had one viable embryo for transfer. The embryo didn’t take and I had a period after two weeks. It was very sad,” says Hannah.
“We had saved up in case we needed more treatment and we knew that we wanted to try again. We gave it a few months and I did a 10k run whilst Luke did another marathon and then we went on holiday before going back to Bourn Hall.”
ICSI used to achieve fertilisation
The second time – as with the first – the couple had IVF using a procedure called Intracytoplasmic Sperm Injection (ICSI) which is commonly used when the sperm needs a bit of ‘extra help’ to achieve fertilisation. Hannah’s eggs were collected and then Luke’s sperm was directly injected into her eggs in the laboratory, before two resulting embryos were transferred to her womb.
Two weeks later a pregnancy test confirmed that the treatment had worked. “We were grinning like maniacs. It never crossed our minds that both embryos might have taken,” laughs Hannah.
When a scan revealed that the couple were expecting twins, Hannah says it was “beyond good news. We were shocked but ‘happy shocked’!”
Twins Max and Adaline were born in September 2018 – “it was surreal when they were born; it was amazing,” says Hannah.
Asked what IVF has means to them, Luke says: “It’s meant we’ve been able to have a family. Max and Adaline wouldn’t be here without IVF and that’s an impossible thing to imagine. “
Common causes of male infertility
Male fertility tests check for the quality and quantity of sperm.
Poor sperm quality
Sperm quality and quantity can vary greatly and is affected by your health and nutrition. All semen contains a proportion of poor sperm that can be abnormally-shaped or unable to swim; the problem occurs when there aren’t enough good sperm – sometimes there are no sperm at all.
In some cases it is possible to boost sperm production through lifestyle changes, supplements or medication and this might be sufficient to improve your chances of natural conception. Other options include: intrauterine insemination (IUI), where the sperm is injected high into the uterus; or IVF, where the eggs are collected and a single sperm injected sperm directly into the egg, a process called ICSI.
Lack or absence of sperm
There are two main reasons for a low or zero sperm count. The first is that the sperm are not being made in the testes (non-obstructive) this can be a hormonal issue. The second is where a blockage prevents the sperm from reaching the ejaculate (obstructive).
It is important that men with absent or low sperm numbers are thoroughly investigated, to ensure that they do not have an underlying illness causing their infertility or a genetic problem. For example, some men are carriers for the cystic fibrosis gene and may be unaware as they do not have any symptoms of the condition, however, this can mean they have been born without a vas deferens.
If a genetic issue is identified then the couple can be counselled about the chances of passing a genetic problem onto their offspring, and also about the chances of success if surgical sperm retrieval is required.
More information
Read more from the male perspective in our Men Talk section.
See more information about treatments for male fertility issues.
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