Male infertility treatment

Male Infertility

Infertility is an increasingly prevalent issue, affecting nearly a quarter of all couples of reproductive age. Male infertility accounts for up to 50% of all infertility cases and is associated with changes in semen quantity and quality. In many instances, treatments are available that can improve sperm quality. Northway Fertility Centers offer a full range of male infertility treatment services, from fertility assessments to surgical interventions and modern assisted reproductive techniques. 

Deterioration of sperm quality

A common misconception that a large volume of semen released during ejaculation automatically indicates high sperm quality exists among men. However, this is not the case. In reality, men's sperm quality and fertility have been decreasing for quite some time. Clinical studies show that over the past 45 years, the average sperm count in men’s semen has decreased by as much as 51.6%. In 1973, the average sperm count was 101 million per millilitre, but by 2018, it had plummeted to just 49 million.

Research has shown a connection between male infertility and overall health. Additionally, it has been shown that the quality of a man's sperm not only affects his ability to conceive but also plays a crucial role in the health and well-being of his child.

Causes of male infertility

There are a number of reasons why sperm quality may be unsuitable for fertilisation:

• Health issues and diseases: one of the most common causes of male infertility is varicocele. Sperm quality may be unsuitable for fertilisation due to undescended testicles, lack of sperm production in the testicles, previous infections, testicular cancer, chemotherapy, and other factors. Erectile dysfunction also hinders the ability to conceive.  
• Age: While a man's ability of having a baby is not affected as significantly as a woman's, it does decline with age. If the man is over 40, it may be more difficult for the couple to conceive, especially if the woman is also older. Also, women with a husband older than 45 are at higher risk of miscarriage.
• Environmental factors: Sperm is negatively affected by air and environmental pollution from parabens, polychlorinated biphenyls, pesticides, bisphenol A (BPA) used in plastic production, and phthalates, as well as microplastics, which are components of plastic degradation. Microplastics can lead to various endocrine disorders, including fertility issues in both men and women. Due to their specific structure, some microplastics interact with and bind to sex hormone receptors in the male body. Numerous studies involving both animals and humans have shown that even a small exposure to microplastics significantly decreases testosterone levels and worsens sperm quality. 
• Lifestyle: Sperm quality can be negatively affected by poor nutrition, obesity, lack of physical activity, harmful habits (such as smoking and excessive long-term alcohol consumption), heat in the testicular area (like using saunas or steam rooms), carrying a phone in the front pocket of pants, placing a laptop on the testicles, prolonged stress, anxiety, tension, and many other factors. 
• Unknown causes: Unfortunately, there are times when the exact cause of infertility cannot be determined. This is referred to as unexplained infertility.

When and where to go for possible infertility?

If a couple with a regular sex life has been unable to conceive within a year given that they are not using contraceptive methods (or within six months if the woman is over 35), it is recommended that the couple undergo an evaluation. The man is advised to seek a consultation with a clinician specializing in andrology or urology, focusing on fertility issues.

It is important to note that there are many specific causes of infertility and ways to address them that may not be understood by specialists who do not delve deeply into fertility problems. Therefore, we highly recommend consulting clinicians specialising in this field, particularly urologists or andrologists. 

Where to start?

• We recommend the man start the investigation of the causes of infertility in your couple with a spermogram. You can take the test at our centres in Vilnius, Kaunas and Klaipėda.
• To register for a spermogram, please call our desk office at +370 633 30 303.  
• Arrive at the testing location at the scheduled time, or submit a semen sample for testing within one hour after ejaculation.
• You will receive the results of the spermogram with a comment from the embryologist by email:
  • If the test results show no abnormalities, we recommend that your partner/couple seek further investigation into the causes of infertility by an obstetrician-gynaecologist specialising in the treatment of infertility.
  • If the test results show abnormalities, we recommend that the man see an endocrinologist and urologist or a urologist specialising in infertility treatment for a more detailed examination.

Male fertility testing

Northway Fertility Centers offer comprehensive male fertility testing:

• A clinical examination will be carried out to assess the physique, identify any pubertal disorders, check for enlarged mammary glands and look for any other abnormalities suggestive of hormonal imbalances. The testicles are also examined. 
• An ultrasound examination is carried out to assess the structure and size of the testicles.
• A spermogram is carried out to assess a man's sperm quality, parameters and potential causes of abnormalities.
• Semen-specific tests: assessment of oxidative damage, sperm HBA and sperm DNA fragmentation tests.

Male infertility treatment

Every infertile couple is treated individually. Once the cause of a man's infertility is identified, we will offer options how to treat it. Northway Fertility Centres employs a variety of efficient treatment approaches.   

Drug therapy

Every infertile couple is treated individually. Once the cause of a man's infertility is identified, we will offer options how to treat it. Northway Fertility Centres employs a variety of efficient treatment approaches.

Lifestyle changes

A healthy balanced diet, weight loss, increased physical activity and mobility, quitting smoking, and consuming alcohol and caffeine in moderation all have a good impact on sperm quality and male fertility. The usage of antioxidants also increases the chances of conception to some extent.

Some lubricants have been shown to diminish sperm viability and motility, as well as hinder migration through the female genitalia. Therefore, if lubrication is required during sexual intercourse, it is best to choose lubricants that do not affect the quality of sperm. 

Medical acupuncture

Medical acupuncture procedures are also offered to couples facing infertility. The effects of acupuncture on fertility have been demonstrated through scientific research. According to their findings, the use of acupuncture in conjunction with medical assisted reproductive techniques has a significant positive impact on conception rates. Acupuncture influences the release of hormones that are important for fertility, thereby improving the function of the reproductive organs. Acupuncture therapy also effectively reduces the release of stress hormones and affects the sympathetic nervous system, which, when activated, inhibits the parasympathetic nervous system that includes reproductive function. Additionally, acupuncture may help enhance sperm quality.

Surgical treatment

One of the most common causes of male infertility is varicocele. Varicocele is found in about 15–20 percent of men and refers to the enlargement of veins, most often occurring on the left side, but it can also affect the right side or both sides of the scrotum. The veins in the scrotum become swollen and engorged with blood, which raises the temperature in the scrotum and adversely affects male fertility.  

A small incision and a straightforward urological procedure—varicocelectomy—during which a powerful microscope is used and the veins in the scrotum are removed, can significantly improve sperm quality and increase the chances of conceiving a child. Northway Medical Centres in Vilnius, Kaunas, and Klaipėda offer advanced microscopic varicocele removal surgery, which is considered the gold standard for treating varicocele and yields excellent outcomes. Many men have successfully become fathers following the surgery.  

Assisted reproduction procedures

If the changes in spermatogenesis have an unclear origin, treatment decisions are made based on the duration of infertility, the degree of changes, the couple’s age, and other factors. In cases of minor deviations, the couple is sometimes left under observation for a period of time, while in other cases, they are referred for assisted reproductive procedures. 

Depending on the quality of the sperm, various assisted reproductive procedures are used: 

• Intrauterine insemination (IUI). This is a procedure in which a man's sperm undergoes special preparation in a laboratory and is then injected directly into the woman's uterus.
• In-vitro fertilisation (IVF). In this technique, eggs and sperm are fertilised in the laboratory to produce embryos, which are later implanted in the woman's uterus. 
• ICSI (intracytoplasmic sperm injection). This process involves injecting the sperm directly into the egg.   
• TESA or microscopic TESE. TESA is a microsurgical procedure where seminiferous tubules are extracted from the testes and searched for sperm cells. Microscopic TESE is a procedure in which the coverings of the testicles are carefully opened, and sperm cells are searched for under a microscope, even if they are not present elsewhere. Even a single found sperm cell can be used to fertilise an egg. Thanks to these procedures, those who have lost hope can still experience the joy of biological fatherhood. 

If a man is unable to produce sperm and there is no possibility of obtaining sperm even through TESA or microscopic TESE procedures, the couple must choose between not having children or having them using donor sperm. Sperm donors are selected based on very strict criteria, and they undergo all necessary tests for various diseases and conditions. Therefore, it is definitely worth considering this option to experience the joy of fatherhood. 

Psychological support

Every year, more and more couples struggling with infertility seek help from specialists. Most of them experience tremendous stress, tension, and even pressure from those around them. Questions from relatives and close friends about when they will finally have children feel like a stab in the side, and depression is a common companion for infertile couples. Studies show that the rate of depression among infertile couples is the same as that among individuals with cancer. 

The high intensity and fluctuations of various emotions, along with long-term stress, anxiety, tension, and feelings of hopelessness and helplessness, can negatively impact the outcomes of infertility treatments. Therefore, Northway Medical Centers also offer support from psychologists and psychotherapists to the couples who are struggling to conceive.