‘Don’t put your infertility in a cupboard’ urologist Oliver Wiseman interviewed for podcast

Boost chances of success

“Think about your own lifestyle as well and what you can do to maybe improve things, such as adopting a healthier lifestyle, trying to lose some weight, giving up smoking, and taking regular exercise; those sorts of things. Taking these steps might not change what treatment you end up needing, but it may mean that the treatment is more likely to be successful.”

So, you have a very low or zero sperm count – what next?

Oliver says that a number of tests are needed ahead of an appointment with a male fertility specialist. These are:

• Two semen analyses taken three months apart – sperm count and quality changes and can be affected by illness, so repeating the test provides a more accurate indication of quality.
• Hormone profile from a blood test – the important hormones are testosterone and FSH, which stimulates the testicles to make sperm, and these should be done in the morning.

Oliver continues: “Patients want answers, so ideally there should be some preparation before the appointment so I can try to answer their questions.

“The sperm test gives an indication of sperm quality and quantity, and the hormone levels tell me if the problem is with sperm production. If the levels of FSH are normal it could be that sperm is being produced but there is a blockage that prevents delivery.

“Previous surgery or injury can cause an obstruction, and medication can impact sperm levels.

“I would then examine the patient, asking them to stand up because that is when varicose veins around the testicles become more prominent – they can look like a ‘bag of worms’ – and this too can affect fertility.

“With this information I would normally know if the cause of the zero or low sperm is due to a blockage problem, such as an absence of the vas tube, or due to a problem with the testicles not working properly. At this stage it might be useful to have a genetic test.

Creating a pathway with the couple

“Once I have all the results back, I can then outline a possible path for the patient and the couple can move forward with their fertility journey.

“I never make any assumptions about what a couple will decide to do because it is an individual decision for the couple; all I can do is lay out what options they have.

“Often it involves weeks – if not longer – of discussions between the couple, sometimes with the help of a counsellor, who I think can be really useful in helping to explore some of the feelings around their options.”

Hope for those with zero sperm

“I think the biggest thing to happen over the last ten to fifteen years has been the introduction of MicroTESE. There may be small pockets within the testicles where sperm are being made.

“We can retrieve sperm from those small areas of tissue using MicroTESE. The embryologist can then use ICSI to inject one good sperm into an egg during IVF. This is absolutely phenomenal – it has completely changed the way that male factor infertility is treated.”

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