Make sure your man’s fertility isn’t overlooked

The Daily Mail reported that when Mark Griffiths and his girlfriend Jeanette Parker still hadn’t conceived after a year of trying, they went to their GP.

He referred them to a gynaecologist and, after a series of scans and tests, it was suggested that Jeanette, 38, might have a blocked fallopian tube.
She underwent four minor procedures which cleared the blockage, at least partially.

‘A number of doctors have given us very poor advice and failed to pick up on my problem,’ said Mark Griffiths, pictured with girlfriend Jeanette Parker. Tests on Mark also revealed that while his sperm count was reasonable, the volume of semen was small and the sperm itself ‘acidic’.

However, the gynaecologist dismissed this as nothing serious. ‘He made a joke about making sure you hit the pot and nothing more was said about it,’ recalls Mark, 42, from Portsmouth.

It was only after Jeanette, a personal assistant, had undergone three unsuccessful IVF cycles — costing £15,000 — plus the removal of one of her two fallopian tubes, which had to be removed after an ectopic pregnancy, that doctors suggested that, in fact, the problem might be with Mark’s sperm. He was referred to a specialist male fertility doctor who diagnosed a blocked ejaculatory duct. This was preventing the normal volume of semen being released.
The condition, which causes up to 5 per cent of cases of male infertility, may be triggered by a cyst or scarring due to prostate infections.

Jeanette and Mark now believe if his problem of a blocked ejaculatory duct had been spotted earlier, it could have made a real difference. Babies can also be born with it. Acidic sperm is another sign of a blockage (it also contributes to infertility by making sperm attack the eggs, rather than fertilise them).

Last July — three years after being sent to the gynaecologist — Mark had an operation to clear the blockage.
Research shows up to 30  per cent of those with this condition go on to conceive naturally, suggesting the three IVF attempts Mark and Jeanette endured might not have been necessary. IVF conceptions are twice as likely to end in an ectopic pregnancy (a potentially life-threatening condition where the embryo implants outside the womb).

By costing her a fallopian tube, IVF has actually made it more difficult for Jeanette to conceive — and even if she does, she is at increased risk of another ectopic pregnancy.
‘It has been a very traumatic and costly few years which may all have been unnecessary,’ says Mark, a fire sprinkler installer.

‘A number of doctors have given us very poor advice and failed to pick up on my problem, which is very disappointing.’ In fact, the couple had previously managed to conceive naturally and have a six-year-old son — they now believe if Mark’s problem had been spotted earlier, it could have made a real difference. ‘If I’d had the procedure at the beginning, Jeanette would have most definitely had a greater chance of a natural conception,’ he says.
Mark is just one of thousands of men whose fertility problems are going undiagnosed and untreated, according to some of the country’s leading male health doctors.

Jeanette and Mark had previously managed to conceive naturally and have a six-year-old son
They blame the fact that IVF clinics tend to focus on women’s fertility issues, with little attention paid to men’s problems. Most clinics don’t even employ a male fertility specialist, they say. As a result, some women are going through expensive, and often gruelling, IVF unnecessarily.
As Rowland Rees, a urological surgeon at the Royal Hampshire County Hospital, Winchester, explains: ‘The majority of fertility clinics are gynaecology-led, where the emphasis is on investigating the female partner and carrying out assisted conception.

‘The investigation and treatment of male-related fertility problems is often not done thoroughly enough, and sometimes not at all. In half of cases male problems are partly responsible and, in 20  per cent, it is purely a male issue. Around 50 per cent of male fertility problems are treatable, but unfortunately this is commonly overlooked.
‘Therefore, couples are undergoing IVF — with all the inherent costs and emotional turmoil it can cause as well as the risks to women from conditions such as ovarian hyperstimulation — when they could have conceived naturally had the man been treated. Treating male infertility may also be cheaper, more successful, and less invasive.’

Fertility problems, defined as a failure to conceive after a year of regular, unprotected intercourse, affect around one in six couples. Male infertility can be caused by various factors. One of the most common is low sperm count. A very low sperm count of less than five million sperm per millilitre may be caused by rare genetic conditions such as Klinefelter’s syndrome, Kallmann’s syndrome or Kartagener’s syndrome.

For some men, simply changing their lifestyle is all that is needed to rectify a low sperm count For some men, simply changing their lifestyle — stopping smoking, eating healthily, exercising and cutting down their alcohol and caffeine consumption — is all that is needed to rectify the problem.
Antidepressant drugs, certain types of medication such as chemotherapy, injury to the testes and infections such as chlamydia or mumps, can also affect a man’s fertility.
In 40 per cent of cases, problems are caused by varicose veins in the testes, a condition known as varicoceles.
With many of these conditions, a microscope-assisted procedure, carried out as a day case, can help rectify the problem. For example, a simple procedure to tie off veins containing a faulty valve causing a varicocele may significantly improve pregnancy rates.

But too many men are never offered treatment, says David Ralph, a urological surgeon at University College Hospital London. ‘If a couple goes to an IVF unit, they generally get IVF,’ he says. ‘In many fertility clinics, if a man’s sperm sample comes back as low, the solution is often immediately to have a type of in vitro fertilisation treatment called intracytoplasmic sperm injection (ICSI) — where sperm is surgically removed from the man then injected into an egg to fertilise it.

But there have been major advances in male fertility treatment since IVF and ICSI were introduced some 20 years ago. ‘These now allow successful treatment of many male fertility problems, allowing the couple to conceive naturally. What’s more, corrective procedures are about half the price of ICSI.’

Furthermore, going straight to sperm injection means couples will encounter the same problems conceiving if they want another baby, because the underlying condition has not been treated. And if the problem is a hereditary condition and has not been diagnosed, the man may unknowingly pass it on to his child.

The reason why men are being overlooked is the way fertility care is set up in Britain, say the doctors. Couples with fertility problems tend to be sent by their GP to a gynaecologist for tests or bypass their GP altogether and refer themselves directly to an IVF clinic. But most fertility clinics do not have a urologist who specialises in male infertility — an andrologist — on their team.

Furthermore, if sperm does need to be surgically extracted for IVF, the operation is often carried out by a gynaecologist, says Mr Rees. ‘Andrological problems, such as testicular lumps, low testosterone, erectile dysfunction or ejaculatory problems, may not be picked up on or dealt with,’ he says.
‘Many men are going along their partners to a clinic, are being asked to produce semen and, in some cases are having it surgically extracted without looking at the reasons for a low sperm count or treating it.

‘If men do require surgery to find sperm, this is bizarrely done by gynaecologists — women’s health specialists — as opposed to men’s health specialists. ‘This is not the case in most other countries, where things have been set up differently.’

Yet fertility clinics are not solely to blame. For years male infertility has been neglected as a medical speciality, with urologists focusing on other areas such as cancer and prostate disease, adds Mr Rees. ‘This is now changing and andrology is expanding as a distinct sub-speciality.
‘It’s probably ten years overdue, but if we can treat the cause of male infertility we could prevent many couples having to go through IVF.

‘However, fertility is big business and clinics do not want to give up patients.’ As with all medical problems, the best way to ensure you are seen by a male fertility specialist is to go through your GP, who can refer you to a urologist specialising in fertility, adds Mr Rees.

‘Most regions in the UK now have a male fertility specialist,’ he says. ‘The thing to avoid is self-referral to IVF units before you know what the problem is.’
Meanwhile, although Mark Griffiths’s sperm count and volume are now normal, he and Jeanette have not yet conceived and are planning IVF again because they are ‘getting older’. Mark is urging men who think they may have a fertility problem to seek help from a specialist sooner rather than later. ‘It could prevent a whole lot of heartache and hopefully lead to the baby you are wishing for,’ he says.

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Tertia Albertyn is the founder of Nurture - South Africa’s longest-running and most successful Egg Donation Program. An accomplished speaker and an award-winning published author, as well as an ex-infertility patient herself, she is highly regarded in South Africa and internationally for the work she does in infertility. Tertia was instrumental in establishing the first FDA-approved frozen donor egg bank in Africa. Tertia has an MBA from the University of Cape Town and lives in Cape Town, South Africa with her husband and three children.