Male infertility is the sole factor in almost a third of cases where couples are struggling to fall pregnant, and a contributing factor in half of all presentations. Despite this, many women are sent off for blood tests, ultrasounds, X-rays and laparoscopies before their male partner’s reproductive system has been examined.
Some kind of fertility or general health issue is suspected if couples have tried to conceive unsuccessfully for 12 months.
Loading
In the new guidelines, it is mandatory for initial evaluations to be done on both male and female partners at the same time.
A physical examination of the testes, not just semen analysis, is also compulsory in primary healthcare settings. Physical examinations are considered best practise because they help identify clinically significant issues with the veins around the testes. Ultrasounds pick up minor cases of varicocele, which often do not require treatment.
It’s also recommended that doctors encourage male patients to undertake regular testicular self-examination until the age of 55.
Urological surgeon Dr Shannon Kim said that in severe cases, varicocele can feel like a “bag of worms” immediately above the testes. People with this condition have a warmer scrotum – thanks to blood pooling in the swollen veins – which can cause pain, lower sperm count and reduce testicular volume.
Kim says the new guidelines will avoid delays in fertility treatment.
“We’ve known about varicocele since 500 BC, thanks to a naked sculpture [that likely depicts the condition]. If you read the medical histories, it used to be horrible what they’d do to those veins. They used to put hot barbs through the skin of the scrotum to strangulate them.”
These days, the procedures are less invasive, more precise and men are put under general anaesthetic.
Abi-Khattar says he was “in and out” of day surgery within a few hours and was told he and his wife could start trying to conceive three months after his surgery.
Loading
“There was a little bit of pain after the surgery. But nothing unbearable,” he says.
The father of three says he now tells all his friends who have been “trying and not striking luck” to book in a physical examination with their GP.
“Just go. Get it done. Kids are a gift.”
Professor Luk Rombauts, medical director of Monash IVF, welcomed the new guidelines. He said that in his experience, men can be less comfortable talking about their fertility issues than women.
“It’s something that causes them shame,” Rombauts said. “I hope that in the years to come we can be more open in discussing these problems. GPs have a role to play there. That’s where the guidelines are going to be particularly useful.”
Dr Karin Hammarberg, a women’s and global health expert, agreed.
“There has been a lack of focus on the male partner in the past, so this is really timely.”
Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.
