Male factor infertility is common. There is insufficient knowledge in the general population of how to optimise fertility in men, and preconception counselling often focuses on female factors. This article provides advice on preconception care for men and discusses strategies that may be implemented to optimise male fertility based on the existing evidence base.
About one in six couples experience infertility and 50% of cases are due to male factors, either as a sole cause or as a contributing factor.1 Although there is increasing awareness about optimisation of general and reproductive health before pregnancy, preconception counselling primarily targets women. Male partners often receive less attention and less is known about preconception care for men.2
Preconception care aims to improve general and reproductive health and should be offered to both partners. Preconception counselling is recommended for all couples who are aiming to conceive. Preconception advice can be divided into four domains:
- advice based on the person’s medical history and a fertility assessment
- educating couples about coital practices
- recognising and eliminating modifiable risk behaviours and exposures
- recommending treatments that may improve fertility.
History and fertility assessment
Early and appropriate recognition of reproductive risks is important and helps to identify people who would benefit from early assessment and targeted interventions. In addition to taking a general medical history, basic fertility assessment of a male partner should cover the following:
- coital frequency and timing and any difficulty with erections or ejaculations
- previous fertility
- childhood conditions (e.g. mumps orchitis, undescended testes or testicular torsion)
- previous genitourinary tract infections
- adverse lifestyle exposures, including past or current use of anabolic steroids.
Early semen analysis and referral to a specialist in male reproduction or urology are warranted if the history is abnormal.