Male infertility is defined as the inability of a man to father a child. Although male infertility may be associated with impotence, many infertile men have perfectly normal and happy sexual relationships. Male infertility can be classified into four main types:
- No sperm (azoospermia) accounts for 3-4% of male infertility.
- Poor sperm quantity (oligospermia) or quality e.g. low motility (asthenozoospermia) or a high percentage of abnormal sperm (teratozoospermia). Antisperm antibodies, etc. This subgroup may account for about 90% of male infertility.
- Sperm dysfunctional, where there is a normal semen analysis but the sperm lack or have a defective fertilizing capacity, resulting in complete failure of fertilization or poor fertilization of the eggs in IVF. This accounts for 3-6% of male infertility. Inability to ejaculate into the vagina. This accounts for 4-6% of male infertility
Many people assume that infertility is a “woman’s” problem. It may surprise you to know that many cases of infertility is the result of a male factor. Male problems may be a contributing factor in 30 to 50% of couples suffering infertility. The male partner will undergo a physical examination to determine if he has any underlying physical abnormalities or hormonal disorders such as breast enlargement, and a genital examination to assess the size of the testicles, to locate the opening of the urethra and to detect varicocele. Thereafter, the doctor will order initial investigations to examine the functions of the reproductive system and to determine the presence of any systemic or hormonal disorders. It is important to note that no semen test can fully predict fertility.
1. Semen Problems
- Volume: 2 ml or more.
- Liquefaction: normal (immediately after ejaculation the semen contains jelly like particles but after about 30 minutes these should liquefy more or less completely).
- Count: 20 million or more sperm per ml.
- Morphology: 30% or more of the sperm should have normal shape.
- Motility: 50% more of the sperm should be swimming and moving forward.
- Vitality: 75% or more of the sperm should be alive.
- Cells: white cell count should be less than 1 million per ml. If there are more cells, this may be an indication of an infection.
The semen analysis test is the most important infertility test. Semen analysis is the first step in the medical evaluation of male infertility. The semen analysis test is usually performed after 3-5 days of sexual abstinence or performed after a minimum of 3days and maximum of 5days of sexual abstinence. The clinic usually provides the man with written instructions about the method of collection. The sample is usually collected after masturbation into a sterile pot. The volume of the ejaculate is measured, and liquefaction of the ejaculate is estimated. Then a drop of semen is examined under the microscope where the number of sperm is counted, how they move around is assessed, and the proportion of normal sperm can be estimated. Semen assessment should be performed in accordance with World Health Organization (WHO) methodology. The WHO semen values are based on populations of fertile men and are described as ‘reference’ values rather than ‘normal’ values.
You may be asked to produce a “split-ejaculate” collecting the first one or two spurts of the ejaculate into the “first pot” and the remainder into the “second pot”. The reason for the split ejaculate is to assess each pot separately. Pot one usually contains the best sperm.
Providing a semen sample by masturbation can be very stressful for some men. Men who have this problem should ask for help from their partners to provide the sample. If all these fail, it is possible to collect the semen sample using a special condom during sexual intercourse.
A normal sperm test is reassuring. If the test is abnormal, the test will need to be repeated two to three times over a period of two to three months to confirm whether the abnormality is persistent or not.
Remember that fertile men may have from time to time an abnormal test, so a single semen analysis test is of little significance. Because of the natural variation in sperm quantity and quality, many doctors request that two or three samples be examined over an interval of one to three weeks. It is just not possible to say with certainty that a man with a low sperm count is infertile, as many men with low or moderately low sperm counts are fertile. Similarly, it is not possible to say with certainty that a man with a normal count is fertile as his sperm may be lacking fertilizing capacity.
2. MAR Test
4. Sperm Function Tests
IVF is the ultimate sperm function test because it directly assesses whether or not the sperm can fertilize the egg.
5. Testicular biopsy
Testicular biopsy is best performed in a center where there is a facility to freeze the sperm, thereby obviating the need for a repeat procedure during treatment with ICSI. The Assisted Conception Unit at Finney Hospital is equipped to do this. Furthermore, when surgery is carried out outside a treatment cycle, any sperm found should be stored for future use.
If no sperm is retrieved; which could be due to either congenital absence of germ cells or sperm maturation arrest.