Male infertility 

Male infertility

Evaluation, Examination, Semen analysis


Male Infertility Information

Most couples assume that getting pregnant will be easy. Yet, for millions, trying to conceive will be much harder than they expect. This is because as many as 1 in 10 couples experiences problems with infertility.

Fertility is an issue that involves both men and women. Approximately 40 percent of infertility cases are caused by a male factor, and 20 percent of all infertility cases are caused by a combination of male and female factors. Infertility is defined as failure to achieve pregnancy after one year of unprotected intercourse.

Fertility depends on the man's ability to deposit adequate numbers of healthy, mature, functioning sperm into the female reproductive tract near the time of ovulation. For most men, a detailed medical history, a physical examination and a semen analysis will for the major part of the fertility screening.

The causes of male infertility are multiple. The primary cause is deterioration in sperm quality. Unlike female infertility, male factor infertility decreases with age just slightly. Deterioration of sperm quality is usually caused by the conditions listed below.


Diagnostic procedures

Once you have been trying to conceive for more than a year without success, it may be time to make an appointment with a fertility specialist for an evaluation. All the diagnostic procedures will start with a detailed conversation. This conversation is vital for getting an accurate account of the previous infertility situation.

Fertility Evaluation
The specialist physician will need information relevant to male fertility and will determine if adequate sexual contact is taking place. Sexual history may also be discussed at this time.

Physical Examination
The testes and prostate are examined for consistency, size and evidence of abnormalities. Examination of sperm transport disorders and erection problems.

Semen Analysis
Male fertility is also evaluated through the microscopic study of sperm. Your doctor will want you to provide a semen sample. The results of these tests are sometimes helpful to the physician in determining the likelihood of pregnancy or selecting treatments.


Fertility Evaluation

Men who feel uncomfortable about the fertility evaluation should discuss these feelings with their partner and physician. Talking about anxiety beforehand can make the actual exam much easier.

Fertility evaluation will start with a detailed conversation. This conversation is vital for getting an accurate account of the previous infertility situation and medical history.

Be prepared to answer questions about the following:fertility evaluation
  • general medical history;
  • frequency of sexual intercourse;
  • a vasectomy or vasectomy reversal;
  • infection of the reproductive organs and bladder;
  • sexually transmitted diseases;
  • trauma to the testes and undescended testis at birth;
  • a hernia in the groin or mumps after puberty;
  • radiation or chemotherapy for cancer;
  • thyroid disease;
  • tobacco, drug and alcohol use;
  • exposure to environmental toxins;


Physical Examination

After the medical history is completed, a physical examination is required. The physician generally concentrates on signs of testosterone production, genetic abnormalities, muscle and fat distribution, voice pitch, hair distribution and overall well-being.

The testes and prostate are examined for consistency, size and evidence of abnormalities. Sperm transport disorders can be caused by inflammation, varicocele, and congenital disorders. In these cases even if the sperm quantity is sufficient, the spermatozoa still can't move to the female reproductive tract since the ducts are obstructed.

A low sperm count can often have genetic causes. A small sample of vein blood is enough to identify several genetic disorders that may be the cause of infertility.


Semen Analysis (Spermogram)

Semen Analysis spermogramMale fertility is evaluated through the microscopic examination of sperm. The examination assists in evaluating the semen's ability to fertilize the egg. The quality of the semen has a significant effect on choosing the most appropriate treatment.

Your doctor will want you to provide a semen sample. The sample is collected by masturbation at your doctor's office or fertility clinic, in a private, comfortable room designed specifically for this purpose.

You will be asked to collect your semen in a sterile specimen cup. It is important that the sample is examined within one hour of having given the sample. It may also may be brought from home in a sterile sample container within half an hour of having given the sample.

It is important to abstain from ejaculation 3 or 4 days before giving a sample for semen analysis. Abstaining from ejaculation for a shorter period of time may influence the sample by reducing sperm density and abstaining from ejaculation for a longer time increases the number of dead sperm.

It is also important to ensure the entire sample goes into the dish because the composition of the semen is different in different stages of ejaculation.

If the results are not normal or the sample is not complete because you missed the container for sperm collection, this test may need to be repeated. Test results often vary, so you may need to do this procedure more than once.


What is checked in a semen analysis?

Different samples of the same person may exhibit notable differences in the number of sperm in your semen (your sperm count), how well they swim (motility), and whether they are normal (morphology). Since sperm quality may change, a spermogram may be repeated after a period of time recommended by your doctor or clinic.

A number of variables are checked in a semen analysis.

  • The first of these is the sperm count, or the number of sperm per milliliter of semen. Normal semen usually contains at least 20 million sperm in each milliliter.

  • The second variable is sperm motility, or movement of the sperm. In a normal specimen, usually more than half of the sperm are moving forward progressively. A sperm's swimming motion helps it travel upward through the cervix to the uterus and fallopian tubes. Motility is also needed for the sperm to penetrate the egg's tough outer shell-like covering for fertilization.

  • The third variable is sperm morphology. Morphology is the medical term for shape or form. About half the sperm in normal semen have oval heads and slightly curving tails, which is normal. Every man has some abnormally shaped sperm. Most specialists believe that these abnormal sperm will not fertilize an egg.sperm morphology

    Many patients are concerned that abnormal sperm will increase the risk or birth defects, but this is not the case. A large percentage of abnormal sperm may reduce the number of normal sperm with fertilizing potential.
While evaluating sperm morphology, physicians also look for a large number of white blood cells, possibly indicating inflammation, infection or both.The volume of ejaculate varies normally from one to five milliliters; there are about five milliliters in a teaspoon. If the volume is low, the sperm may not reach the cervix.

Other factors examined include semen viscosity (thickness) and semen volume (amount). Ejaculated as a liquid, semen immediately assumes a jelly-like consistency and then liquefies again within 30 to 40 minutes. Therefore, semen viscosity is examined at an interval after ejaculation when full liquefaction should have occurred.

If the sperm count, motility or morphology are reduced artificial insemination, IVF or ICSI may be required. The appropriate treatment method will be individually selected by your doctor after evaluation of diagnostic results of both partners.


Other Factors

In case of the total absence of sperm cells in sperm (azoospermia), biopsy of the testicular tissue (TESA) may be required to examine sperm production or to get sperm cells for assisted reproductive techniques. With the help of TESA and ICSI procedure men with azoospermia became able to have healthy offsprings.

Men who smoke have a 13 - 17% lower sperm count that those who do not. High alcohol intake can markedly reduce the sperm count and motility, however low and moderate consumption up to normal recommended levels has not been found to lead to problems. Cannabis, cocaine and anabolic steroids all reduce the sperm count and affect motility and number of normal sperm.

Tight fitting clothes and prolonged periods of sitting can lead to a reduction in sperm count through excessive heating of the testes. Men who have an abnormal semen analysis should wear loose fitting trousers and underwear such as boxer shorts.

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