If you suspect that you are sub fertile, you should be aware that
infertility is a “couple’s problem”. Convincing data supports the assertion that approximately half of all infertile couples have a male component. The male semen analysis is one of the most important infertility tests and should be done early in the course of your infertility evaluation.
Your partner may have a normal semen volume and still be sub fertile. Viable sperm must be produced in his testicles, transported through the vas deferens past the prostate gland, through the urethra, and ejaculated out the penis. Once deposited in the vagina, they must swim through the cervical mucus, past the cervix, and into the uterus. Sperm must attach to and penetrate an egg to cause fertilization.
The semen analysis examines many factors according to the Kruger Strict Criteria or the World Health Organization Criteria. In general, the semen analysis includes:
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Volume of sperm in the ejaculate- the normal value is more than 20 million sperm/milliliter.
- Motility (ability to swim)-More than 50% should be actively motile (moving)
- More than 14% normal forms- the heads and tails are properly shaped.
- Less than 5 white blood cells per high power microscope field. More could indicate infection.
- Other characteristics, such as viscosity, are also evaluated.
The time required for sperm cells to develop to maturity is three months. A semen analysis done today reflects the conditions affecting sperm development three months ago. For example, the scrotum performs the vital function of controlling the temperature of the testicles. If the temperature of the testicles needs to be lowered the scrotum expands moving them further away from the body. The reverse happens when the temperature of the testicles needs to be increased.
Occupation can have a negative impact of sperm quality, as could be the case with a long distance truck driver. Since he remains sitting for long periods of time, the scrotum cannot perform its cooling function. A semen analysis done on this man today may be low because of conditions that existed three months ago. This is true for other factors that can affect sperm count including high fever and/or infection, environmental toxins, alcohol, heavy metal exposure, smoking, etc. Conversely, actions taken today to correct the problem will not yield improvement for three months.
A varicocele is a common cause of subfertility that consists of a “mass of varicose veins” in the scrotum. Veins carry blood away from organs, and in the case of the testicles, also perform a cooling function. A varicocele effectively raises the testicular temperature thus negatively affecting sperm production. A urologist can usually surgically correct a varicocele.
A man may produce antibodies to his sperm. When antibodies are present they seek to destroy the sperm cells as if they were viruses or bacteria. Sperm cells must be exposed to blood cells before an antigen--antibody reaction can occur. In some cases, antibodies result from testicular trauma. In other cases, antibodies result from surgery (such as vasectomy and vasectomy reversal).
Male infertility is rarely caused by hormonal imbalances. The hypothalamus releases gonadotropin releasing hormone (GnRH), which stimulates the pituitary to produce FSH and LH. FSH stimulates the Sertoli cells in the testicles to produce factors that support sperm development. LH is also essential since it causes testosterone production by the testes. Abnormally high levels of FSH usually indicate poor sperm “quality” and imminent failure of the testes.
Very few medications are effective in treating male infertility unless it is due to hypogonadotropic hypogonadism (extremely low levels of FSH and LH). This condition can sometimes be treated with medications such as intramuscular testosterone and hCG.
Mild male factor infertility is often treated using
intrauterine insemination (IUI). In this procedure, sperm are collected, washed, concentrated, and injected directly into the uterus. Moderate to very severe male factor can be treated with
in vitro fertilization and
intracytoplasmic sperm injection ( ICSI ).
ICSI was a major breakthrough in male infertility treatment because fertilization can be accomplished with as few as one sperm. The sperm can be obtained from the ejaculate or directly from the reproductive tract using
percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE). At UAB, epididymal sperm is obtained, frozen, and later used. This epididymal sperm is then thawed and inserted directly into the egg using a microscopic needle at the time of in vitro fertilization.
(See ICSI)
In the past, donor sperm was the only option for couples with moderate to severe male factor. Now, as long as a single viable sperm can be obtained, the couple can have a genetically related child.