Male Factor Infertility
Male problems may be contributory in about 30-40% of infertile couples. The initial screening evaluation of the male partner includes a history and two properly performed semen analyses. If abnormalities are revealed by either the history or analyses, the male partner should be evaluated. The semen analyses and additional laboratory tests which may be performed in the male’s evaluation are discussed below.
Semen Analysis: At least two semen samples collected by masturbation on separate days
are recommended. Each sample should be collected after abstaining from ejaculation for
at least 48 hours, but not longer than five days. The complete ejaculate should be
collected in a sterile container provided by the clinic or laboratory and should be
examined within one hour of collection. Components of the semen examination and normal
values are detailed below:
- Liquefaction (conversion into a liquid): complete within 60 minutes
- Appearance: homogeneous, gray-opalescent ejaculate
- Volume: (amount): > 2 milliliter
- Consistency: Not viscous (not thick)
- Morphology (structure): > 14% have normal shape
- Concentration: > 20 million per milliliter
- Total count: > 40 million sperm per ejaculate
- Motility (movement): > 50% at one hour
- pH (acidity): > 7.2
- White blood cells: < 1 million per milliliter
- Endocrine (Hormone) Evaluation: Normal sperm production and sexual function are dependent on a normal hormonal environment. An endocrine evaluation may be performed if: 1) a low sperm concentration is detected, 2) there is impaired sexual function, or 3) there are other signs of endocrine disease. Endocrine evaluation includes measurement of follicle stimulating hormone (FSH) and testosterone. Luteinizing hormone (LH) and prolactin are also commonly measured.
Additional Semen Tests
These optional tests may provide more information about the semen or sperm and can help define specific abnormalities or diseases of the male reproductive system. These tests include:
- Vital staining – determines numbers of living and dead sperm.
- Semen fructose – the absence of fructose, a sugar-like substance in the semen, means either the vas deferens are obstructed or that the seminal vesicles are absent.
- Peroxidase staining – differentiates white blood cells from immature sperm to assess for possible infection.
- Semen culture – checks for bacteria that may cause genital infection.
- Genetic Evaluation: The importance of genetic evaluation in infertile males with severe oligospermia (sperm counts of less than 5 to 10 million per ejaculate) or non-obstructive azoospermia (absence of sperm in semen, not due to blockage) has recently been established. These patients may have abnormalities in the number of chromosomes (karyotype) or abnormalities in the structure of the male chromosome (microdeletion of the Y-chromosome). Patients with azoospermia as a result of being born without two vas deferens frequently have a mutation of a gene responsible for the disease cystic fibrosis but do not have the disease itself.
No semen test can fully predict fertility. Not all of the tests discussed above are appropriate for every couple. The tests performed will depend upon the findings during your evaluation.
Treatment Options
Treatment options for male factor infertility include intrauterine insemination (IUI) of the husband’s sperm, intracytoplasmic sperm injection (ICSI) during an IVF procedure and the use of anonymous donor sperm when the husband’s sperm is absent.
More recently, we have been able to aspirate sperm directly from the testes when there is an obstruction in the vas deferens. This can be an alternative to vasectomy reversal but requires IVF and ICSI because the amount of sperm obtained is very small.
This information was modified from the American Society for Reproductive Medicine Patient information sheet for male factor infertility (www.ASRM.org)