The importance of a thorough evaluation of both partners in the relationship cannot be overestimated. Male factors account for at least 30 to 50 percent of all fertility issues in patients.
The semen analysis is done on an ejaculated sample collected after masturbation. It is best to do this test after a patient has abstained from sexual activity for two to five days. The test can be inaccurate if there has been recent ejaculation (counts too low) or if ejaculation has not occurred in a long time (too many dead sperm). Once the sample has been taken to the laboratory, it is analyzed for many different parameters, including fluid volume, sperm numbers, sperm motility (the percentage of moving sperm), and sperm morphology (the shape and appearance of the sperm). Variations can occur from test to test, even in the same man, and sometimes the test needs to be repeated.
A urologist often is consulted after an abnormal semen analysis is obtained. The most common abnormality discovered by the urologist is a “varicocele.” A varicocele is a dilated vein around the testicle, which raises the core temperature of the testicle and can impair the process of making sperm. The correction of a varicocele involves a minor surgical procedure. The procedure ligates the dilated vein, which improves blood flow around the testicle.
You are not alone — it is common for couples to seek help and advice if they are having difficulty conceiving. Infertility cannot always be explained, however there are sometimes reasons why couples find it difficult to become pregnant.
Fertility treatment is an intensive process that requires sensitivity and an understanding of the physical and emotional aspects of every patient’s journey. With the help of our elite fertility specialists, we can introduce you to advanced treatment options, which can in many cases bring light on your journey to parenthood.
In women, fertility problems can be —
- Age: a crucial factor in female fertility as the biological clock limits the ability to conceive. Women start to become less fertile when they are in their 30s and female fertility declines dramatically when women reach their 40s.
- Hormone problems: an imbalance in the hormones that regulate egg production and ovulation can mean that eggs are not produced, released or do not develop properly each month.
- Problems with the fallopian tubes: these lead from the ovaries to the womb and if they are blocked, scarred or damaged in any way, it can stop the egg travelling along them preventing it from meeting the sperm. Damage can be caused by infection or scar tissue.
- Endometriosis: a condition where tissue similar to the womb lining starts growing elsewhere around the reproductive organs.
- Polysystic Ovary Syndrome (PCOS): where there are undeveloped follicles (or cysts) just under the surface of the ovaries that can disrupt ovulation.
- Premature Menopause or Premature Ovarian Failure (POF): where the ovaries stop functioning many years before they should. This can be caused by chemotherapy or radiotherapy for the treatment of any kind of cancer. POF may also occur in cases where genetic conditions are present such as hypoplastic atrophic ovaries or Turner syndrome.
In men, fertility problems can be —
- Azoospermia (no sperm) or Oligozoospermia (low sperm count)
- A blockage in the testes: Where sperm cannot be transported to the penis for ejaculation.
- Retrograde ejaculation: A condition in which semen is ejaculated into the bladder rather than out through the urethra because the bladder sphincter does not close during ejaculation.
- Varicoceles: A varicocele is the enlargement of the internal spermatic veins that drain blood from the testicle to the abdomen (back to the heart). A varicocele develops when the one way valves in these spermatic veins are damaged causing an abnormal back flow of blood from the abdomen into the scrotum creating a hostile environment for sperm development. Varicocoeles may cause reduced sperm count and abnormal sperm morphology which cause infertility.
Reproductive functions are the most important functions in every living organism to continue their species. Different interferences with an organism`s functions can evolve into infertility: vascular, neurogenic, endocrine, immune, psychological state, and even dietary habits.
Testicular Sperm Extraction – TESE
Testicular sperm extraction (TESE) is a surgical procedure that requires the removal of small amounts of tissue from the testicles and extracting the fluid with a thin needle. Further obtained tissue will be used in ICSI manipulation (intracytoplasmic sperm injection).
Spermogram (sperm clinical analysis)
Before conducting an analysis, the man should refrain from sexual activity for a minimum of 3 days, but no longer than 1 week. It is recommended to refrain from visiting a sauna, taking a hot bath, or consuming alcohol the day before a semen analysis.
A common misconception is that infertility affects only women. Actually, in 45% of couples who experience difficulties conceiving, male infertility is the reason.
Unlike women’s eggs, male sperm does not necessarily deteriorate with age, however, despite the fact that men can continue producing sperm and theoretically fathering children into their 90’s, low sperm count and poor quality sperm is becoming more common.
Sperm is released with semen when a male ejaculates. Usually, over 40,000 sperm are released and it only takes one sperm to fertilise an egg and result in pregnancy. Healthy sperm has good motility, meaning the sperm can move easily and is the correct shape to penetrate the shell of and fertilise the ova.
Factors of Male Infertility
Low Sperm Count
One of the increasing problems facing men is a low sperm count. A male sperm count is the number of sperm that are released in semen. The lower the concentration of sperm in semen the less likely the chance of fertilisation.
If few sperm are present in semen, the higher the quality of the sperm needed for conception to take place. The benefit of IVF is that following the extraction of the sperm from semen, healthy sperm can be identified and used to fertilize the egg.
Poor Quality Sperm
High quality sperm is determined by three main factors – the morphology, or shape, of sperm; the motility of sperm that is the ability of the sperm to move; the speed of the sperm.
Sperm is shaped similar to a tadpole. The genetic cells needed for fertilisation of the ova are contained in the front of the sperm and the tail end of the sperm directs it forward. Sperm that is abnormally shaped does not move as well through the semen, reducing the chance of fertilization.
Motility of Sperm
Sperm motility is determined in part by the shape of sperm as well as by the speed. Sperm motility, the ability of the sperm to move forward through the cervical canal to the egg, defines the overall health of the sperm.
Speed of the Sperm
As soon as sperm is ejaculated in semen, the quality of the sperm begins to decrease. The faster the sperm, the healthier the sperm that reaches the egg. Sperm that move quickly and have good motility can penetrate ova without any artificial assistance.
Impaired delivery of sperm
Healthy sperm is often produced but for various reasons cannot be ejaculated. Ejaculation problems can be caused by a blockage in the testes, as a side effect of another illness or by impotence problems.
Infections, viruses and hormonal imbalances all damage sperm. Past illnesses, certain medications and injuries to the testes can damage the quality or amount of sperm produced. Overheating testicles or being exposed to lead and x-rays can all cause male factor infertility.
Surgical Treatments for Male Infertility
Generally, male infertility is caused by problems with sperm or the ejaculation of sperm. For some men, surgery may be required to treat the cause of the infertility.
Commonly known as varicose veins of the testis, varioceles make the temperature of the testis higher which can affect cause low sperm counts. The procedure to remove the varioceles involved removing the blood supply from the varioceles. Following a varicocelectomy procedure the chances of conception are increased.
Blockages in the epididymal prevent sperm from being ejaculated naturally. These blockages are often caused by scarring or cysts which can be removed in a microsurgery procedure called a vasoepididymostomy. This surgical procedure is complex and is only performed if the scarring or cysts are severe.
How Common is Male Factor Infertility?
Male factor infertility is commonly related to the quality or quantity of sperm present in semen. Male infertility can be as a result of blockages that prevent the ejaculation of semen. This cause of male infertility can be overcome by using sperm retrieval methods such as TESE to collect sperm for use in IVF.