Male Infertility Evaluation Treatment

Semen analysis:

This is the main laboratory investigation for the assessment of the male fertility potential. A sample of semen is examined in the laboratory checking several well defined parameters. These parameters together give a reasonably accurate impression of how normal the semen is. However, there has been great difficulty in defining the optimal value of these parameters. This is because some patients with relatively poor semen parameters can still father children provided their partner’s fertility potential is high.

A semen sample is produced for analysis by masturbation after two to five days of abstinence from ejaculation. Usually an abstinence period of two to three days is adequate. This period of abstinence is for the purpose of standardization so that result from different men can be compared easily. The ejaculate is collected into sterile plastic containers that non-toxic to spermatozoa. It is recommended that the man washes his hands and genitals with soap, rinses them several times with clean water and dries with a clean towel. No lubricant such as petroleum jelly is allowed during masturbation since most of these lubricants have been shown to be toxic to spermatozoa.

Normal values of standard semen analysis
Liquefaction Complete with 60 minutes at room temperature
Appearance Homogenous, grey opalescent
Odour ‘Fresh’ and characteristic
Consistency Leaves pipette as discrete droplets
Volume 2.0ml or more
Sperm concentration 7.2 or more
Total sperm count 20 x 10 6 spermatozoa/ml or more
Motility 40x 10 6 spermatozoa per ejaculate or more
Ejaculation 50% or more spermatozoa with forward progression (grade ‘a’) within 60 minutes of ejaculation
Morphology 30% or more spermatozoa with normal forms
Vitality 75% or more live spermatozoa
White blood cells Fewer than 1 x 10 6 / ml
Immunobead test Fewer than 50% motile spermatozoa with beads bound
MAR test Fewer than 50% motile spermatozoa with adherent particles


Treatment of Male Infertility

Treatments for male infertility range from surgical intervention or intrauterine insemination (IUI) to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Depending on the source of the problem, sperm can be taken from the man’s ejaculate for use in assisted fertilization procedures.

One treatment option for men who do have sperm in the ejaculate is intrauterine insemination (IUI). Intrauterine insemination is an infertility treatment in which sperm are placed directly into the female’s uterine cavity near the time she ovulates. IUIs are commonly performed when there is a low sperm count or low motility. The sperm that will be injected during the procedure are prepared using a process called sperm washing. The sperm are “washed” to remove any extra cells and debris in an effort to obtain the greatest concentration of the highly motile sperm that will be used for the insemination.

One of the most common problems affecting male sperm levels is a varicocele, a tangle of swollen veins surrounding the testicle. Surgical correction of large varicoceles may improve sperm DNA quality and semen analysis results, as well as restore fertility in about two-thirds of cases.

In some cases there is no sperm in the ejaculate so surgical options for sperm retrieval are explored. Advanced sperm retrieval techniques, including TESA, PESA testicular microdissection and testicular biopsy, combined with IVF and ICSI, now allow men with either a low sperm count or no sperm in their ejaculate the chance to produce a child.

Testicular biopsy - an in-office surgical procedure in which several small pieces of testicular tissue are removed and examined for sperm which can be used in fertility procedures.
Testicular sperm aspiration (TESA) - a needle biopsy of the testicle in which a sample of tissue is taken directly from the testis and used to extract sperm for IVF or ICSI.
Percutaneous sperm aspiration (PESA) - a procedure involving a needle inserted into the epididymis in an effort to locate and aspirate a pocket of sperm.
Testicular microdissection - involves careful surgical intervention in the testicle to locate any areas of potentially active spermatogenesis. This allows minimal extraction of testicular tissue which minimizes the risk of permanent damage to the testicles.
For some couples, the use of donor sperm remains the best option for building a family. Obviously, donor sperm is the only option for men whose testicular biopsy reveals complete azoospermia - no trace of sperm in the testicular tissue. The use of donor sperm may also be considered when genetic screening indicates a possibility of passing on hereditary conditions such as cystic fibrosis to male offspring.

An increased understanding of male factor infertility and the recent advances made in assisted sperm retrieval techniques are now giving men who never thought they could have biological offspring the chance to father a child.