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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Male Infertility

Male infertility is very common. Approximately 1 in 20 men are sub-fertile and a male-factor is present in half of all fertility couples. One third of all IVF procedures are performed due to male-factor infertility. For most men discovering that they are infertile comes as a huge surprise.

Often the infertile man is completely healthy but for some reason produces poor quality sperm. In other cases, an infertile man may have serious medical problems, such as low levels of the male hormone testosterone. It is therefore important that men in infertile relationships, consult and are assessed by a doctor who specializes in reproductive medicine. Factors such as previous fertility, genital surgery, infection or injury, undescended testes and certain systemic diseases are of importance. Investigations of male-factor infertility include, amongst other things, the assessment of; the adequacy of sexual development, the size and texture of the testes and the normality of the tubes attached to the back of the testes.

Many infertile couples have more than one cause of infertility, so it is important for both partners to consult a specialist. Several tests may be required to determine the cause of the infertility. In some cases, a cause is never identified (idiopathic). Fertility tests can be expensive and may not be covered by insurance. Find out in advance what your medical plan covers.


This involves a physical examination of your genitals and questions about any factors that may affect your fertility, such as any inherited conditions, chronic health problems, illnesses, injuries or surgeries. Your doctor may also enquire about your sexual habits and your sexual development during puberty.


The most important diagnostic tool in the initial investigation of male infertility, is the analysis of freshly ejaculated semen. The proper assessment of semen quality is essential for the diagnosis of a number of treatable disorders affecting male fertility. Even if no treatment is available to improve semen quality in many male-factor patients, semen analysis provides important information regarding the possibility of natural pregnancy or the use of assisted reproduction techniques (ART's).

Semen is a mixture of secretions from several components of the genital tract. The testes contribute 5% of the semen volume, but all of the sperm. During ejaculation, the seminal fluid which is primarily produced by glands at the base of the bladder, particularly the seminal vesicles and prostate, moves up through the epididymis and vas deferens. The first part of the ejaculate contains the highest number of sperm with the best motility.

Semen quality varies widely between men. Even for a particular man, a minimum of 2 sperm counts at least 3 weeks apart, need to be taken to give an accurate indication of sperm quality. Sperm samples need to be taken after 2-5 days of sexual abstinence and it is important that there are no changes in temperature.

The analysis of the ejaculate includes several characteristics of the seminal fluid:

* Seminal fluid volume, ph/ standard tests volume > 2.0 ml
* Sperm count/ concentration > 20 million sperm/ ml
* Sperm motility > 50% with forward movement
* Sperm morphology > 15% normal forms
* White blood cells < 1 million cells/ ml
* Sperm antibodies (Immunobeads tests) < 50% sperm with adherent particles

Seminal fluid volume- The average volume of semen produced at ejaculation is 2-5 ml. Volumes of less than 1.5ml (hypospermia) or more than 5.5ml (hyperspermia) are probably abnormal. Lower volumes may be seen after frequent ejaculation and higher volumes are seen after prolonged abstinence. Various factors regarding the seminal fluid will also be evaluated, such as the fluid's colour, viscosity and how long it takes for the semen to liquefy after ejaculation. All of these aspects have an impact on sperm health.

Sperm count- A sperm count greater than 20 million/ml is considered normal. However, the average for the population is 60 million and some men produce up to 200 million/ml. Sperm counts between 5 and 20 million do not necessarily indicate a serious fertility problem on their own. Several other factors play a role in this regard, such as sperm motility and sperm morphology.

Sperm motility- This refers to a sperms ability to swim. Under normal circumstances, 50% of sperm show some motility. Sperm motility is often impaired in men with idiopathic (unknown) poor sperm production. Sperm autoimmunity, a condition that accounts for 6% of male infertility cases, is a condition that predominantly affects sperm motility. Immotile sperm may also be indicative of a structural problem in the sperm tail or necrospermia (the death of a sperm). In a normal sperm count, at least 25% of spermatozoa should be swimming with rapid forward movement and at least 50% should be swimming forward, even if only sluggishly. At least 75% of spermatozoa should be alive (it is normal for up to 25% to be dead).

Sperm morphology- The shape of sperm is an important predictor of fertility. At least 30% of spermatozoa should be of normal shape and size. As this percentage decreases, so does fertility, particularly in men with ejaculates with less than 5% of normal-shaped sperm. Sperm are stained and viewed under microscope, with the assessment of the head, middle and tail. This is known as the Kruger morphology test. Many sperm that are structurally abnormal, have more than one defect, which may affect all regions of the sperm.

The following terms are used to describe conditions in which one or more factors is abnormal:

* Aspermia- the patient produces no sperm
* Azoospermia- the patent produces semen containing no sperm
* Oligozoospermia- the patient has a low concentration of sperm, less than 20 million per ml


As part of a semen analysis, a test may be carried out to look for antisperm antibodies. The immune system produces antibodies as part of the normal defense against foreign substances and organisms. Sperm are normally protected from exposure to the immune system. If sperm come into contact with the body's immune system, through trauma or injury for example, antibodies may be produced. These antibodies cause the sperm to club together, have an impact on their motility, and affect their ability to penetrate their partner's cervical mucous. Antibodies located on the sperm head may prevent the sperm from fertilizing the egg. You are likely to have antisperm antibodies if you have had a vasectomy reversal. The immunobead technique is a simple test that can be used to detect antisperm antibodies in blood or semen. A mucus interaction test may also be performed, to establish the sperms ability to swim through mucus.


It is important to assess sperm vitality or the percentage of sperm that are alive. A decline in sperm vitality is associated with genital tract infections and disorders of sperm transport through the genital tract. A high white cell count is a marker of possible genital tract infections. Even in the absence of a history or symptoms, the finding of a high white blood cell count, indicates the possible existence of an infection and may require appropriate antibiotic treatment. These infections may contribute to sperm damage and are easily treatable.


In men who are producing no sperm or who have a very low sperm count, blood tests may be performed, to ascertain whether the failure to promote sperm development, is due to testicular or central nervous system failure. Hormones that play a role in this regard are; testosterone, follicle stimulating hormone (FSH) and luteinizing hormone. Poor testicular function can reduce testosterone levels, which in turn affects sex drive and energy levels. FSH tests provide information about the amount of sperm being produced. In normal men or those with a blockage of sperm outflow, FSH levels are normal. However, when the testicle is severely damaged and few or no sperm are being produced, FSH levels rise progressively. A few cases of infertility may be improved by replacing or boosting hormone production.


An ultrasound uses high-frequency sound waves to produce images inside your body. A small wand is moved over the surface of your scrotum to produce images on a video screen. A scrotal ultrasound provides evidence of varicocele or obstruction of the epididymis, the part of the testicle that stores sperm. It is also used to confirm small or atrophic testes, or abnormally formed testes.


This type of ultrasound, involves inserting a small, lubricated wand into your rectum. Transrectal ultrasounds, allow your doctor to check the health of your prostate and to check for any blockages in the ejaculatory ducts and seminal vesicles, that are responsible for the transportation of semen.


This test is useful for identifying a condition known as retrograde ejaculation, whereby sperm travel backwards into the bladder instead of out the penis during ejaculation. A urine sample needs to be collected after orgasm and is then checked for the presence of sperm.


Certain genetic abnormalities are associated with absent or very low sperm count. Sometimes these abnormalities only appear as infertility in otherwise healthy individuals, or infertility reveals genetic abnormalities that may be transferred to a male's offspring. Since some of these abnormalities are genetically transferred, they may have significant implications for the couple's child. Genetic analysis, tests and counseling are recommended for these couples before they attempt to conceive through assisted reproduction.

These blood test can reveal whether there are subtle changes in the Y chromosome, signaling the possibility of a genetic abnormality. Genetic testing may also be ordered to diagnose Klinefelter's syndrome or cystic fibrosis.


A testicular biopsy may be performed under anesthetic, if the semen analysis indicates that there is no sperm production. This test involves removing samples from the testicles with a fine needle, to ascertain whether sperm production is normal and if there are sperm present in the testes. If it is, the problem is likely to be related to an obstruction or another problem with the sperm transport system. In some cases of blockage, an ultrasound of the prostate and bladder region is performed.


When ultrasound results are uncertain, a vasography may be performed. Contrast dye is injected into the vas deferens, the tubes connecting the site where the sperm is stored to the duct that expels it, and the ejaculatory ducts. An x-ray is taken as the dye flows through the ducts, to determine if there are any blockages.


Having healthy sperm is an important factor in male fertility. A number of tests can be performed to establish; how well your sperm survive after ejaculation, how well they can penetrate an egg, and whether there is any problem attaching to the egg.

In men with a very low sperm count or those who have azoospermia, a fructose test may be performed to ascertain whether the sperm is blocked or just not being produced.

In cases where a man has such a low sperm count that no sperm are noticed on the initial slide test, a spun sperm specimen test may be performed. This test helps determine if there are any sperm or not, by spinning down the ejaculate sample, allowing the sperm that may be present to separate and gather at the bottom of the tube. If sperm are identified, certain ART techniques may be available to the couple, such as intracytoplasmic sperm injection (ICIS) with IVF.

When investigating the possibility of male infertility, there are a number of tests and factors that your fertility specialist will want to explore and evaluate. While semen analysis still remains the cornerstone in the evaluation of a male's infertility. If needed, a more extended evaluation will be explored, including urological and endocrinological interventions. Ideally, the male partner should be evaluated at the same time as the female's fertility diagnosis, so as not to lose time during treatment.