About 40% of the issues involved with infertility are due to the man, another 40% due to the woman, and 20% result from complications with both partners1.
In the diagnosis of male fertility, the quality of the sperm is crucial. The fertility specialist organises a semen analysis, which is used to evaluate a number of key parameters. These include the number of sperm cells, their motility and morphology. For this purpose it is necessary to provide fresh ejaculate.
The sperm examined should not be older than half an hour when analysed. In order to provide a fresh sample, a man will typically masturbate in a separate room in the doctor’s surgery or fertility clinic.
The semen analysis provides the fertility specialist with information about about a man’s fertility potential at the time of analysis. It is crucial to understand that this information represents merely a snapshot. It does not indicate whether the man’s sperm is permanently good, “suboptimal” or if an environmental factor may have caused a temporary reduction in sperm quality. Because new sperm cells are continually produced at a rate of approximately 1,500 per second2, a semen analysis can look dramatically different in a matter of just a few weeks.
There are also male fertility disorders in which the sperm quality is high, but despite this conception may be unlikely or even impossible. This can be the case with erectile dysfunction, antibody reactions against a man’s own sperm cells, different genetic diseases or hormonal abnormalities. In such cases further investigations are necessary in order to ascertain the causes and possible treatments of these impairments.
With the help of a detailed consultation and a few further analyses, the fertility specialist can attempt to find out the causes of a man’s infertility. However, rather often the factors that cause the reduced quality of sperm cannot be clearly established3. This phenomenon is called unexplained or idiopathic infertility4.
As part of the initial investigation, the male fertility specialist will discuss the patient’s
- overall health condition,
- chronic diseases,
- any previous chemotherapy5
- or operations and accidents involving the reproductive organs,
- infections and childhood conditions after puberty,
- known genetic conditions within the family,
- any existing children, including miscarriages,
- frequency of intercourse,
- consumption of Alcohol6 and nicotine7 or drug abuse8, 9
The male fertility specialist will also
The male fertility specialist may also conduct
- Post-ejaculation urinalysis, which can indicate whether sperm cells are traveling backward into the bladder instead of out of the penis during ejaculation (retrograde ejaculation).
- Blood tests measuring hormone levels produced by the pituitary, hypothalamus and testicles (testosterone), which play a key role in sexual development and sperm production.
- Genetic tests to diagnose possible Y chromosome changes or various congenital or inherited syndromes.
Sperm cells are extremely sensitive both during their 74-day production and, once ejaculated, to their environment. This is why men produce about 10 million sperm cells every hour10.
Studies have shown that one of the main reasons for the historical trend of deteriorating sperm cells since 1990 is poor nutrition11. The Western diet lacks many many important vitamins, amino acids and other micronutrients in sufficient quantity, including nutrients needed for optimal sperm production.
Further investigations into male infertility
A sample of urine will be tested to determine whether the male has chlamydia. If the test returns positive, your doctor will prescribe antibiotics to treat it.
If there is evidence of only very little or no sperm in the ejaculate of men, the doctor can determine whether the production or transport of the sperm cells is malfunctioning with the help of a testicular biopsy. If for example one or both of the vasa deferentia are blocked, the sperm cells cannot be ejaculated.
In the testicular biopsy some tissue is taken from the testicle under a local or general anaesthetic13. This can be subsequently examined for existing sperm cells.
A testicular biopsy is meaningful only if the couple are considering artificial insemination outside the body (IntraCytoplasmic Sperm Injection directly into the ovum, commonly referred to as ICSI14). This is because there is no actual improvement in fertility as a result of this operation.
If a man decides to have a testicular biopsy, he should ideally use a clinic which can directly freeze existing germ cells, so that they can be used later for the fertilisation of egg cells. This saves him having to undergo an additional operation in order to obtain sperm.
Further investigations into a couple’s fertility
Post coital test (PCT)
The post coital test is used by some doctors for diagnostic purposes15, if the previous investigations provide no reasons for reduced fertility. Other doctors recommend the investigation at the start of fertility treatment, because it is quick and easy to carry out.
- “Hudson, B. (1987). The infertile couple. Churchill-Livingstone, Edinburgh” ↩
- http://humrep.oxfordjournals.org/content/18/2/447.full” ↩
- “http://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/causemal.htm” ↩
- “http://en.wikipedia.org/wiki/Unexplained_infertility” ↩
- “Paoli D, Gallo M, Rizzo F, Spano M, Leter G, Lombardo F, Lenzi A, Gandini L. Testicular cancer and sperm DNA damage: short- and long-term effects of antineoplastic treatment. Andrology. 2014” ↩
- “Muthusami KR, Chinnaswamy P. Effect of chronic alcoholism on male fertility hormones and semen quality. Fertil Steril. 2005; 84(4): 919-24” ↩
- “Mitra A, Chakraborty B, Mukhopadhay D, Pal M, Mukherjee S, Bannerjee S, Chaudhuri K. Effect of smoking on semen quality, FSH, testosterone level and CAG repeat length in androgen receptor gene of infertile men in an Indian city. Syst Biol Reprod Med. 2012; 58(5): 255-62”consumption” ↩
- “http://en.wikipedia.org/wiki/Male_infertility#Diagnosis” ↩
- “Battista N, Pasquariello N, Di Tommaso M, Maccarrone M. Interplay between endocannabinoids, steroids and cytokines in the control of human reproduction. K Neuroendocrinol. 2008; 20(1): 82-9 ↩
- “Padubidri, VG; Daftary, SN, eds. (2011). Shaw’s Textbook of Gynaecology (15th ed.). p. 201” ↩
- “Decline in semen concentration and morphology in a sample of 26 609 men close to general population between 1989 and 2005 in France. http://humrep.oxfordjournals.org/content/early/2012/12/02/humrep.des415.abstract” ↩
- “http://www.altmedrev.com/publications/5/1/28.pdf” ↩
- “http://www.nlm.nih.gov/medlineplus/ency/article/003908.htm” ↩
- “http://en.wikipedia.org/wiki/Intracytoplasmic_sperm_injection” ↩
- “Hessel M, Brandes M, Bruin JPD, Bots RS, Kremer JA, Nelen WL, Hamilton CJ. Long-term ongoing pregnancy rate and mode of conception after a positive and negative post-coital test. Acta Obstet Gynecol Scand. 2014; 93(9): 913-20″ ↩