Causes and Investigations of Male Infertility

Male infertility (or sub-fertility) as it is often known) is defined by a sperm count of less than 20 million per millilitre of semen, compared with the average of around 62 million.

There are many reasons why a man's sperm count is low, usually related to health and hormone balance and these issues are discussed in the 'Lifestyle' section of this site.

Sperm count is not the only issue - and sperm quality and motility (the ability to swim within the female reproductive system) are important issues too.

There may also be psychological reasons. The male sex organs are complex and delicate and blockages can occur at several points which prevent the effective release of sperm on ejaculation.

It is unfortunately the case that many of the tests available to assess sperm counts and motility are inaccurate and out-of-date and you may be getting misleading information - see the next section 'Infertile? Don't be so sure'.

A total absence of sperm in the ejaculate is known as azoospermia. There are two main reasons for this occurrence:

1. A blockage, or congenital abnormality, which prevents movement of the sperm between the testis (where sperm is produced) and the penis.

• A blockage can be the result of a previous vasectomy or infection.
  
• Congenital abnormality presents as an absence of the tubes which carry the sperm from the testis to the penis. Some men are born with this 'congenital absence of the vasa'. This condition is likely to be associated with an abnormal gene for Cystic Fibrosis.

2. A poorly-functioning testis, resulting in low sperm production.

• This may happen when the testis has been affected by conditions such as mumps, infections, trauma, testicular torsion or undescended testes

OR

• genetic abnormalities may be the cause. It is now recognised that up to 15% of men with azoospermia may carry abnormal genes responsible for their infertility. It is, therefore, important to perform a genetic screen to check this, not only to understand the problem, but also to assess the risk of transmission to the child.

However, in many cases, the reason for azoospermia will remain unknown.

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Sperm analysis

The next step is a sperm analysis which will enable us to assess your condition with accuracy.

Production of sperm samples

Sperm samples should be produced by masturbation at Bridge so that the analysis can take place immediately after production. However, if you feel you are unable to produce a sample on-site, please speak to one of our laboratory staff to discuss alternative arrangements.

Please make sure that you do not ejaculate for three days prior to producing a sperm sample for analysis. This is important as it will ensure that the sample you produce on the day is at its optimum in terms of numbers and quality.

Results

The results of your sperm analysis will be available after three days and will be discussed with you by your consultant. We do not give results out over the telephone, although you may request a written report.

Appointments

Appointments are required and can be arranged and booked via Admissions on 020 7089 1449.

We will send you a comprehensive information pack and registration form.

Click here for Contact Form

The Analysis

The following parameters will be assessed in the Semen Analysis:

• the number of sperm present within the ejaculate (the sperm count)
• the number of sperm that are moving (the motility)
• the number of sperm that are normally formed (the morphology)
• whether or not there are anti-sperm antibodies present
• the ability of sperm to survive over a 24 hour period
• whether or not there is any infection present within the sample.

What is a 'normal' semen analysis result?

A normal semen analysis will show the following

• a semen volume of between 2 and 3mls
• a sperm count of significantly more than 20 million sperm per ml
• at least 45% of the sperm will be motile
• at least 30% of the sperm will be normally formed
• less than 10% of the sperm will be affected by antisperm antibodies

The degree of variance from these accepted normal values will be assessed and the implications explained by your consultant during a follow-up consultation.

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Repeated Centrifugal Analysis (RCA)

Some men with infertility problems are told that it is not possible to find any sperm in the ejaculate following routine semen analysis. This condition is called azoospermia. If these men wish to father a child using their own sperm it is then usually necessary to undergo a surgical procedure to try and extract sperm directly from the epididymis or from the testis. (PESA or TESE)

However, this surgery may not always be necessary. In some cases, men who have been told that they have azoospermia do in fact produce some sperm that can be found in the ejaculate. The sperm is produced in very minute quantities and, as a result, can be missed during a routine semen analysis. Using advanced analysis techniques it may be possible for the embryologist to recover a few sperm from the ejaculate, which can then be cryopreserved. This procedure can be carried out on several occasions and it may be possible to store enough sperm to be used in a treatment cycle. If sperm is collected using this method there will not be sufficient sperm to be able to fertilise eggs in the normal way and Intra-cytoplasmic sperm injection (ICSI) will always be required.

Th non-surgical recovery technique is called Rapid Centrifugal Analysis (RCA). Firstly, the man will need to give several ejaculates for analysis over a period of weeks. Each of these ejaculates is then prepared by spinning in a centrifuge at very high speed. This concentrates all the cells, including any sperm cells in the sample, into a very small volume. It may then be possible for the embryologist to identify a few sperm using a very powerful microscope. If any sperm are seen then the ejaculate will be cryopreserved for future use.

Not all men who undergo this procedure will be successful, however we see it as an important first step in the process and expect that, for about 25% of men treated, we will be able to collect enough sperm for use in an ICSI treatment cycle.

If these sperm are used during ICSI then around 65% of the eggs will fertilise following the injection of a single sperm. Pregnancy rates following IVF/ICSI vary for many reasons and your consultant will discuss his with you.

For any further information, please contact Admissions on 020 7089 1449.

Hormone Assessment of the Male

In cases of azoospermia, blood will be taken for the analysis of hormones (FSH, LH and testosterone). This will tell us if there is a blockage or if there is no sperm production within the testis. In the first instance, sperm can be retrieved through PESA or surgery might correct the problem. In the second instance, in around 50% of cases, Testicular Sperm Extraction (TESA) will retrieve enough sperm to fertilise the egg. In the most severe cases, if the levels of testosterone are too low, hormone replacement therapy will be advised.

Testicular Biopsy

Testicular Biopsy involves taking one or several small samples of the testes - either for analysis, or, in the most severe cases of azoospermia, for the recovery of sperm for immediate test or cryopreservation for use later.

Moral - don't give up

At Bridge, we think every avenue should be explored before any would-be father gives up hope of becming a biological parent. We run one of the largest sperm banks in Europe and have excellent stocks - but we would much rather work with our male patients to find the best solution.

Continue to: Male Factor - Treatment >>>>