the past, the female was the main focus of the infertility
evaluation. It is now recognized that male fertility
is a common cause of sub fertility and is implicated
in up to 47% of infertile couples. This means that the
semen analysis is one of the most important tests conducted
in the fertility evaluation. Most specialists agree
that treatment of the female should not begin without
the male evaluation.
some physicians (non infertility specialists) prescribe
fertility medications, like Clomid, without the male
evaluation. If male fertility is present, treatment
of the female can never be successful and extended use
of fertility medications can produce side effects.
women, whose fertility declines dramatically with age,
most men are capable of fathering children until much
later in life. Age related male infertility is usually
not an issue before age 55.
are produced in the seminiferous tubules of the testicles
under the influence of the hormone testosterone. The
testicles are composed of these tubules and the epididymus,
which stores and transports sperm.
travel from the epididymus to the vas deferens (small
tubes), past the seminal vesicle and prostate where
seminal fluid is added, and ultimately out the urethra
at ejaculation. This path must be free of obstructions.
testicles are suspended in the scrotum which serves
as a temperature regulating organ. When the testicular
temperature is elevated, the scrotum expands increasing
the distance of the testicles from the body thus lowering
temperature. Conversely, when the temperature of the
testicles drops, the scrotum contracts drawing them
closer to the body.
that tend to increase the testicular temperature, such
as prolonged sitting in hot tubs, occupations such as
a long distance truck driver where the scrotum cannot
perform its cooling function, can lower sperm count.
Sperm take approximately three months to mature so changes
in habits that could affect sperm count are not immediately
semen analysis involves evaluation of numerous sperm
characteristics and is best conducted by a reproductive
medicine laboratory. Most of these laboratories use
the Kruger Strict Criteria; however, some still use
the World Health Organization criteria. The Kruger Strict
criteria evaluate the following semen characteristics.
One cause of male sub fertility can be a varicocele, which
is the existence of varicose veins in the scrotum. These
veins cause abnormal circulation raising the temperature
of the testicles and diminishing sperm production. A urologist
can usually perform a surgical procedure to remove the
varicocele. A urologist can also sometimes successfully
revclass="style1"erse a vasectomy depending on patient specific variables.
- Motility- the percent of sperm moving when the
semen is examined under the microscope. Normal is
defined as >50% motile.
- Progression - the forward movement of sperm cells.
- Viability- the percent of live sperm.
- Sperm morphology or shape- Normal is > 14% "highly
- Additional semen contents, such as white blood cells,
an indication of infection. Less than five white blood
cells per high power field is considered normal.
fertility medications, such as Clomid and FSH, have
been used to treat male infertility. Unfortunately,
they are limited in usefulness and require extended
therapy which can be extremely expensive.
health products boast that they can increase sperm quality
and quantity; however, to date, no study has demonstrated
a statistically significant advantage to using these
there is mild male infertility, intrauterine insemination
(IUI) or artificial insemination is often the treatment
of first choice. In IUI, the sperm are collected via
masturbation then washed and concentrated. The concentrated
sample is placed directly into the uterus using a small
catheter. Unprepared sperm must never be inserted directly
into the uterus as very serious allergic reactions and
severe uterine cramping can result.
the past men, with moderate to severe male factor had
no hope of producing a genetically related child. Due
to recent advances in in vitro fertilization and intracytoplasmic
injection (ICSI), a pregnancy can be produced even when
very small numbers of sperm are present. A single sperm
is inserted directly into the egg in the ICSI procedure.
sperm can be collected from ejaculation or, if the male
has had a vasectomy, sperm can be extracted directly
from the male's testicle using Testicular/Epididymal
Sperm Aspiration (TESA), or from the epididymus using
Microsurgical Sperm Aspiration (MESA). This means a
pregnancy can be produced even if no ejaculate can be
some cases couples choose to use a sperm donor. Fortunately,
most sub fertile men can now be effectively treated
though surgery or by using assisted reproductive technologies.
Fact Sheet from
the American Society for Reproductive Medicine.