Male fertility seems less complicated than female fertility simply because the male is responsible for fewer stages in the process of creating a baby. Essentially, male fertility is largely dependent on the state of the sperm. Sperm number, morphology and motility are important factors.
Usually, male infertility is not treatable except with assisted conception.
There will be a decrease in fertility if the sperm are:
- Not being produced in adequate numbers (or not at all)
- Being produced, but facing an obstruction that prevents them from reaching the outside world
- Being produced, but not swimming very well
- Stimulating antibody production in either partner by causing an allergic reaction.
Some of these causes can be treated surgically, but in most cases assisted conception or donor sperm are the best options.
"Andrology" means for men what "gynaecology" means for women. As part of Genea's reproductive laboratories in the city, Genea provides state-of-the-art diagnostic andrology services. Our procedures more than comply with current World Health Organization standards. Australia's first sperm microinjection pregnancies were achieved at Genea in 1989 and since then, Genea has maintained their position as experts in treating severe male infertility.
The semen analysis
Testing for male infertility is a very straightforward process and it's another service we can offer.
A semen analysis will examine three factors:
- Sperm count - the number of sperm per ml of ejaculate
- Sperm motility - the sperm's ability to swim
- Sperm morphology - the shape of the sperm.
A 'normal' sperm count will have:
- An overall volume of at least 1.5 mLs
- A sperm density of more than 15 million sperm per mL
- A motility of 50% or better (the percentage of sperm cells present that are moving)
- A proportion of normal forms of 4% or greater
That is not to say that couples will not get pregnant, even with a much lower count (after all, it just takes one sperm), just that the chances of pregnancy are reduced by low sperm counts or sperm that do not swim well.
The complete absence of sperm in the ejaculate (azoospermia) can be either because of a blockage in the epididymis or vas deferens, or a problem with the actual production of sperm in the testicles. A blockage can sometimes be overcome by microsurgery, and even if sperm are not being produced, it may be possible to surgically extract enough sperm cells from the testes to use for ICSI.
If all else fails, using donated sperm can be an option.
Morphology and motility
Abnormal morphology (what the sperm looks like) and poor motility can prevent the sperm from reaching the egg. The sperm need motility to be able to swim well and survive for a number of hours in the female reproductive tract. If they do meet, abnormal-looking sperm might be incapable of fertilisation.
Anti sperm antibodies
Antibodies are the body’s natural defence against foreign objects. They are part of the immune system. Sometimes a woman’s immune system can recognise her partner’s sperm as foreign and develop antibodies against them. Men can even develop antibodies against their own sperm! This is most common in men who have had a vasectomy reversal.
The antibodies can attack the sperm by paralysing them, causing them to clump together or coating them so that they can’t fertilise the egg. Antibodies will be found in the semen, the cervical mucus, or either partner’s blood.
Tests at Genea
The following male fertility tests can be performed at Genea.
- Semen analysis - tests the overall appearance, acidity/alkalinity and volume of the semen, measures the sperm concentration, motility and vitality, and assesses morphology.
- Sperm Chromatin Integrity Test (SCIT) - a test for sperm DNA fragmentation. High levels of DNA fragmentation in sperm can be a factor in miscarriage and male infertility. The SCIT is only done at our Kent Street lab, but we can make special arrangements to do the test on semen samples which are frozen at other labs and shipped to Kent Street.
- Semen microbiology - detects bacterial infections of the urinary tract that might affect sperm function.
- Trial wash - evaluation of semen for various assisted conception procedures. Depending on the quality and number of sperm, different methods of assisted conception can be recommended (this is a test to see “how the sperm cells scrub up”!).
- Retrograde ejaculation evaluation - determines whether ejaculation is in fact retrograde and whether sperm can be successfully isolated from the urine for an assisted conception procedure.
- Genetic tests - for men with severely depressed sperm counts, a genetic basis can be identified, and the likelihood of passing the condition on to the children can be assessed.
- Antisperm antibodies - tests can be performed on the semen, the cervical mucus or the blood of either partner to detect the presence of antisperm antibodies.
Assisted conception treatments
- Assisted insemination - If the sperm count is high, assisted insemination can have some success. Careful washing and preparation of the sperm activates them so that they enter into the high energy state needed to fertilise the egg.
- Donor insemination - For more serious cases of male infertility, donor insemination was for a long time the only answer. This is where the sperm of another man is used to inseminate your partner. The child is genetically that of the donor, but legally that of the couple. Donor insemination is still available, although today we have methods of overcoming even very severe male infertility.
- In vitro fertilisation - IVF can be effective for lowered sperm counts because the sperm and egg are brought together in the small space of a special plastic dish, improving the chance of fertilisation.
- Sperm microinjection - Since the development of ICSI (intra-cytoplasmic sperm injection), fertilisation can be achieved even when there are hardly any sperm in the ejaculate. A single sperm is injected directly into the body (cytoplasm) of the egg, bypassing most of the barriers to fertilisation.
- Surgical sperm extraction - When there are no sperm in the ejaculate or if the sperm are severely affected by antisperm antibodies, sperm can now be retrieved directly from the testes (testicular sperm extraction - TESE) or the epididymis, which joins the testis to the vas deferens (epididymal sperm aspiration - ESA). ESA or TESE can be used in conjunction with ICSI to achieve fertilisation, even when there is only one sperm per egg! Immature and poorly swimming sperm are also usable with ICSI because they don't need to swim to the egg in order to fertilise it.
Read "Time's up, mate", an article about age-related male infertility by journalist Steve Dow