Male Infertility

The main way to evaluate a man’s fertility potential is to perform a semen analysis.

Semen analysis samples are typically produced on site at your fertility doctor’s office. There are several factors that are examined in the semen analysis. The first is sperm count which is a measure of sperm concentration in the sample. The average sperm count is about 60 million/millliliter, however the count is not considered abnormal unless it is less than 15 million/milliliter. Sperm movement is also assessed in the sample. This is reported as the percentage of sperm that are moving. At least 40% of the sperm in the sample should be moving. The motility can also be graded based on the sperm progression in the sample. The shape of sperm is also important in that the shape can affect not only the motility of the sperm, but the ability of the sperm to bind and fertilize the egg as well. Shape is referred to as morphology in the sample. In evaluating shape, both the head and the tail of the sperm are examined. The sample is considered normal if 4% or more of the sample has a normal shape. It is important to evaluate each one of these parameters in conjunction with each other, because the parameters themselves are reported as percentages and concentrations. Therefore, a low motility percentage might not matter if the overall count was very high. The volume of sample will also be measured. If the volume is less than 1.5 ml it may indicate a partial or complete blockage of the seminal vesicles. In this setting an evaluation for a potential obstruction should be undertaken. Semen analysis samples can vary from month to month, even week to week. Therefore, if the first sample is abnormal, it is important to recheck it again. Sperm take about 72 days to develop. Therefore, it is important to take into consideration if a man has had an illness or injury several months before an abnormal semen analysis, as these factors could lead to a temporary production of normal sperm.
A semen analysis will help to identify those men with a sperm issue. 20% of infertility is caused by a male factor. Although for some men, the cause of their infertility may be genetic, there are other reasons that a man could have abnormal sperm production that may be temporary and fixable. Men can have something called a varicocoele, which is a dilation of a vein in the testicle, which can negatively affect sperm production. Surgical treatment of varicocoeles can result in improvement in sperm, but it sometimes takes several months to see the results. Therefore, having this surgery may not make sense clinically if the woman is having fertility issues related to age, when time is of the essence. However, because of the positive potential of the surgery, this option should be discussed with both a fertility physician and urologist. Ilicit drugs and anabolic steroids can all cause a reversible decrease in the number of sperm. Several medications, including some high blood pressure medications, anti-depressants and hair loss medications can negatively impact fertility. Environmental sources of heat like Jacuzzis can lead to reversible decreases in sperm counts. Even obesity can decrease sperm counts. Many environmental factors can affect male fertility; some of these factors are more prevalent in today’s society, such as industrial pollutants and endocrine disrupters. There are numerous articles that suggest sperm counts in the general population are decreasing and these may be the cause. However, several other researchers have not found evidence that sperm counts are declining.