Male fertility occurs in about 40% of cases of infertility. It’s important to remember that at least 25% of couples will have both male and female factor infertility, and as you probably know, it does currently take an egg, a sperm, and a uterus in order to make a baby. There’s actually not a lot known about male fertility, which is kind of crazy.
How is Male Fertility Tested?
The primary test for male fertility is to look at the sperm under the microscope, and we’ve been doing that for hundreds of years. We really haven’t advanced a lot in hundreds of years in terms of analysis and diagnosis of male fertility. We know how to count the sperm and look at motility percentage. We also look at concentration. You take the volume- what is the normal volume? Normal volume is about two millimeters to five millimeters of ejaculate. Then we look at them under the microscope. They’re spread out on a little slide with a grid so we can calculate the concentration. Normal concentration is 20 million total sperm per milliliter. Everybody’s got some sperm in the ejaculate- some dead sperm, some moving sperm, some good looking sperm, and some yucky looking sperm. That’s normal. 50% should be moving. Then there’s usually always a measure of forward progression. We typically use a scale from zero to four, so zero is when they’re dead, and really not moving at all. Four is like a rocketship. Two and above is normal. That’s like medium- they’re moving around and doing a good job. That’s your basic semen analysis. If you have normal parameters, if you have a good concentration and good motility and they’re moving forward pretty well, then you’re most likely in good shape.
What are the Other Methods of Testing Male Fertility?
There’s a lot of other more subtle things to do as well. A really common thing that we see is morphology, and two common scales are the WHO and the Kruger scales. The important thing to remember is that morphology is extremely subjective. It’s the andrologist or the person in the lab who is looking at the sperm, looking at the shape of the sperm under the microscope, who determines their health. Do they look handsome and normal and symmetric, the way they’re supposed to? Or are they funny-looking? Do they have double heads, or double tails, or weirdly-shaped tails or weirdly-shaped heads? That’s morphology, and we do believe that if someone has a lot or mostly severely abnormal sperm, it could be an issue in terms of being able to fertilize an egg. We don’t understand it really well though, because when you look at some of the studies, when people have poor morphology and normal counts and motilities, the morphology doesn’t seem to matter as much.
How is Sperm Analyzed?
Morphology, we believe, is much less important than the basics of count and motility. Then there are anti-sperm antibodies. That’s another common test, and what we’re looking for are proteins in the sperm that bind to the sperm head, the midpiece, or the tail. If you have proteins coating the sperm, this could possibly affect motility and possibly cover the cap of the sperm, which has to attach to the egg. Though that could be a cause for infertility, it’s not very common at all.
IVF, IUI, and Sperm Function
We also wash the sperm and put it through processing as if we’re going to be doing IVF or IUI. IVF is in vitro fertilization, where we put the sperm in the egg together in the lab. IUI is intrauterine insemination, where we wash the sperm and put it into the woman’s uterus at the time of egg release. We have to wash the sperm to get rid of the dead sperm, the poorly shaped sperm, and the actual semen, because the semen is just fluid that carries the sperm out of the testicles and out of the penis to be able to deliver it to the vagina. That’s not necessary to go into the uterus, and in fact, contains a lot of chemicals that could cause a lot of cramping. That’s why we remove it for IUI and IVF.
Once you remove it and look at the amount of sperm you recover, that’s another measure of the health and the function of the sperm. For an IUI prep, we often like to recover a total motile count of 5 million or more, because what the studies say is that if you have 5 million motile sperm recovered, or you have 50 million motile sperm recovered, you still have the same IUI pregnancy rate. On the other hand, if you have between one and 5 million sperm recovered in this IUI washing process and you do IUI, the IUI pregnancy rates are lower if all other factors are equal. If you consistently can only recover less than 1 million sperm for an IUI prep, those patients often just don’t conceive with IUI. They likely need to do IVF with ICSI or intracytoplasmic sperm injection, which is a very successful IVF treatment where we actually take a single sperm and inject it into the egg at the time of IVF in order to normalize fertilization. That procedure has been around since the 1990s and has almost eradicated male factor infertility. If you can do IVF, then even if you have very low counts, your pregnancy rates can be the same as people with normal counts. That’s a short summary of semen analysis.
I hope this has been helpful and you’ve learned something valuable about male infertility. If you have any more questions about this topic or others related to fertility, pregnancy, or reproductive health, please reach out today! I’ll be happy to answer any of your questions and keep you informed about whatever is on your mind.