Male infertility

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.

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.

Sperm count

A 'normal' sperm count will have:

• An overall volume of at least 2 ml.
• A sperm density of more than 20 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 

The following male fertility tests can be performed at our clinic-

Semen analysis - tests the overall appearance, acidity/alkalinity and volume of the semen, measures the sperm concentration, motility and vitality, and assesses morphology.

Assisted conception treatments

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 (percutaneous epididymal sperm aspiration - PESA). PESA 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.