Infertility Education - Male Factor Infertility

When a couple has trouble having a baby, there's about a 40% chance that the male partner has a problem contributing to the pregnancy.

Possible problems include:

  • Producing too few sperm to fertilize an egg
  • Making sperm that are not shaped properly or that do not move the way they should
  • Having a blockage in the reproductive tract that keeps sperm from getting out

Semen analysis

A semen analysis is an essential part of the initial fertility workup. Semen is the fluid that nourishes, protects, and carries sperm during ejaculation and initial transport into the female reproductive tract. A semen analysis is a laboratory evaluation of the male ejaculate. The sample is typically collected in a sterile container following masturbation. If masturbation is not culturally acceptable, a special condom can be used to collect semen during intercourse.

The semen analysis provides information about the quantity and quality of both semen and the sperm it contains. Some of the things that are measured include:

  • Volume: how much semen is produced
  • Concentration: number of sperm in each milliliter of semen
  • Motility: percentage of sperm that are moving
  • Morphology: percentage of sperm that have a normal size and shape.

The analysis can also suggest if there is an infection in the reproductive system.

It is preferred that the semen sample is tested within an hour of collection. Avoiding ejaculation for 2 to 5 days before providing a sample may be recommended to optimize results. Samples from two separate visits several weeks apart may be required, as samples can show variation over time.

Hormone levels and reproduction

Hormones play a vital role in sperm production. They also affect your interest in sex and your ability to have sex. Too much or too little of these hormones can cause problems with sperm production, obtaining or maintaining an erection, and/or reaching orgasm.

Hormones involved with male reproduction include luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), and prolactin.

Other testing

If the semen analysis or blood hormone levels are abnormal, additional testing or referral to a urologist may be recommended. Further workup may include physical examination and/or imaging to evaluate for any testicular or scrotal masses, staining of the sperm to assess their viability, testing for anti-sperm antibodies, culturing for infection, or performing genetic tests that may indicate an abnormality that blocks sperm production.

No semen test can fully predict fertility. Other than a semen analysis, not all tests discussed are appropriate for every couple.

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