Have you ever gone through a fertility assessment before? For couples who have done it, you would know that it can sometimes look very complicated with all those internal ultrasound (transvaginal) scans, blood tests, x-ray tests and sperm test for a male partner.
In this article, I will simplify the fertility tests for a male partner. I’ll start with a sperm test and go on to other tests required when a man has no sperm (azoospermia).
For a man, the most important test is a semen analysis (sperm test). In a third of all couples, the problem lies with the male partner and thus it is a very important test.
“A 70-year-old man can still reproduce, so this can’t be a major issue right?”. It’s a yes and a no. It is true that a man continues to produce sperm but the quality of the sperm deteriorates as he ages. Low sperm quality equals to lower chance to conceive.
What is a sperm test?
In a well-equipped andrology laboratory, four basic parameters are of concern. These parameters are reported according to WHO standards (World Health Organisation)
- Sperm concentration: The lower range of normality is when at least 15 million sperm for every millilitre (ml) of semen is found. Sperm concentration above this value is considered “normal”.
- Vitality: This means the percentage of live sperm in the sample. It should be at least 58% (at least 58 out of 100 sperm are alive).
- Motility: This parameter looks at the movement of the sperm. At least 40% of the sperm should be moving. The movements are further graded according to how fast it moves and the direction of the sperm movements.
- Morphology: This parameter looks at the physical shape of sperm. This is done under a high powered microscope. At least 4% (you read it correctly!) of the sperm should be normal-looking to be considered “normal”.
What about men with Azoospermia (no sperm upon ejaculation)?
Azoospermia can be due to either a production problem (i.e. sperm not produced by testis) or an obstructive problem (i.e. sperm is produced but there is an obstruction in the sperm exit pathway).
How do we know what causes azoospermia?
Generally, I will do a physical examination to look for any signs of testosterone (male hormone) deficiency. Blood tests for hormones (i.e. FSH, LH, testosterone) are also done. If it’s an obstructive problem, sperm can be retrieved via a minor procedure called TESA/TESE. This is a minor surgical procedure where a small needle is inserted into the testis to retrieve testicular tissue that contains the sperm. The procedure is done under anaesthesia/sedation.
If it’s a complete production problem, there will be no sperm to retrieve. However, it is very rare to have a complete production problem, more often there are some sperm which can be retrieved.
Sometimes oral medications can be used to boost up sperm production, but this can be determined after the examination and blood test results.
When sperm is retrieved via TESE/TESA or by ejaculation, IVF/ICSI is the next appropriate step towards a successful pregnancy.
Treatments for male infertility
Reduced sperm quality
According to world standard (World Health Organization), sperm quality is taken as ‘normal’ when the sperm concentration is > 15 million/ml, motility is > 40%, normal form is > 4%, vitality > 58%.
When the semen analysis shows the lesser value, it is considered ‘low’ in sperm quality. In cases like these, lifestyle changes (such as to stop smoking, reduce alcohol intake, reduce weight and stress) are called for, together with an oral medication called anti-oxidants.
Research had shown that a high level of reactive oxygen sepsis (ROS) and low level of antioxidants in the semen reduce sperm quality. Supplementing men with oral antioxidants improves the sperm’s quality and motility. There are many antioxidants such as vitamin C, vitamin E, L-carnitine, Co-enzyme Q, zink, and selenium. Your doctor will give a combination of these antioxidants.
Treating Azoospermia (no sperm)
When there is no sperm found, it could be due to obstruction in the channel that sperm passes through (vas deference) or due to low or no sperm production in the testis. Your doctor will perform some tests and examine the testicles to arrive at a diagnosis.
An obstruction can be caused by infection or injury to the testicles. Sometimes the men are born without vas deferens. It can also be due to previous vasectomy (male sterility procedure).
Several procedures can be used to retrieve the sperm
For men with the previous vasectomy, a vasectomy reversal surgery can be done. However, the success rate is low. If the reversal surgery failed, PESA or TESE / TESA can be done.
If an obstruction is diagnosed, PESA (Percutaneous Epididymal Sperm Aspiration) can be done. In this procedure, sperm is directly aspirated from the epididymis (where sperm is stored in the testis) using a fine needle.
If obstruction or low sperm production is suspected, TESE (Testicular Sperm Extraction) or TESA (Testicular Sperm Aspiration) can be done, where a biopsy or several biopsies are taken directly from the testis after making a small incision in the scrotal skin.
Featured image source: Fotolia
By Dr. Agilan Arjunan
Consultant Gynaecologist & Fertility Specialist
KL Fertility Centre / Monash IVF
