While most men perceive that infertility is mainly a woman’s problem, male factor is the primary cause in 40% of all infertility cases, while an additional 10% of cases can be attributed to both male and female infertility factors. Through dependable diagnosing procedures and advances in treatment technology, Shady Grove Fertility has helped numerous men overcome male factor infertility and become fathers. In fact, Shady Grove Fertility patients with a male factor diagnosis have a clinical pregnancy rate of 62% per cycle.
Shady Grove Fertility physician Melissa Esposito, MD explains that obtaining a complete and reliable semen analysis during a couple’s infertility evaluation is a critical first step in the process. This simple test allows Shady Grove Fertility clinicians to examine the semen sample in a number of different ways, offering insight into the likelihood of male factor infertility.
“A semen analysis is a fast, simple test that uncovers a wealth of information,” Dr. Esposito says. “We need a complete picture of the health of the couple to be able choose the most effective treatment.”
Collecting A Sample
Shady Grove Fertility’s Andrology Center is the largest male infertility testing laboratory in the U.S., performing more than 20,000 semen analyses and sperm washes for IUI per year. The Center processes and evaluates samples from both SGFC patients and patients who have been sent to the Center by more than 750 referring physicians. Results are usually available to the patient and their physician 3-to-5 week days following their appointment.
“The advantage to having the semen analysis done at Shady Grove Fertility is that we look at everything in the sample,” Dr. Esposito said. “We have over 30 expert andrologists and embryologists who work with semen samples every day and know what to look for, not just in the sperm, but also in terms of all the other secretions and enzymes that make up a healthy sample.”
All 14 of Shady Grove Fertility’s full-sevice locations provide semen analysis services Monday through Friday by appointment only. While many SGFC offices have collection rooms, samples are encouraged to be collected at home. To help ensure the most accurate analysis, the following should be followed:
- Three to five days of abstinence from ejaculation prior to collecting for analysis.
- Fresh semen samples are to be collected via masturbation only.
- Samples are to be collected in a dry, polypropylene container with a lid (containers can be obtained from your SGFC office or any pharmacy).
- Lubricants are prohibited as they may interfere with sperm motility.
- Samples collected at home should be delivered to our office within two hours of collection, and the container should be shielded from extreme hot or cold temperatures.
Once a patient has provided a semen sample, there are several factors that are examined in asemen analysis.
First is the volume of the sample. “We want to see at least 2cc’s of fluid in a sample,” explains Dr. Esposito. Besides sperm, semen contains amino acids, enzymes and several other secretions made by the male reproductive system. If the volume of ejaculate is low, that can mean the sample may be lacking in these important secretions that aid in the fertilization process. It could also signal a blockage or other issue in the semen’s pathway.
Next is the concentration of sperm, or what people commonly call the “sperm count.” A low concentration can signal a problem with the testicles or male hormones that is preventing the testicles from making enough sperm.
The motility, or movement of the sperm, is another important factor. If it is low, it can affect the ability of the sperm to reach the female reproductive tract and find the egg.
Finally, morphology is an important component of a semen analysis, especially when done for an infertility diagnosis. Morphology looks at the percentage of normally shaped sperm in the sample. The head of the sperm is the part that penetrates and fertilizes the egg. If these are misshapen, it may mean they do not contain the proper enzymes or other materials that are necessary to complete fertilization.
Dr. Esposito explains that “having an abnormal result in any one of these areas can impair the fertility process.”
Scoring the Results
The results of the semen analysis are most commonly graded on one of two scales – the World Health Organization (WHO) scale, or the “Kruger Strict” scale. Shady Grove Fertility uses Kruger Strict because it includes criteria for morphology, which is an important factor in diagnosing infertility. These criteria establish what is considered a healthy range for factors like sperm concentration and motility.
Dr. Esposito explains that the criteria used at Shady Grove Fertility are so important to an accurate semen analysis, that she will many times ask a patient to repeat the semen analysis even if they have already done a semen analysis with an urologist.
“If the analysis they show me does not include morphology, I will have them repeat it, because I have seen cases where everything was normal except morphology,” says Dr. Esposito. “Additionally, if the initial semen analysis shows anything abnormal I will have them do a second one to make sure the results are correct.”
Factors That May Affect Sperm Quality
There are many risk factors that may affect the health and quantity of sperm including:
- Excessive consumption of alcohol
- Use of anabolic steroids, cocaine, heroine or other recreation drugs
- Sexually Transmitted Diseases (STD)
- Hot baths & saunas
- Being underweight or overweight
- Exposure to environmental toxins
- Genetic conditions such as:
- Sperm production disorders that lead to many sperm being abnormal in shape or unable to move well.
- Immune system disorders caused by men developing antibodies to their own sperm which may attack and weaken the sperm.
- Anatomical or structural problems in which there are no sperm in the ejaculate, however, the testes may still be producing sperm.
Finding the Good Ones
For men who have low or weak sperm, andrologists can examine the sample and choose good looking sperm for fertilization. For those with no sperm, there are several procedures that can attempt to recover healthy sperm.
One procedure is called Percutaneous Epidydimal Sperm Aspiration or Testicular Sperm Extraction (PESA and TESE). In this procedure, a needle is inserted into the testicle and fluid is withdrawn. The fluid is then inspected under a microscope and healthy sperm are extracted from it.
If PESA or TESE is unsuccessful in retreiving sperm, a second option may be to do a Testicular Biopsy. In this procedure, a needle or knife is used to remove a small sample of tissue from the testes. The tissue is then inspected under a microscope and any healthy sperm found are extracted from it.
“Most men squirm when hearing the descriptions of these procedures, but they are done with local or general anesthesia and are not painful to the patient,” says Dr. Esposito, “And they have proven successful at helping men with male factor conceive children.”
Depending on the severity of the male factor, the physician may recommend simple treatments such as sperm washing for Intrauterine Insemination (IUI) or advanced treatments such as In Vitro Fertilization (IVF) with or without Intracytoplasmic Sperm Injection (ICSI), the process of inserting a single sperm into the egg.
Intrauterine Insemination (IUI) is a process whereby a concentrated specimen of sperm is placed in the uterus. The sperm sample is specially prepared in the andrology lab in a procedure commonly known as “sperm washing”. This creates a final sample that consists of the most active sperm available from the original sample.
IVF with or without ICSI may be required to overcome a male factor that has not responded to less intensive therapy. Once the egg has been injected with the sperm, the embryologist will observe the egg, and if fertilization occurs and the embryo matures properly, it will be transferred into the female’s uterine cavity usually 3-to-5 days after fertilization.
Men may be fearful of finding out their diagnosis, but it’s important to know that male factor is one of the most successfully treated forms of infertility. All that is needed is one good sperm to fertilize the egg. With a reliable semen analysis, our physicians can create a treatment option for nearly anyone.
“There are so many advances in male fertility. It’s really incredible,” says Dr. Esposito, “There are many, many different ways that couples with male factor infertility can be helped.”