Infertility is often thought of as a women’s issue, but in reality, nearly one-third of infertility cases are due to male infertility, and another one-third are related to issues with both the male and female partners.
Male factor infertility can stem from several issues related to structural issues of the testes, hormone imbalances, or sperm quality. In many cases, the issue is directly related to the health of the sperm.
The health of sperm is often broken down into three categories; sperm concentration, sperm motility (the ability of sperm to swim), and sperm morphology (the shape of the sperm).
The Value of a Semen Analysis
During an initial consultation, the doctor will review medical history, perform a physical exam, and often order bloodwork in addition to requesting a semen analysis.
The semen analysis is a non-invasive test that is performed in-office. The results are then analyzed to help determine if there are issues with the sperm in terms of volume, sperm quantity, motility, or morphology. The results from this test are reviewed along with the medical history and bloodwork results to determine if they suspect any underlying causes of infertility due to male factor issues.
While this is generally the first step in determining male factor fertility issues, the semen analysis is a very important test that provides a detailed look at the visual appearance of the sperm. It gives the doctor an idea of what is going on with the sperm and if they are generally healthy.
During a semen analysis, the doctor can see if the sperm count is within normal range or on the lower end, which could potentially impact fertility. It can also help determine if the sperm are motile or able to swim properly to go through the female reproductive tract to get to the egg. Not all sperm are motile, and that’s normal. It’s also common to find sperm that are abnormal in shape, where they may have head or tail defects. These defects can range from crooked or double tail to a misshapen head.
Not all sperm are motile or have good morphology or normal shape, but the doctor will evaluate the results to determine if there are enough healthy sperm to consider the sample within the normal range.
What If a Semen Analysis comes back showing Few or No Sperm
In some cases, a semen analysis may uncover an issue where the male partner is either producing few sperm or no sperm at all. When only a few sperm are present, this is referred to as oligospermia, while no sperm is referred to as azoospermia.
When there is a low sperm count or no sperm detected, the doctor will often look at issues associated with hormone production or structural issues, such as blocked tubes, to determine the next steps.
Doctors can then prescribe medication or perform several procedures to help extract sperm or clear a potentially blocked tube. For patients who have no sperm, their doctor may recommend a procedure called TESE to explore and potentially extract sperm directly from the testes.
Fertility Treatment Options for Male Factor Fertility Issues
Intrauterine insemination (IUI)
During intrauterine insemination, a sample of your semen is collected and treated in the lab to isolate and concentrate the healthiest sperm. Then they inject the sperm into your partner’s uterus at the time she’s ovulating. IUI is often a good choice for men with borderline sperm count or motility for couples with a female partner < 40.
In vitro fertilization (IVF)
In vitro fertilization refers to the general term of eggs and sperm fertilized outside the body. Fertilization can take place using one of 2 methods: Conventional insemination and ICSI (see below). During conventional insemination, washed sperm is placed around the egg inside a petri dish for natural selection to choose the best sperm. This method may be preferred if the sperm counts are normal.
Intracytoplasmic sperm injection (ICSI)
During ICSI, your partner’s eggs are retrieved and sent to the lab. Then your embryologist identifies a single, healthy sperm and injects the sperm directly into the egg. The embryo is then observed over time and either transferred back into the uterus in a ‘fresh transfer’ or frozen for future use.
If you are dealing with issues related to male infertility, you can call our office to schedule your initial consultation, where our highly trained doctors and embryologists can help you determine your options for treatment.