Male infertility

One third of infertile couples will have sperm related problems. For a pregnancy to occur there must be approximately 10 million sperm deposited each ejaculation. They must have good motility and a normal shape.

Tests
• A semen analysis is usually one of the first tests performed on infertile couples.
• Some tests can come back with incorrect information, mistakes can be made, and hence they are not absolute.

Possible sperm problems
(It is possible to have one or more of these problems)
(More than one test may be required)
• Sperm count (quantity of sperm, less than 20 million per ml could be a problem)
• No sperm in the semen (inability to produce or a blockage)
• Sperm motility (how well the sperm swim)
• Sperm morphology (the shape, they have to be able to penetrate the egg)
• Sperm antibodies (the immune system produces antibodies that coat the sperm making penetration of the egg difficult)

What can be done?
Rather than attempting to correct the sperm, fertility treatments usually try to make the best of the sperm that exists. Modern fertility treatments can use as little as one sperm to fertilize an egg.

Gonadontrophin
This is the reproductive hormone that controls sperm quantity; it can be used if the male has a low sperm count. Ask your doctor about this.

In Vitro Fertilisation and Embryo Transfer (IVF-ET)
• Procedure used if semen is of poor quality
• The best sperm are selected
• They are then placed with an egg in a test tube
• Works for 90% of male infertility cases
• It is an infertility treatment as well as a diagnostic test for sperm ability.

Pronuclear Stage Transfer (PROST)
• The (IVF-ET) is performed then the contents of the test tube are placed into the fallopian tubes
• It has the disadvantage of two anaesthetics for the female within close proximity.

Assisted Fertilisation by Microinjection (ICSI)
• Used for severely abnormal sperm, the sperm just has to be alive
• An intra-cytoplasmic sperm injection is injected into the egg.
• The sperm is surgically retrieved from the epididymis (micro epididymal sperm aspiration or NSA) or the testes (testicular sperm aspiration or TESA)

Donor Insemination (DI)
• Female is inseminated with donor semen
• Semen can come from an anonymous donor who is screened for genetic and infectious diseases.
• Counselling is recommended due to the impact of this decision.