Diagnosing Male Infertility at IVF Plano

Male factor infertility affects 40% of the couples that are treated at IVF Plano. There are many causes for male infertility, including abnormal semen and sperm production, failure of sperm delivery and general health and lifestyle issues.

Male infertility is usually diagnosed first by a semen analysis but other test may be required to correctly diagnosis the cause. Semen analysis is a simple test. The semen sample is collected either at home or at the lab. The lab analyses the semen sample for the following qualities:

Semen Analysis

Volume and physical characteristics 
Semen is normally translucent or whitish-gray opalescent in color. Semen that is yellowish, greenish, reddish, or brownish, as well as semen that is too thick or watery or carries a foul odor, can prevent sperm from achieving fertilization. Abnormal semen can be caused by infections, diseases, and other causes.

Most men ejaculate between 2.5mls and 5mls of semen and lower semen volumes can result in fertility problems for couples. Smaller semen volumes can impact fertility because there is an inadequate amount of fluid to bring the sperm in contact with the cervix and allow the movement of the sperm toward the fallopian tube to meet and fertilize the egg. Occasional low semen production may be normal; however, consistently low volume needs to be treated. Low semen volume has several causes, including:

• Blockages in a seminal vesicle or ejaculatory duct, sometimes due to a varicocele
• Retrograde ejaculation, a condition in which part or all of the semen flows backwards into the bladder
• Infections
• Hormonal abnormalities

If the low semen volume is due to a blockage it can be treated through surgical procedures to eliminate blockages or with antibiotics to clear up infections. However in some cases when the cause of low semen volume cannot be successfully treated there are a variety of infertility treatments, including sperm retrieval and artificial insemination, which can help a couple successfully conceive.

Concentration (number of sperm per milliliter of semen)
A normal sperm count is considered to be 20 million per milliliter of semen. Low sperm count, also known as oligospermia, is a very common cause of male factor infertility. A low sperm count is characterized as less than 20 million sperm per milliliter of semen. Male factor infertility due to oligospermia can be caused by a variety of factors including:

• Stress
• Smoking and drug use
• Obesity
• Nutritional deficiencies.
• Hormonal
• Varicocele
• Previous surgeries or injuries to the testicles
• Missing part of the “Y” chromosome

Motility (percentage of moving sperm) 
Low sperm motility is a male infertility condition in which sperm’s ability to swim or penetrate an egg is diminished. More than 60% of sperm should be motile for normal fertility, but even men whose motile sperm constitutes only about a 30% of the total sperm count may be able to cause a pregnancy. In men with low sperm motility, fewer than 8 million sperm per milliliter show normal movement. When the sperm motility is abnormal many times there are other abnormalities also such as asthenozoospermia and necrozoospermia.

Couples demonstrating this type of male factor infertility may want to consider advanced treatment such as intrauterine insemination or intracytoplasmic sperm injection at IVF Plano.

Morphology (sperm shape)
Male factor infertility can be caused by sperm with an abnormal shape or size. Abnormally shaped sperm can prevent normal motility and egg penetration, which results in infertility. Common sperm abnormalities include sperm with an overly large or too-small, tapered, or crooked heads, two heads, or a tail with kinks. A normal semen analysis using the current strict morphology standard should show greater than 6% normal sperm shape. Fortunately abnormally shaped sperm just don’t work and are thought to be unable to fertilize an egg or create a viable pregnancy. They do not appear to cause chromosomal abnormalities in embryos. Abnormally shaped sperm may have a greater effect on male infertility than sperm motility does; however, treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF) offered at our Plano practice can help couples with this problem achieve successful pregnancy.

Read more about Sperm Shape

Germ-cell aplasia
One of the rarest but most serious causes of male factor infertility is germ-cell aplasia. The condition is characterized by the inability to produce sperm, resulting in azoospermic semen. The cause of germ-cell aplasia is not known; however, some researchers believe the condition develops from hormonal therapy, irradiation, gonadotropin deficiencies, environmental toxins, and other factors. Fertility is impossible for most patients with germ-cell aplasia and donor sperm is usually recommended to help couples conceive.

Other tests that may be helpful in diagnosing infertility include:

• Blood work to check hormone levels of follicle stimulating hormone (FSH) and testosterone, also luteinizing hormone (LH), estradiol, or prolactin
• Tests to check for the presence of infection including HIV, hepatitis, Gonorrhea and Chlamydia all of which can impair fertility.
• Specialized semen analysis, including genetic testing of the sperm and evaluation for the presence antisperm antibodies
• Post-ejaculatory urine sample to rule out or indicate retrograde ejaculation.
• Cervical mucus penetration test a post-coital test is designed to evaluate the effect of a woman’s cervical mucus on a man’s sperm.
• Genetic testing may be recommended to couples with severely low sperm counts who will be using intracytoplasmic sperm injection (ICSI). Genetic testing can help identify the possibility of inheritable genetic diseases that can be passed on to children.

Structural Causes of Male Infertility

Varicocele
Varicocele is a common male factor infertility condition in which a varicose veins connected to the spermatic cord, which runs between the testes and scrotum, become enlarged. This causes blood to flow improperly and back up, causing swelling in the testes and scrotum and may prevent normal cooling of the testicle. This can lead to reduced sperm count, motility, and morphology. Varicocele is treated surgically by tying off the enlarged veins. However, the surgery does not always correct the sperm abnormalities.

Read more about Varicocele

Undescended testicle 

Undescended testicle is a condition when one or both testicles fail to move from the abdomen into the scrotum during fetal development. Undescended testicles are exposed to the higher temperature in the body and can result in decreased sperm production.

Abnormal Sperm Delivery
If your partner has received results of a semen analysis that indicate that things are normal, you may be experiencing problems with the delivery of sperm from the penis into the vagina, including:

Sexual Issues
Several problems during intercourse can impact male fertility, including erection difficulties (erectile dysfunction), premature ejaculation, dyspareunia, or psychological or relationship problems.

Retrograde Ejaculation
Caused when semen enters the bladder during orgasm rather than exiting out of the penis, retrograde ejaculation can result from various conditions such as bladder, prostate or urethral surgery, diabetes, and certain medications.

Duct Blockage
When the epididymis or the ejaculatory ducts are blocked, the male partner may have trouble impregnating his partner. Some men do not have tubes that carry sperm, called the vas deferens, from the testicle to the opening in the penis, which can also lead to problems conceiving. This is most commonly seen with men who have cystic fibrosis.

Misplaced urinary opening (hypospadias)
If the urinary (urethral) opening is located on the underside of the penis, sperm delivery can be hindered unless surgery corrects the issue.
General Health and Lifestyle Issues
Your overall health and lifestyle choices can contribute to conception problems. Consider these areas:

Lifestyle Issues that Impact Male Fertility

Emotional stress
When you experience a great deal of emotional distress, this situation can impact the hormones needed to produce sperm and influence sperm count. Fertility problems can contribute to overall stress and aggravate the situation.

Malnutrition
If you don’t get enough vitamin C, selenium, zinc or folate, you may have difficulty trying to conceive.

Obesity
Caring excessive weight can hinder male fertility.

Cancer and/or Cancer Treatment
Radiation and chemotherapy may impair sperm development and production; the closer treatment is to the testicles, the greater the chance of developing fertility issues. If one or both testicles must be removed, your fertility will probably be affected.

Alcohol and Drug Use
Dependency on alcohol or drugs can cause health issues and reduce fertility. Specific drugs, like anabolic steroids, can also play a part with infertility.

Age
Once you reach age 40, your fertility may decline.

Other Medical Conditions
Major surgery, a serious injury, and certain health conditions like diabetes, thyroid disease, Cushing’s syndrome, or anemia may lead to male infertility.

Overheating the Testicles
While trying to conceiver, refrain from regular use of saunas or hot tubs because these activities can elevate your core body temperature, impairing your sperm production and lowering your sperm count.

Substance and tobacco use 
Narcotics such as marijuana and cocaine may temporarily reduce the quality and number of sperm. If you smoke, you may have a lower sperm count then men who don’t use tobacco.

Read more about Evaluation of Male Infertility