One of the first topics I discuss when seeing an infertility couple for their initial visit is the most common causes of infertility. It is not unusual for them to be very surprised when I tell them that male factor infertility occurs in at least 30% of couples. In fact, many times, both the man and women have issues that can lead to infertility. Accordingly, a semen analysis should always be a part of the initial evaluation even if the woman presents with a known problem that can cause infertility.
A semen analysis examines three main factors: sperm concentration, motility and percent normal morphology (percent of sperm that appear normal). All these parameters are equally important and can be negatively impacted by a variety of factors both biologic and environmental.
If an analysis is abnormal, I always recommend that a repeat sample be provided for analysis. Results can be quite variable and factors such as length of abstinence and spillage while acquiring the sample can have a significant impact on the results. Generally, we recommend that the period of abstinence be at least 3 days and no longer than 7 (preferably 5 days). Typically, if a man produces a sample and has not had an ejaculate for a long period of time, the percent normal morphology and sometimes motility can be adversely affected. Likewise, if a sample is not produced in the office and is not presented to the lab within 45 minutes to an hour or if the sample is exposed to extreme temperatures, motility can be significantly lower.
Part of my initial evaluation includes a detailed history of both the male and female. Important questions that can point to reasons for an abnormal analysis include: history of previous urological surgery; history of undescended testicles as a child or adolescent; significant trauma to the testicles; infections that involve the male urogenital tract or the testicles; decreased libido; difficulties with sexual performance; medications that can affect sperm production such as testosterone, drug, alcohol or tobacco abuse, toxic exposure; and testicular exposure to high heat such as use of Jacuzzis, hot tubes or saunas, and certain types of exercise.
Assuming the repeat semen sample remains abnormal despite obtaining the sample correctly, the next step would be a referral to a urologist for a detailed examination and other necessary tests. Blood testing that determines various hormone levels is also an important part of the evaluation. As with women, a man’s fertility potential is very much dependent upon normal hormone levels such testosterone, LH, FSH, thyroid hormone, prolactin and estrogen.
Once the evaluation is completed, a course of treatment can then be recommended. Treatments may include fertility medication, hormone replacement therapy or surgery. Trying to optimize sperm health includes a healthy lifestyle; maintaining a normal weight, good diet, avoiding exposure to chemicals or drugs that can adversely affect sperm production and intake of certain vitamins that can improve sperm quality. Ingestion of antioxidant vitamins such as vitamin C, E, Selenium, beta-carotene, zinc have been linked to improvement in sperm quality.
Fortunately, even if specific medication or surgery cannot improve sperm parameters, we can offer other fertility treatments such as intrauterine insemination and in-vitro fertilization. With the developments in assisted reproductive technologies, our IVF center can offer IVF treatment to men with extremely low or even zero sperm counts and in many cases this treatment has led to successful pregnancies outcomes.