Sperm are formed in the testes and once the formation is complete, the sperm enter the epididymis, a comma-like structure on the outside of the testicle, where it finishes maturation. The maturation period is 2-3 months. This means that when attempting to influence sperm health, a program must focus on changes that affect sperm 2-3 months prior to intercourse.
For successful conception to occur, sperm must overcome many obstacles- ensuring that only the strongest, healthiest sperm penetrates the egg leading to fertility. This is survival of the fittest at its best. The seminal fluid protects the sperm in multiple ways including buffering the acidic environment of the vagina, assisting with motility through cervical mucus and suppressing an overzealous female immune system that can destroy sperm. Because of the complexity of survival, many millions of sperm are required at the time of intercourse for fertilization to occur.
In couples with fertility problems, around 25% is due to male infertility and in 40-50% of cases, it is the main or contributing cause. No amount of focus on fertility will overcome at times unless male factors for fertility are considered. Because the evaluation of male fertility is simpler and less invasive than the evaluation for female fertility, it makes sense to evaluate men before an extensive or extensive work-up is done to determine why a couple isn’t getting pregnant
What Is Semen Analysis?
Semen analysis is a simple but vital test that measures the three most important semen parameters:
Concentration or Count: number of sperm in each ml of semen
Motility: the percentage of sperm swimming forward
Morphology: the percentage of sperm that are of normal size and shape
|Semen Analysis Parameter||Normal Values|
|Volume||1.5 ml or more|
|pH||7.2 or more|
|Concentration||15,000,000/ml or more|
|Total motility||40% or more|
|Progressive motility||32% or more|
|Morphology||4% or more|
|Vitality||58% or more live|
|White blood cells||Less than 1,000,000/ml|
Common male fertility problems are usually caused by:
- Low sperm count
- Damaged sperm ducts
- Hormonal deficiency
- Testicular failure
- Sperm antibodies
- Unexplained infertility
Low Sperm Count
This is the most common reason for low male fertility, which could be caused by hormonal deficiencies, varicoceles or infections. Sperm production can be increased via fertility drugs (Clomid, Pergonal) or high-tech procedures.
A varicocele is an enlargement of the veins within the scrotum- the loose bag of skin that holds your testicles. Varicoceles are one of the most common causes of low sperm count and decreased sperm quality. Almost 40% of infertile men will have a varicocele, and the exact impact on fertility is still unknown. A surgery that blocks the affected vein redirecting blood flow into normal veins can be performed, which increases the sperm count and improves fertility. It takes three months for normal sperm development so an impact on fertility should not be expected before this period of time.
Damaged Sperm Ducts
Blocked sperm ducts account for up to 15% of male infertility. Scarring in the sperm ducts caused by varicoceles or infections due to sexually transmitted diseases (STDs) may prevent the sperm flow. Minor surgery may be needed to remove the scarring or blockage.
Fluctuating or very low levels of FSH and LH can reduce sperm production. Gonadotropins are usually the recommended therapy, although hormonal imbalance is a complex issue that may need further exploration.
In this condition, the pituitary gland is releasing sufficient hormones but the testes fail to respond producing low sperm counts. Causes include injuries, surgeries, STD’s, and other diseases. If there is no sperm production, there is no treatment. However, if there is still some sperm production, fertility drugs may improve the sperm count.
In this condition, the man’s own body creates antibodies to destroy his sperm. This condition occurs in 10% of infertile men. Potential therapies include steroids or adrenal hormones which can block the immune system from attacking the sperm.
Similar to unexplained infertility in females, about 30% of men have unexplained infertility- meaning that the doctor is unable to determine an apparent cause for why the man is unable to achieve healthy sperm production. Various factors contribute to unexplained male infertility and include:
- Oxidative stress- sperm does not have the necessary repair systems to protect themselves against excessive free radicals being made that destroy them.
- Poor lifestyle choices- smoking, heavy drinking, unhealthy diet
- Exposure to heat, toxins and heavy metals
- Too tight clothing
- Activities that affect the genital area, such as long bike rides
It is sometimes hard to know whether low male fertility is the only cause or just a contributing cause when a couple experiences infertility. Part of the problem is that numbers are just numbers:
- Men with very low sperm counts and low motility scores can sometimes have children
- Some men with normal counts are infertile without using IVF
What matters, in the final analysis, is not how many sperm are made or how fast they swim – but whether they can fertilize the female partner’s eggs. This is really a biochemical issue at the molecular level. Therefore, looking at the “little swimmers” under the microscope is not always a perfect way of assessing the ability of the sperm to fertilize the female’s eggs. If a man’s sperm count is abnormal. It is best to recheck it several weeks after the abnormal testing to confirm the results. If a man’s sperm count is normal, daily intercourse is recommended during a women’s optimal fertility window (best quality cervical fluid). If the sperm count is low, you may opt to have sex every other for conception to occur to allow the sperm count to build to a higher more fertile level.