Fertility Tests- Male Infertility and the Semen Analysis

Male factor infertility is solely responsible for about 20% of infertile couples and is contributory in another 30 to 40%. Therefore, it is critical that both partners are evaluated. Additionally, it is important to understand that a normal result of a semen analysis does not rule out all male factors that may be causing or contributing to the infertility. In nearly all cases there is no way to predict the fertility of a man without having a semen analysis performed. Because day-to-day sperm production can be quite variable, if the first semen analysis returns abnormal it is usually recommended that a second semen analysis be performed.

There is a long standing World Health Organization system defining “normal” values for semen analysis.

Semen volume: >1.5mL
Sperm concentration: > 20 million/mL
Motility (swimming ability): >50%
Morphology (shape of sperm): >50% normal

There is another system for evaluation of sperm shape (morphology) called “strict morphology.” Our lab, (as do most IVF programs) uses this system. With the strict morphology system, normal is >9%. Men may fall between 4% and 9% in the so called “indeterminate zone.” Some men in this group will show normal fertility and some will be infertile-it is not possible to distinguish how these sperm will function. Men with morphology below 4% are clearly abnormal and concern exists that these sperm may not be able to fertilize an egg.

Sperm antibodies are an uncommon but real problem affecting some men. The first time our lab washes or analyzes a man’s sperm sample, a screening test for sperm antibodies is performed (ASAT test). There is an additional charge for this test-it is done only once.

There is also new information on what sperm numbers and motility are defined as “normal.” It is not as simple as suggested by the WHO standards. This new definition recognizes an “indeterminate” zone regarding these two parameters-as above with the shape parameter. Sperm numbers from 12 to 50 million and motility between 20 and 60% are broad “gray” areas (indeterminate). Men in these ranges may or may not be fertile. Many men fall into these ranges of number or motility.

Other tests have been devised to test sperm function-hampster test, acrosome reaction test, and zona assay. Unfortunately none of these are very useful.

Genetic Testing

Men with low sperm counts are offered testing to evaluate whether they carry a genetic abnormality that could be transmitted to the offspring. This is because some causes of low sperm counts are genetic so a couple is at risk for having a male baby who will have similar problems as his father.

A karyotype is a genetic test that looks at the chromosomes, in general, for any abnormalities. There is also more focused testing, such as microdeletion testing that look for genetic pieces that are missing. These missing pieces of certain genetic information on the Y-chromosome are known to cause male factor infertility.

In men with no sperm (azospermia) karyotypes are abnormal 10-15% of the time and Y-microdeletion testing is positive in approximately 15%. In men with sperm concentrations less than 2 million/mL a karyotype will be abnormal 5% of the time and Y-microdeletion testing is positive for an abnormality in about 10% of cases. Meeting with a genetic counselor is also available for couples.

All genetic causes of male infertility are not known or testable so a normal result to genetic testing does not rule out the possibility that male infertility might be inherited. Frequently, genetic testing in infertility is not covered by insurance.

Forty percent of men with no sperm in the analyzed semen have an obstruction (blockage) that prevents the sperm from being ejaculated. This can result from infection in the reproductive tract, from failure of a surgical procedure to reverse a vasectomy, or by a malformation in the tract known as congenital bilateral absence of the vas deferens (CBAVD). CBAVD is frequently associated with the gene complex responsible for Cystic Fibrosis. Genetic testing for Cystic Fibrosis is recommended in these cases.

Treatment

Abnormal results of a semen analysis may lead your physician to suggest a consultation with an urologist. Testing by the urologist may reveal a hormonal or anatomic problem that can be corrected thereby improving the sperm quality.

In situations where the urologist concludes that the quality or quantity of the sperm cannot be significantly improved, specific treatments can be offered such as intrauterine insemination of the partner’s sperm (IUI), donor insemination or in vitro fertilization (IVF).

About Vitamins, Antioxidants for the Male

There is some evidence that male fertility may be improved by taking over the counter medications-vitamins and antioxidants. The research on this issue is inconclusive. A combination of these over-the-counter drugs, that does no harm, and may improve male fertility includes: a multivitamin with zinc (without iron), Vitamin C 500 mg, Vitamin E 400 mg, selenium 10 micrograms. Even men with “normal” sperm counts may benefit. This treatment is inexpensive-a few dollars a month and can easily be purchased at nutrition stores.

Proxeed is a product containing L-carnitine and acetlycarnitine. Supplementing these in men with low sperm numbers or low motility has been shown to improve pregnancy rates. It costs about $100 per month (www.proxeed.com).

Another more complicated formulation for men is called “Fertile One.” It contains vitamins, minerals, L-carnitine and more-some amino acids (the building blocks of protein) that have long been thought to be responsible for improving sperm movement. Medical research on this product is promising, but incomplete at this time and it is more costly (about $91 per month) than the regimen above. Fertile One can be purchased at Coast Reproductive or by calling 1-877-237-3748.

Another product commercially available for men is Conception XR by Fertility Sciences – go to www.conceptionxr.com for more information and pricing. It has vitamins, minerals, and L-carnitine, similar to FertileOne.