According to the National Institutes of Health, male infertility is involved in approximately 40% of the more than 2 million infertile married couples in the United States. One-half of these men experience irreversible infertility and cannot father children, and a small number of these cases are caused by a treatable medical condition.
In men, hormone disorders, illness, reproductive anatomy trauma and obstruction, and sexual dysfunction can temporarily or permanently affect sperm and prevent conception. Some disorders become more difficult to treat the longer they persist without treatment.
Sperm development (spermatogenesis) takes place in the ducts (seminiferous tubules) of the testes. Cell division produces mature sperm cells (spermatozoa) that contain one-half of a man’s genetic code. Each spermatogenesis cycle consists of six stages and takes about 16 days to complete. Approximately five cycles are needed to produce one mature sperm. Energy-generating organelles (mitochondria) inside each sperm power its tail (flagellum) so that it can swim to the female egg once inside the vagina.
It is difficult for any person to admit that they have a fertility problem. However, because of the old fashioned idea that women are typically the cause of infertility issues, many men find it especially hard to admit that they might be the one with the problem. When going for fertility testing, it is important for the male partner to undergo a semen analysis in order to assess how well his sperm work. This simple test can provide fertility specialists with a great deal of insight into a man’s fertility.
In almost half the cases of subfertility, there is a male contribution to the problem. The initial investigation requires a sample of semen for analysis. This is usually produced at home after abstaining from ejaculation for 2 to 3 days. A shorter time than this will reduce the total number and longer abstinence can lead to a falsely high number of poorly motile (slow swimming) sperms. The sample needs to be delivered to the laboratory within one hour for analysis. The following are considered a normal result:
Concentration: more than 20 million per ml
Motility: more than 50% progressively motile
Form: more than 30% normal appearance
White blood cells: less than 1 million per ml
We clinics suggest two samples should be received for analysis, particularly if there are any abnormalities with the first test. It takes around 74 days to make sperm, so if 2 samples are checked in a shorter time than this, it is likely that they are from the same population. This might be important if, for example, a man had a viral infection, or a poor result followed a period of particularly heavy alcohol intake. In this case, it would be better to delay the second sample for 3 months.
There are several other specialised tests for semen analysis, but these are not routinely recommended, as their ability to predict infertility and direct the correct treatment has not been proven. One particular test is the anti-sperm antibody test.