Male-factor infertility accounts for 30 per cent of infertility cases and is a common problem among couples trying to conceive.
To determine whether a man has a reproductive problem that is causing infertility, a specialist can run different tests to reach a diagnosis.
Usually, doctors request a basic physical exam and a semen assessment, and often a blood test, to assess levels of hormones such as follicle-stimulating hormone (FSH), luteinising hormone (LH) and testosterone. Depending on the results, the specialist may require more checks, such as sperm DNA fragmentation, an immunobead test or a testicular biopsy. This section gives you detailed explanations of these male-specific tests.
Please remember anyone can be affected by infertility and while it can be a challenging experience, the good news is that there are options available to help you achieve your dream of having a baby.
A semen assessment evaluates the amount and quality of a man’s semen and sperm to determine his potential fertility. This test is sometimes called a sperm count.
A semen assessment is used to assess the following:
A semen assessment can help clarify whether a man has a reproductive problem that is, in part, causing infertility, and then determine what treatment options are reasonable. A severely low sperm count or low motility may indicate the need for an advanced approach, whereas a normal semen assessment might suggest a more conservative strategy.
A semen sample is usually collected by masturbation, directing the fluid into a sterile container. No lubricants should be used as they might kill the sperm. Two to five days of abstinence are recommended before a semen assessment, to ensure the reliability of the test. Longer periods of abstinence may affect the accuracy of the results (less active sperm).
Once the semen sample has been collected, it should be delivered to the lab within one hour and kept close to body temperature.
To learn more, please read our fact sheet: Semen assessment.
Sperm DNA Fragmentation is a test that provides a reliable analysis of sperm DNA integrity and may help to identify men who are at risk of failing to initiate a healthy, ongoing pregnancy. Information about sperm DNA integrity may help in the clinical diagnosis, management and treatment of male infertility.
The genetic integrity of the sperm is essential for normal embryo development. A high level of DNA fragmentation in sperm cells may represent a cause of male infertility that a conventional semen assessment (sperm concentration, motility analysis or morphology assessment) will not detect.
Results reported in scientific literature have shown that regardless of the assisted reproductive technology (ART) used, an elevated level of sperm DNA fragmentation will significantly compromise the possibility of a successful pregnancy.
The sperm are captured within an inert agarose gel. These are treated with an acid denaturant, which removes already fragmented DNA. The remaining material is then treated with a lysing agent, which frees the intact DNA into the agarose gel. This gel is then stained to highlight the released DNA and evaluated to determine the degree of fragmented versus intact DNA.
Depending on what caused the damage to the sperm DNA, there may be a way to improve it. Some options are to change to a healthier lifestyle, quit smoking, avoid exposure to toxins, and take a daily supplement of antioxidants and zinc. Further clinical options can be discussed with one of our specialists.
To learn more, please read our fact sheet: Sperm DNA fragmentation.
An immunobead test (IBT) checks for anti-sperm antibodies.
Immunological infertility occurs most often in men. The male immune system can react to its own sperm as if they were invading cells, possibly because of an infection, cancer or a vasectomy. The presence of antibodies can inhibit the ability of the sperm to fertilise an egg.
If the cause of the immunological infertility is related to the female, the current theories are that cervical mucus can kill sperm. However, this theory is unproven.
An IBT can detect different kinds of anti-sperm antibodies in several biological samples. The test can indicate the class and severity of the antibodies and what part of the sperm is affected.
An IBT can also help to determine the fertility treatment options that best suit a couple.
At City Fertility, we carry out “direct” immunobead testing on the semen sample itself. In this test, a small portion of the neat semen sample is mixed and incubated with latex beads and antibodies, then checked for a reaction under the microscope. A positive reaction is where the sperm and beads become bound to each other. A male with a positive result, depending on the level of binding and where the beads bind to the sperm, may find that sperm and oocytes may not interact as expected, but there are ways to overcome this issue.
A testicular biopsy, also known as Testicular Sperm Aspiration (TESA), is a test in which sperm is extracted directly from the testicles for analysis.
A testicular biopsy is performed when the male partner does not have sperm in his seminal fluid. This could be due to a number of factors, including a vasectomy, failed vasectomy reversal, obstruction, retrograde ejaculation, abnormal anatomy (such as an absence of the vas deferens) or certain genetic defects.
Sperm are produced within a network of tiny tubes called “seminiferous tubules” inside the testicles. In the TESA procedure, a fine needle is passed into the testicles under anaesthetic, and a tiny amount of tubules is removed. These tubules are then processed in the laboratory and checked for the presence of sperm, which, provided they are viable, can either be used to fertilise eggs or frozen for use in the future with Intracytoplasmic Sperm Injection (ICSI) – a specialised form of In Vitro Fertilisation (IVF).
Sperm retrieved from the seminiferous tubules in a testicular biopsy procedure are much less in numbers, less mature and less motile than those found in ejaculated seminal fluid. As such, IVF with ICSI is necessary to achieve fertilisation with TESA sperm.
Screening tests and other diagnostic checks for severe male infertility are: