Male Infertility: Causes and Investigation

North Cyprus IVF Clinic specializes in infertility investigation as much as it offers treatments. Even though there is a common misconception that majority of fertility problems are female oriented, in quite a few cases, infertility arises from a male factor. It has been estimated in 2014 that 30% of all infertility cases are male related while female related infertility is also estimated to be 30%. Both male and female factor infertility is also categorized as 30% while the remaining 10% is unexplained infertility. This tells us that around one-third of all infertility cases are solely male factor related, which makes male infertility investigation an important part of fertility/infertility assessment.

Factors Affecting Sperm Parameters and Male Fertility

There are a number of factors that may affect sperm quality and therefore cause male infertility. These range from genetic problems to pathophysiology and lifestyle and environmental factors. Some things that may reduce sperm viability and its ability to fertilize eggs can include:

• Congenital birth defects or genetic disorders can affect spermatogenesis at various stages.
  
• Excessive alcohol consumption is known to negatively affect many sperm parameters.
  
• Recreational drugs or some prescription drugs can possibly interfere with spermatogenesis and sperm quality. Anabolic steroids have also been shown to dramatically reduce sperm count.
  
• Environmental toxins, including pesticides used during farming and exposure to lead can impact sperm viability.
  
• Smoking cigarettes or other tobacco products have been shown to reduce sperm quality.
  
• Health problems associated with bodily infections and fever can severely reduce sperm count. If you had sperm testing following an infection, the sperm parameters may have been affected.
  
• We recommend a retest after three months to double check.
  
• Some medication have been shown to reduce certain sperm parameters. Some antidepressants are also under scrutiny in terms of their impact on sperm DNA fragmentation.
  
• Chemotherapy and radiation therapy affect cells that divide quickly. Germ cells are also such cells and they are targeted by these therapies. Age is also an important factor in terms of decline in male fertility.
  
  

How to Interpret a Sperm Analysis?

The World Health Organization (WHO) has established standardized minimum sperm parameters required for natural conception via intercourse. The following values are the WHO established minimum acceptable sperm parameters:

• Volume: > 2.0 ml
  
• Concentration: >20 million/ml
  
• Motility: > 50%
  
• Morphology: >30% with normal morphology
  
• White Blood Cells (Round Cells): < 1 million/ml
  
• pH: 7.2-7.8
  
  

However, given that these values are established for natural conception, it is possible to achieve pregnancy with values lower values during IVF treatments, especially when ICSI is used.

Oligozoospermia refers to sperm samples with count lower than 20 million/ml.

Astenozoospermia refers to the sample of sperm whose motility has been found to be lower than 50%.

Teratospermia (teratozoospermia) refers to a high level of sperm cells in the ejaculate that are considered to be morphologically “abnormal”.

Azoospermia is a condition characterized by the total absence of sperm cells in the sperm. Azoospermia is further dividen into two sub-categories: Obstructive azoospermia where sperm production occurs but the duct system carrying sperm outside has an obstruction. Non-obstructive azoospermia refers to problems (either genetic or pathophysiological) where sperm production is absent.

If your sperm analysis indicates a problem with any one or more than one of the sperm parameters, further evaluation will be in order. Problems with sperm parameters may indicate other underlying medical conditions which can only be elucidated via proper medical history taking. Effective history taking will allow us to review possible medical issues such as recent fevers, infectious diseases, past history of cancer, problems that might be associated with previous surgeries including retroperitoneal, pelvic, bladder or prostate surgeries as well as family history of cryptorchidism or hypogonadism. Certain medications are known to interfere with spermatogenesis and sperm maturation, therefore, prescription and non-prescription medication, sports supplements or any other drugs must be evaluated in terms of their possible impact. For an effective assessment, you must be forthcoming about all the relevant information because failure to do so can affect the level and quality of your care.

Obstructive Azoospermia versus Non-Obstructive Azoospermia

Non-obstructive azoospermia refers to problems with production and/or maturation of sperm cells. The problem with non-obstructive azoospermia is more severe compared to obstructive azoospermia since surgical sperm extraction methods are not likely to produce desired results. In such cases, using donor sperm usually becomes the next best alternative. If you have been through sperm testing where the result has indicated azoospermia, and if surgical sperm extraction methods such as TESA, PESA, TESE or Micro TESE did not result in a desirable outcome, stem cell therapy can be an option. At North Cyprus IVF Center, we are currently offering stem cell therapy for patients with non-obstructive azoospermia. For more information, please see our “Stem cell therapy for non-obstructive azoospermia” link.

Please contact us for more detail on Male Infertility.