Infertility
Types of Male Factor Infertility
What causes abnormalities in a semen analysis?
Is there anything I can do to improve my semen analysis?
Improving sperm quality
Types of Male Factor Infertility
The results of a semen analysis are evaluated by the doctor along with the couples’ history and the results of investigations of the female, and these are all taken into consideration when making diagnoses and recommendations for treatment.
A general outline of the main types of male factor infertility that may be identified in a semen analysis is outlined below. It is not uncommon for more than one of these characteristics to be seen in the same semen analysis.
Oligozoospermia - Low sperm count
When the number of sperm in the ejaculate is low, the chances of a sperm reaching and fertilising the egg following intercourse may be reduced. In cases of mild oligozoospermia, IUI might be the appropriate treatment, as the sperm can be concentrated before placing in the uterus. More commonly, however, IVF or in severe cases ICSI, may be recommended as fewer sperm are required and fertilisation can be achieved in the laboratory.
Asthenozoospermia - Reduced motility and/or impaired progression.
When the number of actively swimming sperm in the ejaculate is very low, or if the way the sperm are swimming is impaired, the chances of a sperm reaching and fertilising the egg following intercourse may be reduced. When it is just the number of motile sperm that is low, IUI or IVF may be recommended as the motile sperm can be extracted from the ejaculate and concentrated in the laboratory. However, if the ability of the sperm to swim is severely impaired, the chances of fertilisation through IVF may also be low, so ICSI may be recommended.
Teratozoospermia - Raised levels of abnormal sperm
Abnormal sperm have a reduced capacity to fertilise eggs or form viable embryos. When the number of normal sperm in the ejaculate is below normal, the chance that a normal sperm will reach and fertilise the egg may also be reduced. In cases of mild teratozoospermia, IVF may be the appropriate treatment, because a preparation of the most normal sperm can be prepared in the laboratory and used to achieve fertilisation in vitro. When the number of normal sperm is very low however, ICSI may be recommended because the embryologist can examine individual sperm and identify the most normal sperm for injection into the egg to achieve fertilisation.
Azoospermia - No sperm present in the ejaculate.
There are various reasons for complete absence of sperm in the ejaculate. In some cases, the cause of azoospermia may be ‘obstructive’ which means that it is caused by a blockage in the route between the site of sperm production (the testes) and ejaculation. In other cases the cause of azoospermia may be ‘non obstructive’, which means that it is caused by a partial or complete failure in sperm production in the testes.
Obstructive azoospermia may be caused by a blockage in the epididymis, the area where the sperm are held after production or perhaps in the vas deferens, the tubes through which sperm leave the testicles. In some cases the tubes may be completely absent, a condition called congenital absence of the vas deferens (CBAVD). In other cases, the blockage may be caused by a previous vasectomy or failed vasectomy reversal.
In cases of obstructive azoospermia it is usually possible for a urologist to surgically extract sperm from the epididymis or the testes by MESA or TESE and for the embryologist to use such sperm to achieve fertilisation in the laboratory through ICSI.
In cases of non-obstructive azoospermia, an exploratory TESE can be carried out confirm whether sperm is being produced or not. Occasionally, although the ejaculate is azoospermic, there may be small pockets of sperm production within the testis and if these can be extracted, the sperm can be used to achieve fertilisation through ICSI.
If sperm cannot be identified through testicular exploration, the option of using donor sperm [LINK – donor sperm] in combination with IUI or IVF can be explored.
Immunological infertility - Significant anti-sperm antibodies bound to the sperm.
Anti-sperm antibodies are large protein molecules that are detected bound to sperm in the ejaculates of some men. These antibodies have very varied effects on fertility and in some men they have no effect at all. They can be caused by testicular trauma, genital infections and previous vasectomy, although in most cases their cause is unknown. In some cases the antibodies cause the sperm to stick to one another and so effectively reduce the number of free swimming sperm available to fertilise the egg. In some cases, the antibodies seem to slow the sperms’ swimming and in other cases they appear to directly interfere with their ability to bind to and fertilise the egg. Depending on the level of antibodies detected on a semen analysis and their effects on the sperm, IUI, IVF, or ICSI may be recommended.
What causes abnormalities in a semen analysis?
Abnormalities in the semen are primarily due to a defect in sperm production by the testes. The cause of this is usually unknown. Occasionally abnormalities may be associated with previous infections, surgery or excessive drinking. In addition, certain drugs, radiation and radiotherapy may have a detrimental effect on the production of sperm. The presence of a varicoele (a condition where there is an increase in the blood flow around the testicles due to dilated veins) may lead to a rise in the temperature around the testicles, which may adversely affect sperm production and motility.
Complete absence of sperm in the ejaculate as a result of testicular failure, may be the result of a chromosomal disorder, or previous infections such as the mumps. It may also be associated with the history of maldescent of the testes into the scrotum
Is there anything I can do to improve my semen analysis?
There is some evidence that for some men, dietary and lifestyle changes can have positive effect on their semen analysis. It seems that these modifications will tend to enhance rather than dramatically alter the characteristics of the sample and the effects seem to vary between men. Details of these recommendations can be found here.
Improving sperm quality
There are various steps any man can take in an attempt to improve the quality of his sperm. These include lifestyle changes and nutritional supplementation. Below follows a brief summary of recommendations that the male partner of a couple trying to conceive may wish to follow.
Supplements that may potentially improve sperm count/quality.
The following supplements have been shown, in various clinical trials, to improve sperm count and/or quality. It is important to emphasize however, that not all patients will show an improvement in response to nutritional supplementation. All supplements should be taken long term as the sperm production cycle is approximately 90 days long.
• Zinc – 30milligrams twice daily
Zinc deficiency has been linked with a reduced sperm count. Zinc plays an important role in normal testicular development, spermatogenesis (the production of sperm) and in sperm motility. Supplementation with dietary zinc has been shown to improve sperm counts in both fertile and subfertile men. Zinc, in combination with other nutritional supplements (folic acid) has also been shown to improve sperm motility. Zinc is found naturally in meat, wholegrain cereals, seafood, eggs and pulses.
• Selenium – 200micrograms daily
Selenium plays a role in the regulation of the testes and accessory sex glands. Selenium may also have a protective role to the sperm as an antioxidant. Selenium has been shown to improve sperm motility both on its own and in conjunction with vitamin E, another antioxidant. Selenium is found naturally in meat, seafood, mushrooms, cereals and in particularly high levels in Brazil nuts.
• Vitamin E – 400milligrams twice daily
Vitamin E is an antioxidant which may protect sperm from damage. It has been shown that when taken in conjunction with selenium, the sperm of subfertile men can show improved motility. Vitamin E is found naturally in vegetable oils, nuts and green leafy vegetables.
• Folic acid – 5milligrams daily
Folate, of which folic acid is the synthetic form, is essential for DNA, RNA and protein synthesis. Because DNA synthesis is a large part of spermatogenesis, it is likely to be important in this process. It has been shown that folic acid in conjunction with zinc can improve sperm count and motility in both fertile and subfertile men. Folate is found naturally in green leafy vegetables, liver, yeast and fruits.
Lifestyle
Lifestyle can have a major impact on fertility. Various studies have shown that factors such as smoking, heavy drinking and exposure to toxins in the workplace can have serious detrimental effects on sperm and the ability to achieve a pregnancy.
• Smoking
Tobacco smoking is long established as a general health hazard and has been shown to affect reproductive health in both men and women. A recent study has shown that smoking as little as 1 cigarette per day directly reduces the number and quality of sperm. Another recent study has demonstrated that smoking in males decreases the success rates of both IVF and ICSI. This study showed that non-smoking couples were almost twice as likely to achieve a pregnancy as those where the male partner smoked >5 cigarettes/day.
• Alcohol
First the good news; moderate alcohol consumption (<20 units/week) has been found to have no effect on sperm quality or reduce pregnancy rates. However, heavy drinking (>20 units/week) has been shown to double the time taken to achieve pregnancy. There is also some evidence to suggest that in the month prior to fertility treatment, increased alcohol consumption in men can subsequently lead to higher miscarriage rates.
• Occupational exposure to toxins
Various occupations can involve exposure to toxins, in particular organic solvents. These solvents are present in substances such as paint, lacquers, adhesives, degreasers, printing inks and laboratory solvents. It has been shown that males exposed to these solvents on a regular basis are likely to have reduced sperm count and quality. When handling compounds containing these solvents appropriate safety precautions should be followed.
• Temperature
Spermatogenesis takes place at a temperature slightly lower than body temperature. It has been shown that exposure to heat affects sperm quality. Therefore, regular hot baths and regular saunas/steam rooms would be best avoided. Loose fitting underwear has also been suggested to avoid problems with overheating of the testes.
• Stress
High levels of stress have also been shown to reduce the quality of sperm.