Testing for a male factor fertility problem typically starts with a semen analysis. Semen will need to be provided to the lab in a sterile container provided by your doctor. Many labs allow at-home collection for privacy, as long as the sample is transported to the lab (and kept warm, by keeping the cup in your waistband or underarm) within an hour. Many labs offer private on-site collection rooms to eliminate falsely decreased results due to transport of the sample.
Sperm Count Analysis
Once in the lab, the sample will be analyzed for the presence of sperm and a sperm count will be performed. Fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 30 million per entire ejaculate is considered a “low sperm count”. The technician will also analyze how well the sperm are moving and if they are shaped normally. Problems can come in many different varieties. There may be plenty of sperm, with only a small percent moving (low motility). There may be only a small amount of sperm present, but with good movement (low sperm count). There could be no sperm present (azoospermia) or there could be many sperm that move well, but contain a high percent of sperm that are shaped abnormally (abnormal morphology). The results of the semen analysis will help you and your doctor decide which treatment will be right for you and your situation.
Additional Analysis Testing
If the results are abnormal, your physician may choose to order hormonal and/or genetic blood testing or refer you to a reproductive urologist for an evaluation. Testosterone, FSH and LH are hormones that may be measured and medication can be provided if there is a hormone imbalance, which may or may not improve sperm counts and quality. Anatomical problems, like a varicocele, can be corrected through surgery or assisted reproductive technologies can be used to help with conception. Genetic disorders, such as Klinefelter’s Syndrome or congenital absence of the vas deferens, may be treatable using sperm aspiration techniques in conjunction with IVF/ISCI (more on that later).
For slightly low sperm counts, or low motility, or difficulties with intercourse, a more conservative insemination treatment for the female partner may help conception. By placing the sperm directly in the uterus around the time of ovulation, and insemination helps bring sperm closer to the egg and reduces the ‘travel time’, which can be essential if the motility of the sperm is low, or if there isn’t a high number of sperm present (many die en route to their destination, so bringing them closer increases the odds one will make its way inside of the egg). This procedure is known as an IUI (intra-uterine sperm insemination) and is performed out-patient at your doctor’s office.
IVF with ICSI
For more severe cases, such as no motility or a markedly decreased sperm count, IVF with intra-cytoplasmic sperm injection (ISCI) is a great option. ICSI is a fertilization procedure used during IVF; with this option, a single sperm is injected into an egg. During a traditional IVF cycle, the sperm and eggs are placed next to each other in a laboratory dish in order to achieve fertilization, but with ICSI, because the sperm is injected directly into the egg, the process has a much higher likelihood of being successful. Once fertilization has occurred, the embryo is typically transferred back into the uterus around day 3.
In cases in which there are no viable sperm present in the semen analysis, a TESA (Testicular sperm aspiration) or TESE (Testicular sperm extraction) procedure may be performed by a specially-trained urologist. These procedures remove fluid or tissue from the testicles in an effort to obtain sperm. If sperm are present in the fluid or tissue aspirate, it can be frozen and used for an IVF procedure. Should there be no sperm present following TESA/TESE procedures, or if multiple IVF cycles fail, some couples choose to use a sperm donor or consider adoption.
Your physician can help you navigate all of your options, and provide you with resources for agencies and support groups while you and your partner decide what is best for you. There are many treatments available to help overcome male factor infertility. Fertility Solutions physicians understand the difficulties-emotionally and physically-one has to cope with when facing any type of infertility, and can provide the expert, compassionate care you need, when you need it most.
If you are or think you may be facing infertility, contact us online or call Fertility Solutions at 877-813-0159 for a consultation to discuss the fastest and most affordable way to build your family.