Male Infertility and Semen Analysis

Male factor is the sole cause of infertility in about 20% of infertile couples and a contributing factor in up to 40% of the cases.  If properly diagnosed, many cases of male infertility can be treated by medical or surgical means.  In addition, other treatments including controlled ovarian hypertension and IUI, or preferably IVF and ICSI involving injection of a single sperm into a mature egg offers an excellent and realistic chance to father children.  As a result, today even in couples with severe cases of male factor infertility treatment with donor sperm is regarded as the last resort.  Semen analysis is an important part of infertility evaluation in couples and the initial test in male partner.  An abnormal semen analysis always should be confirmed with at least a second semen analysis.  Depending upon the results of semen analysis (sperm count, motility, and semen volume), physical examination of male partner, a urologic consultation, blood test for hormone assays (Testosterone, FSH, LH and Prolactin), chromosomal evaluation, genetic test for Cystic Fibrosis (CF), and testicular or pelvic sonogram may be needed.  On the basis of the blood test results, (levels of Testosterone, FSH, and LH) or with high levels of Prolactin, radiologic evaluation of brain and/or pituitary gland with MRI or CT may be necessary.  After the results of semen analysis and other necessary blood tests, hormone assays, and radiologic tests are available and reviewed an individualized plan of management and treatment will be considered as indicated.

Semen Analysis

Semen analysis is a test which provides information regarding sperm production by the testes, acquisition of motility, and the secretions by the genital tract including testes, prostate, and seminal vesicle.  A man can be considered sterile if there are no sperm in his ejaculate.  On the other hand, a man with apparently normal semen parameters can be infertile if for example there are functional defects of the sperm preventing sperm penetration into the egg.  For semen analysis, a semen sample should be collected by masturbation or coitus using a special condom after two or three days of sexual abstinence.  Ideally, the semen sample should be collected either in the office or the laboratory and the specimen analyzed within thirty minutes to one hour after collection.  If the semen sample is collected at home, the specimen container should be kept close to the body to avoid any temperature changes and be brought to the laboratory or office for evaluation within one hour of the collection.  If masturbation is not an option, the patient should use a silastic sperm collection device or a mylex sheath without any lubricant or spermicide.  These condoms are not toxic to the sperm and allow effective sample collection.  Following ejaculation, the physiologic coagulum that forms after ejaculation should be allowed to liquefy before semen analysis is undertaken.  During semen analysis, semen volume, sperm count, sperm motility, sperm morphology (the shape of the sperm), and presence or absence of any significant number of white blood cells, blood, bacteria, as well as semen viscosity will be determined and reported.  According to WHO standards the limits of adequacy of semen is a semen volume of more than 1.5mL, sperm count 15 to 20 million per mL, sperm motility of more than 50% and sperm morphology of more than 30% normal sperm.  It should be emphasized that an abnormal semen analysis must be repeated and there should be at least two or more preferably three abnormal semen analysis before the final diagnosis is made. 

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Helping patients build a family is my passion. I am completely invested in your treatment and will apply my full knowledge and abilities to achieve your goals. Dr. Guerami

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