Male infertility is a major cause of couples’ infertility. Therefore, one of the first tests in the infertility evaluation is the semen analysis. No treatment of the female should be initiated until it is established that the partner is producing “normal” sperm.
The cornerstone of the male evaluation is the semen analysis. It is very important that the laboratory conducting the analysis have personnel experienced in evaluating semen using the Kruger strict criteria.
The male infertility evaluation examines several parameters including the number of sperm, the shape of their heads, the condition of their tales, their ability to swim in the appropriate direction, viscosity, volume of semen, and others.
Until the advent of intracytoplasmic sperm injection with IVF, intrauterine insemination or IVF using a sperm donor was the only option for couples where the male had moderate to severe sperm abnormalities. ICSI allows a single sperm to be inserted directly into the egg. Sperm can often be withdrawn from the male reproductive tract even though they are absent in the ejaculate. This allows the male to father a genetically related child.
Male infertility can be caused by many conditions including testicular trauma, severe infection, congenital, exposure to high does of radiation or harmful chemicals, hormonal imbalance, and retrograde ejaculation. The female immune system may also produce antibodies that mistakenly identify sperm as foreign bodies and destroy them. Many tests are available to help diagnose factors causing male infertility.
Sperm are also very sensitive to heat and the scrotum normally performs a heating/cooling function. When testicular temperature is too high the scrotum moves away from the body thus lowering the temperature. Restrictive clothing or occupations requiring prolonged sitting can interfere with this regulatory procedure. Sperm can also be damaged by activities such as prolonged repetitive sitting in hot tub.
Another common cause of male infertility is a varicocele. A varicocele is a mass of varicose veins in the spermatic cord. When blood flow is restricted by a varicocele the temperature of the testicles rises and can damage sperm. Small varicoceles may have no effect on fertility but larger ones may have to be removed.
The good news is that most men, even those with no sperm in their ejaculate, can usually father genetically related children.