Male infertility accounts for as much as 30% of the couples who walk into a fertility clinic. In fact, 6% of all men meet the criteria of “low sperm count”-otherwise known as oligospermia. Nearly 1% of men will be found to have no sperm in their semen. As with female infertility, the causes of male infertility are numerous and varied but can be roughly divided into issues involving the production of sperm or issues associated with sperm transport. Sometimes the male fertility problem can be improved, and sometimes it can not be fixed. Often, we can get around the difficulty by using advanced reproductive technology.
To determine if you and your partner are dealing with an issue of male infertility, Fertility Partnership will run a Semen Analysis (SA) as a standard first step with all new patients. This simple diagnostic procedure will assess sperm quality and you typically will receive an answer within 48 hours if not sooner.
Our embryologist will perform extensive tests on a semen sample, analyzing a number of factors including:
Concentration (sperm count in millions per milliliter)
Motility (percentage of actively moving sperm)
Morphology (percentage of normally formed sperm)
Additional testing may be needed if problems are found. Blood tests may be recommended to check hormonal levels, and sometimes genetic testing is needed to understand the problem.
Sometimes, medical treatment can be offered to the man that can improve the quality of the sperm. In fact, certain vitamins and supplements have been shown in medical/scientific studies to improve some of the qualities of sperm. If the sperm is of sufficient quality (at least 10 million moving sperm per 1 ml of semen, normal morphology) then intrauterine insemination, IUI, may be a reasonable treatment option.
If the sperm is not adequate for IUI, then IVF, in-vitro fertilization will allow the man to father a child with his own sperm. Eggs are collected from the woman (typically 10-20 eggs) and individual sperm is chosen based on their movement and their appearance. So even if the sperm count is very low, as long as there are some moving sperm, we can have success. A man dealing with an extremely low sperm count can be cheered in the knowledge in that it only takes a “few good sperms” to get the job done.
Azoospermia occurs when no sperm is found in the semen. Our team will certainly centrifuge and super concentrate the semen to look for any at all, but nearly 1% of all men will be found to have no sperm at all in the ejaculated fluid.
What next? A biopsy of the testicle may be needed. Blood tests will give us an estimate for chances of success. At Fertility Partnership, we perform the procedure TEFNA, or Testicular Fine Needle Aspiration. The skin is carefully numbed and a very small needle is used to collect sperm, if any, directly from the testicle. TEFNA is a simple, safe, and far less invasive or painful than other procedures such as TESE. Success rates have been reported to be quite similar, although rarely we recommend the more invasive TESE.
Men who undergo TEFNA report minimal discomfort and all we require is one day off from normal activities. TEFNA is also much less expensive than TESE. If there are sperm present, then they can actually be used in IVF to fertilize eggs.