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Male Factor Infertility Tests
Also
see the page on male infertility treatment
Advanced
Fertility Center of Chicago
Gurnee & Crystal Lake, Illinois

Human sperm fixed on a morphology slide
Part of the male infertility testing workup
More sperm images
Background
about male fertility and sperm
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About 25% of all
infertility is caused by a sperm defect and 40-50% of infertility
cases have a sperm defect as the main cause, or a contributing cause.
- It is sometimes hard
to know whether the sperm problem is the only cause, or just a contributing cause to the
infertility. Part of the problem is that numbers are just numbers:
- Men with
very low sperm counts can sometimes have children
- Some men
with normal sperm counts can be infertile
What matters is not
really how many or how fast they swim - but whether they can fertilize the female
partner's eggs. This is really a biochemical issue at the molecular level
- looking at the little swimmers under the microscope is not a perfect way of assessing
the ability of the sperm to fertilize the wife's eggs.
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Semen analysis
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This is a very simple
and important test and should be done early in the evaluation process. Sometimes the test
should be done 2, or even 3 times to get an accurate reflection of the numbers and their
variation over time.
Cutoff values for
"normal" vary somewhat, depending on the lab and the interpreter, but the World
Health Organization defines these as normal values:
| Volume |
2.0 ml or
more |
| pH |
7.2-8.0 |
| Sperm
concentration |
20,000,000/ml
or more |
| Motility |
50% or
more with forward progression |
| Rapid
forward progressive motility |
25%
or more |
| Morphology |
30% or
more normal forms (WHO criteria)
(morphology scoring is very laboratory dependent) |
| Vitality |
75% or
more live |
| White
blood cells |
Less than
1,000,000/ml |
If a severe sperm
defect is discovered, the testing on the female partner might be more limited.
Treatment, such as inseminations or in
vitro fertilization can then be started more directly.
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Further testing on the
male with an abnormal semen analysis
In some cases we do
hormone (blood) tests on men with abnormal semen analysis. This can (rarely) sometimes identify a
reason for the abnormality. Occasionally, the problem will be treatable in the male.
Sperm function tests
Sperm penetration assay, also called
the hamster egg test: In this test, the husband's sperm is mixed with
hamster eggs to see whether they penetrate the eggs. It is expensive and
there are many false positives and also false negative results. Some men
are better with the hamster than with the wife... etc. We do not do this
test.
Human zona binding assay: In this
test, the husband's sperm is mixed with pieces of human egg shells (zona
pellucidas) to see how many will bind to the shells. There are a lot
less false positives and false negative results as compared to the
hamster egg test. However, human egg shells are not readily available
for this use - so it is not a very practical test.
Sperm antibody testing
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Sperm antibodies in the blood
of men or women do not affect fertility
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Antibodies on the head of the
sperm can cause failure of fusion with the egg
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Spontaneous pregnancy rates are
higher in couples without these antibodies, however, fluctuations
are seen even without any therapy. Also, since inseminations
are used as treatment for both unexplained
infertility and for sperm antibodies, many infertility
specialists feel that the costs of this test are not justified.
Varicocele
In some cases the man
is referred to a urologist to assess whether he might have a correctable condition
called a varicocele. However, correcting a varicocele
(surgical procedure) many times will not improve the semen quality enough to change the
mode of therapy that will be required to result in a pregnancy for the couple. In other
words, if a couple will need IVF anyway, why bother with surgery for a varicocele. These
treatment options depend on the degree of abnormality in the semen and other factors
involved in the individual couple's case.
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Treatment
of male infertility
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