Sperm Tests and Treatments
Infertility affects men and women equally – around one-third of infertility cases are due to female fertility problems; one-third are due to male fertility problems; and the remaining one-third are due to a combination of male and female factor issues.
Male infertility may be caused by the sperm, the testes themselves, the ducts that lead out from the testes, a functional problem in relation to sexual activity, hormonal issues or genetic problems. However, most causes of male infertility are usually related to sperm disorders – in fact, damage to sperm production affects two thirds of men who are experiencing fertility challenges.
Male fertility is adversely affected if sperm are not being produced in adequate numbers, are of inadequate quality or are not swimming well, or are obstructed from reaching the penis, or if they are being attacked by antibodies from either the male himself or his female partner. In addition, there may be an imbalance of the hormones that allow sperm development and support.
One of the most common causes of infertility in men is damage to the production of sperm resulting in a low sperm count (oligospermia). This can also be associated with reduced sperm movement and abnormally shaped sperm. A severe case of this results in azoospermia, which means the total absence of sperm in the ejaculate. Common causes of damage to sperm production are testicular injury, undescended testes, a twisted testes, cancer treatments, varicocele and genetic problems.
The exact cause of a sperm disorder can usually only be determined medically – erections, intercourse and ejaculation will usually happen normally and the quantity and appearance of the ejaculated semen generally seem normal to the naked eye.
Fortunately, there are many advanced tests are available to determine the exact cause of a sperm disorder from the diverse range of possible causes. There are also many innovative treatments, proven procedures and alternative options that have allowed hundreds of thousands of men to address their fertility challenges.
Male infertility tests determine the quantity and quality of male sperm. These tests include semen analysis, ultrasound examinations and testicular biopsies.
A semen analysis is often one of the first tests done to help determine whether a man has infertility problems.
A semen analysis measures the amount of semen produced and determines the quantity and quality of sperm in the semen sample. There are a number of tests that may be done during a semen analysis, as detailed below.
A Volume test measures of how much semen is present in one ejaculation.
Liquefaction time measures how much time it takes for semen to liquefy from the thick gel at the time of ejaculation. Normally liquefaction occurs within 20 minutes after ejaculation.
A sperm count determines the number of sperm present per milliliter of semen in one ejaculation.
Sperm morphology analyses the shape of the sperm and the percentage of sperm that have a normal shape.
Sperm motility indicates the number of sperm that show normal forward movement.
A pH test determines the acidity (low pH) or alkalinity (high pH) of the semen.
A white blood cell count will reveal the presence of white blood cells, which are not normally present in semen.
A fructose level test measurement determines the amount of a sugar called fructose in the semen, which provides energy for the sperm.
Another useful diagnostic test is an ultrasound examination of the testes and prostate. It is done by placing an ultrasound probe on the testicles, providing an image of the testes and epididymis. It is also used for diagnosing testicular cancer and varicocele.
During a testicular biopsy a small sample of the tissue from a testicle is removed to allow for direct inspection of the sperm-making tissue.
Male infertility tests such as semen analysis, ultrasound examinations and testicular biopsies will assist your fertility specialist in determining the exact nature and cause of a sperm disorder, enabling the precise treatments required to be identified from the range of procedures and options available today, which are detailed below.
Sperm Treatments, Procedures and Options
Hormonal Therapy is used successfully to treat a deficiency in the hormones that control testicular function and causes male hormonal disorder. The therapy involves injections of hormone preparations called gonadotrophins that increase the testes in size to produce testosterone in normal amounts. Sperm should appear in the semen after several months of treatment.
Varicocele Repair involves the repair of a dilation of the veins of the scrotum, which may interfere with the testicle’s production of sperm. The veins are tied or clipped through a small incision in the groin, and within a few months of the procedure, most men achieve a significant improvement in sperm production.
Vasectomy Reversal – also called a vasovasostomy – repairs a surgically removed section of the sperm duct. A semen analysis is done around eight weeks after surgery to track improvements in sperm count and motility. The results depend on how long ago the vasectomy was done – if 10 years or more have passed, the chance of sperm reappearing in the semen is much lower.
Surgical sperm retrieval is used in rare cases where normal sperm production or sperm ejaculation is prevented by an obstruction in the tubal system of the testes. Provided that motile sperm are being produced, sperm can be retrieved surgically directly from the epididymis or the testes with a very fine needle. Even if only one or two sperm cells can be surgically retrieved, fertilisation of an egg is possible, thanks to the microinjection technique of Intracytoplasmic Sperm Injection (ICSI). These techniques have proven a revolution in the treatment of men with very severe infertility, making fatherhood possible even in the most challenging of cases.
Testicular Sperm Aspiration (TESA) is a procedure used to extract sperm tissue by a fine needle that is passed through the skin of the scrotum.
Percutaneous Epididymal Sperm Aspiration (PESA) is a simple technique to obtain sperm in men who have an obstruction of the sperm duct. PESA involves inserting a needle attached to a syringe into the epididymis and gently extracting sperm-containing fluid.
Microsurgical Epididymal Sperm Aspiration (MESA) is usually only done when PESA has been unsuccessful. It involves opening up the ducts of the epididymis and extracting fluid or a piece of testicular tissue to extract live sperm through a fine needle, rather than just fluid as is done with PESA.
Testicular Sperm Extraction (TESE) is performed if there is no epididymis or when there is an absence of sperm in the epididymis. Through a small incision, a piece of testicular tissue is removed to obtain sperm.
Intracytoplasmic Sperm Injection (ICSI) is a microinjection technique through which sperm are directly injected into an egg. It is used in the case of poor semen characteristics and is usually offered to couples who have had or is likely to have poor or no fertilisation during standard IVF. Because only a few normal sperm are needed for ICSI, and because of its rate of fertilisation of around 70%, it is one of the major breakthroughs in male infertility treatment and even men who were previously regarded as completely sterile now have an excellent chance to father a child.
Artificial Insemination (AI) / Intrauterine Insemination (IUI) is sometimes used in cases of a mild sperm abnormality or the presence of anti-sperm antibodies. In this procedure, sperm from a male partner or from a sperm donor is placed directly into the female partner’s uterus.
Sperm Freezing and Storage allows your semen samples to be frozen and stored for fertilising eggs in the future. It is recommended in cases where future fertility may be compromised, for example, undergoing radiation or chemotherapy, pelvic or testicular surgery and vasectomy, or suffering from certain illnesses, diseases or injuries.
Sperm Donation is another option, and Medfem Fertility Clinic founded its own sperm bank in 1990. Medfem’s sperm donors are decent, committed men who give up their time, without compensation, to help others to conceive.
The first step in treating any sperm disorder
A 30 – 60 minute initial consultation with a fertility specialist is your first step in any sperm disorder treatment plan, regardless of which specific treatments you may require.
During your initial consultation at Medfem Fertility Clinic, a highly qualified and experienced fertility specialist will discuss with you your medical history, conduct a physical exam, advise you of your options, and start to plan your tests and treatments.
Simply click here or contact us on +27 (11) 463 2244 to book your initial consultation and take the first step to parenthood.