Infertility (male)

Male infertility refers to the inability to conceive despite 1 year of unprotected intercourse.

Etiology

• Idiopathic in 30% of cases
• Diabetes mellitus
• Hypertension
• Obesity
• Chronic STD
• Alcohol
• Anabolic steroids
• Varicocele
• Testicular trauma

Diagnosis

• Anamnesis
• Hormone tests
• Semen analysis

Semen analysis

• Used to evaluate male fertility and confirm sterility after vasectomy
• Procedure
  • No ejaculation for 3 – 5 days before
  • Semen is collected after masturbation into a sterile container
    • Container should be stored at body temperature
  • Analysis should be performed within 1 hour
  • Analysis should be repeated at least 2x with 12 weeks in-between
• Normal parameters
  • Volume = 1,5 – 5 mL
  • Colour = Whitish
  • Liquefaction = Complete within 30 minutes
  • pH = 7,2 – 8,0
  • Sperm per ejaculate = more than 40 million sperm
  • Sperm concentration = more than 15 million per mL
  • Vitality = more than 58% sperm should be alive
  • Morphology = more than 4% of sperm should be morphologically normal
    • Yes, this sounds very low. But it’s true
  • Progressive motility = more than 32%
    • Progressive motility means sperm which move in only one direction
  • Fructose content = more than 13 µM
  • Leukocytes = < 1 million WBCs per mL
• Pathological findings
  • Aspermia – no ejaculate
  • Hypospermia – ejaculate volume < 1,5 mL
  • Azoospermia – no spermatozoa in ejaculate
  • Cryptozoospermia – < 1 million spermatozoa/mL
  • Oligospermia – < 15 million spermatozoa/mL
  • Teratozoospermia – > 4% of spermatozoa are morphologically abnormal
  • Asthenozoospermia – < 32% of spermatozoa show progressive motility