Infertility (male)

From greek.doctor

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