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Testing for Male Factor Infertility When male factor infertility is suspected, the initial test performed is a semen analysis. A semen analysis allows the doctor to examine the count, motility and morphology of the sperm. At Georgia Reproductive Specialists, we prefer a formal semen analysis over the post-coital test and consider the semen analysis to be more useful in the fertility evaluation.• Sperm count - The normal range for sperm is between 40 and 300 million sperm per milliliter of ejaculate. A low sperm count is fewer than 20 million per milliliter of ejaculate. • Motility - Low sperm motility (movement) may reduce the chances of conception, especially when paired with low sperm count. In a normal semen sample, at least half of the sperm have typical movement. • Morphology - Sperm that do not have normal morphology (shape) are often unable to swim effectively or penetrate an egg. A normal sperm has an oval head, slender midsection and tail that moves in a wave-like motion. In order for a physician to evaluate the count, motility and morphology of sperm, a semen sample must be provided. The sample is most often collected by masturbation in a private, comfortable room in the fertility center. In some cases, the sample may be collected at home by masturbation or during intercourse with the use of a special condom provided by the physician. In some cases, the test results are not normal due to problems during sample collection and the test must be repeated. Abnormal Sperm Morphology My husband went for a semen analysis and the result showed that the morphology was 90 percent abnormal. Is this something you are born with, or does it have to do with a healthy diet or cigarette smoking? Toni Morphology refers to the shape and structure of the sperm. A normal-looking sperm has an oval head and a tail seven to 15 times longer than the head. On a semen analysis, in which we look at sperm under the microscope, we can identify defective sperm by their large heads or strange tails -- kinked, doubled, or coiled. The World Health Organization (W.H.O.) says good quality semen should contain 60 percent normal sperm morphology. A closer evaluation called a strict morphology, or Kruger morphology, is more time-consuming and usually predicts normal sperm function when more than 15 percent are normal. That means that a semen sample can include up to 40 percent abnormal sperm and still be considered fine. All men produce many abnormal sperm. The reason is not known, but considering the rate at which a man's production line operates -- 10 million to 50 million new sperm per day -- some "factory seconds" should be expected. We do know that toxins such as lead have been linked to reduced motility (swimming ability), cigarette smoke to abnormal morphology, organic solvents to coiled tails, and excessive scrotal heat to coiled tails in animal sperm. When you lower your exposure to these agents, abnormal morphology levels usually decrease. I remember one man with a high level of abnormal sperm who transferred to a different job at his company so he could avoid exposure to heat from a blast furnace. He also began taking 1,000mg of vitamin C each day. Within a few months his sperm motility and morphology showed definite improvement. Alternatives to Vasectomy Reversal After my wife and I had the children we wanted, I got a vasectomy. Some years later we divorced. Now my new partner wants us to have children of our own, and I am currently configured otherwise! I've read up on vasectomy reversal, and I am not squeamish about the surgery, but the success rate after 10 years isn't that hot. Plus there are such factors as cost and discomfort. So I'm wondering: Is the amount of sperm retrieved by extraction sufficient for artificial insemination? Or is something more invasive recommended, like IVF? The lady has no fertility problems. Tom Sperm extraction -- regardless of whether the sperm are obtained from testicular biopsy or aspiration or aspiration from the epididymis -- does not provide sufficient numbers of motile sperm to use for insemination. Other than vasectomy reversal, your choices after vasectomy are insemination with donor sperm; retrieval of sperm and eggs for IVF; sperm-egg injection at the time of IVF (a procedure called ICSI); or adoption. Anti-Sperm Antibodies What exactly are anti-sperm antibodies? Is this a female problem, a male problem, or both? Kathy Anti-sperm antibodies can occur in both men and women. Antibodies are protein molecules that are attracted to a specific site on the sperm. Once attached, they may interfere with the sperm's activity in any of several ways. They may immobilize sperm, cause them to clump together, limit their ability to pass through the cervical mucus, or prevent them from binding to and penetrating the egg. Anti-sperm antibodies are frequently seen in men after vasectomy, testicular injury or infection. The cause of anti-sperm antibodies in the woman is unknown. Researchers classify specific antibodies by type (IgA, IgG and IgM) as well as the point at which they attach to the sperm (head, midpiece, or tail). Studies indicate that IgG type antibodies are most common in men and that IgA type can be found in women's mucus and follicular fluid, but the significance of these findings is uncertain. Binding to the head is believed to interfere with attachment and penetration of the egg, while tail binding interferes with motility. Unfortunately, testing and identification of type of antibody or the location does little to suggest who will or won't conceive. Attempts to treat the condition -- say, by lowering antibody levels with steroids or removing the antibodies from sperm -- have demonstrated limited benefit and have been fraught with disastrous complications. A trial of ovulation induction and insemination followed by in vitro fertilization with ICSI (a process that involves injecting a sperm directly into an egg) seems to be the best treatment available. Bent / Curved Penis After years of being normal, at age 42, my penis took a bend of about a 45-degree angle halfway down. What might cause this, and can it be returned to normal? Lee Peyronie's disease is often the cause of painful erections, difficulty achieving or maintaining erections and curvature of the penis with erections. Peyronie's is described as an inflammation of the blood-filled corpora cavernosa (penile erector sets). Patients can often feel a firm plaque at the site of the bend in the penile shaft. Connective tissue disorders such as Dupuytren's contracture, trauma to the penile shaft, and infection have been thought to cause this condition. While sometimes the condition resolves by itself, surgery may be necessary to remove the scar-like plaques that interfere with the normal blood-filling of the corpora cavernosa at the time of arousal and erection. Following surgery, a penile prosthesis may be necessary to achieve satisfactory intercourse. Other treatments have been tried, but with limited success. |
