Health Tips

Not being able to conceive is one of the greatest unfulfilled wishes of many married couples. Infertility is a complex medical issue with many factors to consider from both the male and female. In this article, we give you an overview of male infertility and the roles of semen play in this problem.

Male infertility

Before we talk about male infertility, let’s talk about infertility in general. Infertility in a couple is defined as the inability to achieve conception despite one year of frequent, unprotected intercourse. However, up to 50 percent of young, healthy couples that fail to conceive in the first 12 months will conceive in the subsequent 12 months with no specific treatment. So if you and your partner haven’t tried to conceive for at least a year, just keep going.

Back to male infertility. It was reported that one-third of the infertility cases in Malaysia are related to men. There are many causes to male infertility:

• Hormone problems

• Testicular disorders

• Sperm problems

• Unknown causes (idiopathic male infertility) - Doctor may diagnose an infertile man as having idiopathic male fertility when all diagnostic tests and examination all seem normal. 

In this article, we will only dive into the roles of semen and sperm play in causing male infertility. Keep in mind that if you think you have infertility, always consult a doctor. The doctor will conduct examinations and run tests to find out the exact causes of your infertility, and it may not always have something to do with the quality of your sperm. 

What makes healthy sperm?

Your sperm health is evaluated by looking at its:

• Quantity — A ‘good’ amount of sperm discharged in a single ejaculation should be at least 15 million per milliliter. If it’s less than that, it might be more difficult to get pregnant because there are fewer sperm candidates available to fertilize the egg.

• Motility — This refers to how many of the sperms can ‘swim’ through a woman's cervix, uterus and fallopian tubes to reach the egg. To be fertile, at least 40% of your sperms must be moving.

• Morphology — Essentially, how your sperm ‘looks’ like. Normal sperm have oval heads and long tails, which allows them to swim properly. While not as important a factor as sperm quantity or motility, the more sperm you have with a normal shape and structure, the more likely you are to be fertile.

An abnormality in any of these three parameters may lead to male infertility.

The health of your sperm has a lot to do with your lifestyle choices. A meta-analysis has shown that smoking is linked to poorer quality of semen. Having a healthy body weight is also crucial to male fertility, as obesity in men is often linked to lower levels of testosterone and gonadotropin. 

Semen analysis

Among the many tests and examinations doctors would do to diagnose male infertility is semen analysis. The standard semen analysis consists of the following:

• Semen volume and pH

• Microscopy for:

  • Sperm concentration, count, motility, and morphology

  • Debris and agglutination

  • Leukocyte count

  • Immature germ cells

This analysis allows doctors to identify if there’s any problems with your semen and sperm that could potentially cause the infertility problem.

The semen sample should be collected after two to seven days of ejaculatory abstinence. If possible, the patient should collect the sample by masturbation at the doctor's office. If not possible, then the sample may be collected at home and delivered to the laboratory within an hour of collection.

Occasionally, the doctor may also order a test for your semen analysis called a fructose test. This test allows the doctor to check if you might have obstruction in the ejaculatory duct.

Treatment for male infertility

With the current medical advancement, there are a myriad of treatment options for male infertility.

Besides lifestyle changes–such as quitting smoking, alcohol abstinence and losing weight– surgery is commonly used to treat male infertility, especially those that are caused by low sperm counts or abnormal sperm morphology. Alternatively, the couple may also opt for assisted reproductive technologies, such as:

• In-vitro fertilization (IVF) — IVF involves collecting eggs from the female partner, fertilizing them with sperm from the male partner in a lab, and transplanting the resulting embryo(s) back into the uterus to try to achieve pregnancy.

• Intracytoplasmic sperm injection (ICSI) — ICSI involves injecting a single sperm from the male partner directly into an egg in the lab. This is similar to IVF, but may be more successful if there is a known issue with the male partner's sperm production.

That being said, if you and your partner are facing any issue with infertility, kindly consult a specialist and find out what’s the best treatment options for both of you.

A word from Doc2Us

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References

1. UpToDate - Approach to the male with infertility

2. UpToDate - Causes of male infertility

Cover image credit: "The Sperm Bike in Copenhagen - 01" by Mikael Colville-Andersen is licensed under CC BY-NC 2.0

Written by

Ms Joyce Toh