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What is male infertility?

In the UK, around 15% of couples have fertility problems. The definition of infertility, which applies to the couple and not to the individual: therefore, infertile is defined as a couple that does not reach conception after 24 months of regular and unprotected sexual intercourse, suitable for procreation. In about 50% of cases the cause of infertility is due to a male factor.

What are the options for couples with fertility problems?

In the UK, around 15% of couples have fertility problems. The definition of infertility, which applies to the couple and not to the individual: therefore, infertile is defined as a couple that does not reach conception after 24 months of regular and unprotected sexual intercourse, suitable for procreation. In about 50% of cases the cause of infertility is due to a male factor.

In case of infertility and therefore difficulty in conceiving naturally, it is necessary to carry out a semen analysis, called spermiogram. An altered spermiogram is not necessarily synonymous with infertility, but can instead highlight the existence of a pathology that can affect the quality or quantity of the ejaculate (sperm) that needs further investigations in order to treat, if possible, the underlying problems of the disorder.

In general, the presence of abnormalities in the spermiogram indicates that the couple will have difficulty conceiving naturally, unless the quality of the sperm is improved through adequate therapy.

Continue to try to conceive naturally, while the man will undergo a treatment to improve the quality, quantity and morphology of spermatozoa

· Evaluate some form of medically assisted procreation, based on the condition that triggered the disorder. In any case, it is important that the male undergoes further investigations in order to identify any underlying problems, and that he carries out adequate therapy to improve the quality of the seminal fluid for any future pregnancies.

What can I do for you:

Spermiogram and sperm DNA fragmentation test

In case of anomalies of the seminal fluid, further diagnostic tests are carried out and we treat, if possible, the underlying pathologies that have caused the alterations in the parameters of the ejaculate

· Assistance to couples in deciding whether to attempt natural conception or start a path of medically assisted procreation.

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Medical causes of male infertility

Male infertility can be caused by various problems or therapies.

Some of these are:

  • The varicocele. It is the most common cause of reversible male infertility. Varicocele is the dilation of the veins that drain blood from the testicle. The exact reason why varicocele causes infertility is not known, but it may be related to an abnormality in the temperature regulation of the testicles. Varicocele involves a change in the quality of the ejaculate. Treatment of varicocele can improve the characteristics of the spermiogram.

  • Some infections can interfere with proper sperm production or cause blockages that block the passage of sperm. These infections include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections such as gonorrhea and HIV.

  • Ejaculatory problems. Retrograde ejaculation occurs when seminal fluid travels to the bladder rather than exiting the penis at the time of orgasm. There are several causes that can generate retrograde ejaculation, including diabetes, spinal injuries, certain medications, and bladder or prostate surgery.

  • Anti-sperm antibodies. Anti-sperm antibodies incorrectly identify sperm as harmful external agents and attempt to eliminate them.

  • Tumors (not just testicular ones) can have a direct impact on the male reproductive organs by also acting on the glands that release hormones related to reproduction, such as the pituitary gland.

  • In some men, one or both testicles fail to descend into the scrotum during fetal development. This exposes you to an increased risk of infertility, as well as testicular cancer

  • Hormonal imbalances. Infertility can result from abnormalities affecting hormonal systems such as the hypothalamus, pituitary, thyroid, and adrenal glands. Inadequate testosterone secretion (male hypogonadism) as well as other hormonal imbalances can cause infertility.

  • Obstruction of the seminal passages. There are different structures responsible for the passage, transport and accumulation of spermatozoa. These can become blocked for various causes, including accidental surgical injuries, previous infections, trauma or abnormal development such as occurs for example with cystic fibrosis or other genetic diseases.

  • Chromosomal defects. Hereditary problems such as Klinefelter syndrome, characterized by the presence of two X chromosomes and one Y chromosome (rather than one X chromosome and one Y chromosome) in male individuals, cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility are cystic fibrosis, Kallmann's syndrome and Kartagener's syndrome.

  • Problems of a sexual nature. These include erectile dysfunction, premature ejaculation, pain during intercourse or problems of a psychological or relational nature that interfere with sexual activity.

  • This digestive disorder, caused by gluten sensitivity, can lead to male infertility. Fertility can improve by adopting a gluten-free diet.

  • Some medications. Testosterone replacement therapy, anabolic steroids, chemotherapy, some antifungals, anti-ulcer drugs, and other medications can inhibit sperm production and reduce male fertility.

 

Environmental causes

Exposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or function. Specifically, the causes include:

  • Industrial chemical agents such as benzene, toluene, xylene, pesticides, herbicides, organic solvents, paints.

  • Exposure to heavy metals such as lead or other heavy metals.

  • Radiation or X-rays

  • Overheating of the testicles. High temperatures can impair sperm production and function. Frequent use of saunas or hot baths could temporarily worsen sperm counts. In addition, sitting for a long time, wearing tight clothing or working for long periods with the laptop on your lap can slightly reduce sperm production.

Health, lifestyle and other causes

Other causes of male infertility are:

  • Use of doping substances. Taking anabolic steroids can cause shrinkage of the testicles and a reduction in sperm production.

  • Drug use. The use of cocaine or marijuana can reversibly reduce the number and quality of semen.

  • Consumption of alcohol. Alcohol consumption can lower testosterone levels, cause erectile dysfunction and reduce sperm production.

  • Smokers have lower sperm counts than non-smokers. Passive smoking also has a negative impact on fertility.

  • Emotional stress. Stress can interfere with certain hormones needed for sperm production. Severe or prolonged emotional stress, including the stress caused by fertility problems, impacts sperm counts.

  • Obesity. Obesity can damage fertility in several ways, by affecting the production of sperm itself or by causing hormonal imbalances that reduce fertility.

Spermiogram

The spermiogram evaluates the health and vitality of the spermatozoa. Sperm is the liquid containing spermatozoa (as well as sugars and protein substances) that is released during ejaculation. A spermiogram evaluates three main factors:

  • The number of spermatozoa

  • The shape of the spermatozoa

  • The motility of spermatozoa

Doctors often perform two or three separate spermiograms in order to better assess the health of the sperm. The exams must be repeated at an interval of at least 14 days from each other. The result, in fact, can vary from day to day.

How to prepare for the spermiogram

It is very important to follow these instructions carefully to get an accurate result.
The indications for obtaining an optimal sample are:

  • abstention from ejaculation 24 to 72 hours before the exam

  • do not take alcohol, caffeine and drugs 2 to 5 days before the exam

  • avoid taking hormones

  • inform the specialist if you are taking any medications

What are the normal results?

The specialist will evaluate the following results:

Concentration
The concentration, which indicates the number of spermatozoa present per ml of ejaculate, should fluctuate between 15 and 213 million. The total number of sperm in the ejaculate should be equal to or greater than 39 million.

Motility
There are 3 types of sperm motility:

  • progressive motility (PR)

  • non-progressive motility (PN)

  • immotility (IM)

Under normal conditions, the percentage of spermatozoa moving with progressive motion (PR) is greater than or equal to 32% and the percentage of total motile spermatozoa (PR + NP) is greater than or equal to 40%.

Morphology
The percentage of morphologically normal spermatozoa is greater than 4%. The spermiogram can detect abnormalities in the head, midfoot, or tail of the sperm. It is also possible that the spermatozoa are unable to fertilize the egg because they are not mature.

Volume
Under normal conditions, the semen volume should be greater than 1.5 mL. Low sperm volume may indicate too low a sperm count to fertilize the egg. Excessive ejaculate volume may also be negative, causing the amount of sperm present to dilute.

Appearance

The appearance of the sperm should be opalescent gray. A brown-tinted semen may indicate the presence of blood, a yellowish color may indicate jaundice or be a side effect of some drug.

pH
The pH level must be between 7.2 and 7.8. A pH level above 8 can indicate that the donor has an ongoing infection. A result below 7.0 may, on the other hand, indicate sample contamination or obstruction or absence of the ejaculatory ducts.

Fluidification
The semen liquefaction process should take between 15 and 30 minutes. Failure to liquefy semen within 30 minutes could compromise fertility.

Commonly used terminology

  • Normozoospermia: normality of seminal parameters

  • Oligozoospermia: sperm concentration <15 million / mL or total number of spermatozoa in the ejaculate <39 million

  • Astenozoospermia: <32% of sperm with progressive motility (PR)

  • Teratozoospermia: <4% of spermatozoa with normal morphology

  • Oligoastenoteratozoospermia: alteration in the number, motility and morphology of spermatozoa

  • Oligoteratozoospermia: alteration in the number and morphology of spermatozoa

  • Oligoasthenzoospermia: alteration in the number and motility of spermatozoa

  • Astenoteratozoospermia: alteration of sperm motility and morphology

  • Cryptozoospermia: absence of spermatozoa in the ejaculate, but presence of sperm cells after centrifugation

  • Azoospermia: absence of spermatozoa in the ejaculate even after centrifugation

  • Hypoposia: reduced volume of seminal fluid

  • Hyperposia: excessive volume of seminal fluid

What does an abnormal result imply?

Sperm with abnormalities may have problems reaching and / or penetrating the egg, thus preventing conception.
If on repeating the test the result still shows abnormalities, the specialist may suggest that you perform other tests, including:

  • hormonal dosage

  • scrotal ultrasound

  • sperm DNA examination

  • genetic tests

  • testicular biopsy

  • semen immunoassay

Sperm DNA Fragmentation Test

The sperm DNA fragmentation test is a second level examination that allows to highlight the lesions or ruptures of an individual's spermatozoon. It is a useful tool for diagnosing and treating infertility-related problems that would once have been referred to as "idiopathic," ie without explanation.

Recent studies have shown that up to 80% of men with unexplained infertility have problems with their sperm DNA, which can only be detected with a DNA fragmentation test. Factors such as stress, smoking, alcohol, drugs, obesity and other lifestyle aspects can have a negative impact on the quality of semen.

Why take the test?

Damage to sperm DNA has not only shed light on the diagnosis of unexplained infertility, but has recently also been associated with recurrent abortion conditions. A detailed analysis of sperm DNA damage can provide specialists with the tools they need to treat the problem and assist the patient with therapy that makes a difference.

For example, it is possible to reduce sperm DNA damage by making simple lifestyle changes, by reducing the consumption of alcohol, drugs or smoking.

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Male infertility treatment

The most appropriate treatment will depend on the factors underlying the infertility. In addition to resorting to medical therapies, it is very important to change one's lifestyle to improve sperm quality and reduce sperm DNA fragmentation.

The options are represented by:

  • Treatment of infections. Antibiotic therapy may cure a testicular or seminal infection, but it is not always able to restore fertility.

  • Treatment of problems of a sexual nature. Drug and sexology treatment of erectile dysfunction or ejaculation can help improve fertility.

  • Hormone and drug therapy. If infertility is caused by low or high levels of certain hormones or problems relating to the way the hormones are used by the body, hormone replacement therapies can be used.

  • Surgical correction of varicocele is often carried out.

  • Medically Assisted Reproduction (PMA) techniques. PMA treatments involve the recovery of spermatozoa through normal ejaculation or by surgical extraction. The seminal fluid is then inserted into the female genital tract or used to perform an in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

 

If the treatment doesn't work

In rare cases, it is impossible to treat male infertility problems. The specialist could then suggest that you use the sperm from a donor (banned in Italy) or start the procedures for adoption.

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