Endometriosis and Fertility Resource Page

In approx. 40 percent of infertility cases, sperm abnormalities are either a factor or the factor.

Male Infertility is assessed on the following:

Sperm Count (less than 10 million per milliliter)

Volume (1-5 ml per ejaculate)

Sperm motility (over 60% should be motile and show forward movement)

Sperm morphology (50-60% should be of normal shape)

The average ejaculate has about 200 million sperm. Only a few sperm actually reach the egg. This shows how the odds are played against a man with poor sperm quality. Although, there are ways to improve sperm count, motility, and morphology.

Causes of Male Infertility

Sperm has to be made in the testes, travel through the spermatic ducts, and find the egg.

Radiation, environmental toxins, undescended testis, varicocele, traumatic injury, infectious injury, testicular atrophy, drug effects, prolonged fever, certain endocrine disorders, congenital abnormalities, past surgery in the lower abdomen, tight underwear, poor diet, antihypertensives, antiinflamatories, antihistamines, stress, lack of sleep, alcohol, nicotine, marijuana, and cocaine, all have a large effect on sperm health and male fertility.

A man may also produce antibodies to his own sperm, this means that the immune system attacks the tails of the sperm that they are producing. Sometimes the woman produces antibodies toward her partners sperm, they generally attack the head of the sperm.

Diagnosis of Male Infertility

Medical history will be taken: childhood disease, undescended testes, mumps, sexual disease.

Structural abnormalities will be examined; varicocele (swelling of the scrotum), size and shape of testes.

Secondary sex characteristics will be evaluated.

Hypothyroidism, hypopituitarism, adrenal disorders, hypogonadism, diabetes, and other endocrine disorders will be checked for.

2-3 specimens of sperm will be needed for a proper evaluation. Volume and other characteristics vary from time to time. The semen should look somewhat viscous and opaque. The volume should be between 1-5 ml (remember that one shot of alcohol is 30 ml). There should be over 20 million sperm per ml of semen.

Sperm is evaluated into the following categories:

adequate

aspermia (absence of ejaculate)

azoospermia (absence of sperm in semen)

oligospermia (lowered sperm density)

poor motility and forward movement

high percent of abnormal sperm morphology

antisperm antibodies

Surgery may be needed. Although, many sperm abnormalities and male fertility problems can be effectively treated with diet and lifestyle changes, avoiding what can be harmful, supplementation with vitamins, minerals, and herbs.

Sperm Disorders

Spermatogenesis
This process is continuous and requires about 72-74 days for maturation from germ (stem) cell, or spermatogonium, to spermatozoon. It is most efficient at 34 degrees centigrade, so exposure to excessive heat or prolonged fever within 2-3 months of evaluation can adversely affect sperm count, motility, and morphology. Within the seminiferous tubules, Sertoli’s cells sustain and regulate maturation, and Leydig’s cells produce testosterone required for maintenancde of spermatogenesis.

Azoospermia
No sperm in semen. This may be due to obstruction or congenital absence of the vas deferens or to a primary testicular disorder. The presence of fructose (which is normally secreted in the seminal vesicles) in semen indicates that the ejaculatory ducts are unobstructed.

Varicocele
Abnormal dilation of pampiniform plexus veins draining the testes. This is the most common anatomic abnormality in infertile men (25% vs. 10-15% in the general population). Varicoceles are more common on the left side, where the spermatic vein empties into the left renal vein. A varicocele results in pooling of blood and higher intrascrotal temperatures.

Retrograde Ejaculation
Occasionally some semen meant for ejaculation to the outside of the body backs up into the urinary bladder. This happens especially in men who have neurologic dysfunction or who have had a retroperitoneal dissection (eg. for Hodgkin’s disease) or prostatectomy.

Endocrine Disorders
The following are quite uncommon, although they are known to be associated with defective spermatogenesis. These are hyperprolactinemia, hypothyroidism, adrenal disorders, abnormalities of the hypothalamic-pituitary-gonadal axis, and hypogonadism.

Genetic Disorders
Genetic causes of defective spermatogenesis include Klinefelter’s syndrome and gonadal dysgenesis.

Male Fertility Tests

Detailed personal, medical, and sexual history will need to be given to your doctor. Similar to women, the diagnositc process is threefold; semen analysis & physical exam, hormone assessment, and a third step of further testing if necessary, such as genetic tests, and biopsies.

Semen Analysis & Physical Exam

Physical examination consists of checking for normal testicle size and shape, looking for varicocele, undescended testes, or any other evidence of physical abnormalities.

For the semen analysis, the man is asked to ejaculate into a sterile container. Masturbation on demand is not so easy, mentally prepare for this part. They can also send you away with a special condom that can be brought back at a later time. It is important to refrain from ejaculation for 3-4 days before the sample is required. A urine sample after ejaculation may also be asked for to check for retrograde ejaculation.

Illness that has happened in the last 3 months should also be offered to the doctor, it takes 100 days for sperm to mature, so problems at anytime in the last 3 months could effect the semen sample.

Also, be sure and have your tests done at a fertility lab, or a lab specially designed for male testing. Regular labs that do not understand the importance of the accuracy and timing of these tests may disregard the little things. It would be worth spending as little extra money if it is necessary. It is also worth doing more than one test because semen results can vary a lot depending on stress, illness, and many other factors.

Understanding the results

Appearance: normal semen is opalescent and grayish. Yellowish semen may show high intakes of vitamin supplements, abstinence, or jaundice. An infection may show some red in the semen.

Volume: total volume can range from 1-5ml. Too much can mean it is diluted. Low volume may show past infection blocking the tubes, retrograde ejaculation, or problems with accessory glands such as the seminal vesicles or the prostate. Sometimes there is an abscence of the vas deferens.

Liquefaction: after about 10 minutes semen becomes very runny (to swim better), if this does not happen within an hour, assisted techniques may need to be employed.

Acidity: semen has a pH between 7.2 and 8.

Agglutination: when sperm stick to one another it usually means there is anti-sperm antibodies that coat the sperm and bind to cervical mucus preventing proper movement and difficulty fertilizing the egg.

Antibodies: these tests are usually only done when all else has been ruled out.

MAR (mixed agglutination reaction): if the immunobead test shows less than 50 percent binding, antibody levels should not affect fertility.

Round Cell Concentration: immature sperm or white blood cells. Too many of these in a sample may indicate infection.

Sperm Concentration (count): 20 million sperm per ml of semen is normal. It may be too low, or sperm may be completely absent. Excess ejaculation may lower concetration. Caffeine, tobacco, alcohol, drugs, diet, exercise, and stress can also effect this. If it is very low there may be a genetic chromosomal defect.

Motility: swimming capabilities, fast and straight percentage is what is measured here. Too little or too much ejaculate can adversely effect motility. It is said that one big drinking binge can effect sperm for up to 3 months.

Morphology: shape of the sperm. Big or small heads, small or coiled tails. At least 15% of the sperm should be normal in shape. Avoiding things that are toxic to sperm are very important with morphology.

Hormone Assessment

FSH, LH, Prolactin, and Testosterone. LH stimulates the production of testosterone (necessary for the healthy production of sperm), Prolactin can interfere with LH induced testosterone production. FSH is essential for sperm development.

If there are high FSH and LH, and low testosterone, this may show testicular failure. Low levels of testosterone and FSH may indicate hypothalamic dysfunction.

Further Testing

Cell Culture: inflammation of the testes can reduce or totally obstruct sperm and testosterone production.

Ultrasound: this will show physical problems such as infection, tumors, surgical lesions in the testes, scrotum, prostate, seminal vesicles, epididymis, or absence of vas deferens. Varicocele can also be found this way.

Testicualr biopsy: this shows if sperm are even being made.

Chromosome testing: if counts are lower than 5 million per ml this should be explored. This could represent the possible passing on of cystic fibrosis, Young’s syndrome, Kartagener’s syndrome, or Klinefelter’s syndrome to the offspring.

(Source: Infertility Health Information Organization)

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