Generally, it is considered that up to 45-50% of couples presenting for fertility treatment have a male influence. Male infertility affects about 7% of all men and about 1 in 6 couples suffer with some degree of infertility. These statistics themselves confirm the need to have a semen analysis as soon as possible. A semen analysis allows us to quickly determine if there are any issues with either the concentration, the motility or the morphology of the sperm.
Reasons why you might want to consider a sperm test:
- You are in a relationship and want to assess your fertility potential
- You have been trying to conceive and would like clarification
- You are single and generally would like to be aware of your fertility potential
- You have had a vasectomy and would like to be reassured
- You have had a vasectomy reversal and would like to assess the success of the procedure
- Fast access – No GP Referral Required
- Full explanation of results given by Scientists
- Advice on treatment options
- Understanding staff and relaxing facilities
In the event that one or more of the parameters is abnormal then further investigations may be required.
At Simply Fertility we have a dedicated Andrology/Urology team headed by Mr Sam Datta FRCS (Urol)
Investigating Low Sperm Counts
If a semen analysis shows a low sperm count then it is always advisable to repeat the test. A shorter than normal abstinence period (2-3 days), a recent illness, stressful event or failure to capture the whole ejaculate can all lead to a reduction in sperm numbers. If the second sample confirms a low concentration of sperm (known as Oligozoospermia) or if no sperm are seen (known as Azoospermia) further investigation my be recommended.
If the cause of Azoospermia is due to a known obstruction such as a vasectomy, or a vasectomy reversal has not worked then we can surgically remove the sperm in most cases very successfully.
If the cause of Azoospermia is unknown then we would recommend a referral to our Urologist / Andrologist. This will involve a consultation where the consultant will take the relevant medical history and undertake a physical examination. Following a number of possible tests it is possible to quickly understand where the problem potentially lies. The usual tests that will be required are:
- Consultation and Physical Examination
- Ultrasound Scan of the testes
- Hormone blood tests
- Karyotype – full chromosome analysis (blood test)
- Y-Chromosome deletion test (blood test for genetic screening)
- CF Gene mutation test (CFTR Mutation) (blood test)
- Follow up Consultation
It is not always possible that a cause will be found and it might be recommended that a biopsy in advance of any treatment be carried out. The benefit of undertaking this within Simply Fertility is if sperm are present we can freeze them for possible use in future treatment. This process is known as Surgical sperm Retieval, Please see our guide to Surgical Sperm Retrieval
Investigating Severe Oligozoospermia
Even in cases of severe Oligozoospermia where sperm counts are below 5 million per millilitre we are able to use the sperm utilising the ICSI technique whereby we inject sperm directly into eggs. However it might be important for you to understand why your sperm count is low. We would recommend a referral to our in house Urologist / Andrologist who will look at your hormone profile and offer some routine genetic tests to help understand the cause. Ultimately, though it is likely that the treatment will still be ICSI which overcomes the cause but does not resolve it.
Oligoasthenozoopsermia and Azoospermia can be caused by a number of health issues such as:
Varicocele. Like Varicose Veins but within the scrotum causing abnormal testicular temperature regulation and potentially affects the quality of the sperm and can often be corrected with surgery.
Infection. Some infections can interfere with sperm production or more likely the transport of the sperm by blocking the tubes leading from the testes.
Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm, there can be many reasons why this occurs and with the correct management sperm can be retrieved and processed for treatment.
Undescended testicles. During fetal development one or both testicles sometimes fail to descend from the abdomen into the scrotum. Decreased fertility is more likely in men with this condition.
Hormone imbalances. such as hypogonadism, where the testes produce few or no hormones – this often has an identifiable cause, such as Klinefelter syndrome. A full hormone profile will detect such imbalances and we might recommend hormone replacement therapy.
Defects of tubules that transport sperm can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development such as with cystic fibrosis or similar inherited conditions. This condition is known as obstructive Azoospermia and can be rectified by surgically removing the sperm.
Chromosome defects. Inherited disorders such as Klinefelter’s syndrome cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), and antibiotic and ulcer medications can impair sperm production and decrease male fertility. Some medications are reversible and others may not be but a full review and repeat assessments may demonstrate improvements in sperm production.
You must also be very aware of the environmental and lifestyle effects of sperm
Industrial chemicals. Exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead might contribute to low sperm counts.
Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs and excessive cycling might temporarily impair sperm count.
Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also might increase the temperature in your scrotum and slightly reduce sperm production.
Drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana might reduce the number and quality of your sperm as well.
Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.
Tobacco smoking. Men who smoke might have a lower sperm count than do those who don’t smoke. Smoking will certainly affect the integrity of the sperm.
Emotional stress. Severe or prolonged emotional stress, including stress about fertility, might interfere with hormones needed to produce sperm.
Weight. Obesity can impair fertility in several ways, including directly impacting sperm and by causing hormone changes that reduce male fertility.
Treatments Available at Simply Fertility
Intra Cytoplasmic Sperm Injection (ICSI). In many cases we are able to utilise the sperm we have with this procedure whereby we inject individual sperm into the eggs. This technique allows us to overcome many of the male factor issues we diagnose, but of course does not treat the problem.
Donor Insemination (DI) In rare cases, male fertility problems can’t be treated, and it’s impossible for a man to father a child. If this is the case, you and your partner can consider either using sperm from a donor or adopting a child.
Surgical Sperm Retrieval. In some cases of Azoopsermia we can retrieve sperm from the tubules that contain the sperm around the Testicles or directly from the Testicles. The retrieved sperm can be frozen for later use with ICSI.
Fertility related Supplements: We would recommend a combination of vitamins and minerals to help support all round health and vitality, as well as specific nutrients which have been chosen for their role in fertility and reproduction. There are many products available and all should be taken ideally three months before treatment commences. Important nutrients are zinc, selenium, Vitamin C and Carnitines. Taking supplements may not cause any significant improvements to your sperm count or motility but will improve the integrity of the sperm cells.
We recommend Proxeed Plus® This product contains a patented formulation that targets specific metabolic functions involved in sperm metabolism. However there are many Well Man products available from High Street pharmacies and Natural Health Shops.
Sperm DNA Fragmentation linked to recurrent miscarriage and unexplained infertility
Semen analysis is part of the routine fertility check for all couples investigating their fertility potential. Statistics show that around 30% of men have a semen profile that is said to be normal and so the couple are diagnosed with “unexplained infertility”. This can lead to couples only being offered IVF when ICSI may be the better treatment.
It has been shown that up to 80% of men with unexplained infertility have problems in the sperm DNA. These can only be detected using the SpermComet test.
Sperm DNA can be affected by things like stress, smoking, recreational drugs, obesity and other avoidable lifestyle factors. Even healthy sperm have some DNA damage, but it’s the amount of damage that matters.
Why is this so important?
DNA damage is often a factor when couples have been trying for a baby for some time without success and where there is no obvious explanation why. It can also be a major factor where couples have been successful in conceiving, but have suffered a number of miscarriages.
The important thing for men is to find out what their sperm quality is like. If we find there is a lot of sperm DNA damage, we can help couples make better choices about the right lifestyle choices and the best fertility treatment for them.
For example, with moderate damage, IVF might be the best treatment to try first. If the damage is higher, then the best chance of success might be going straight to ICSI treatment.
The test can also highlight a potential reason for recurrent miscarriages. Research at Lewis Fertility Testing showed that over 90% of recurrent miscarriage patients tested had sperm DNA damage above the levels in couples who did not miscarry. This is true for couples who conceived naturally as well as those who conceived with fertility treatment.
Simply Fertility also provides the following services:
Post Vasectomy testing
We offer testing for anyone who has undergone a vasectomy and wishes to know if there are any motile sperm being produced.
We have facilities for anyone wishing to store their sperm. This maybe because they are undergoing treatment and due to work commitments may be away at the time of treatment. Some men may be concerned that their sperm count is decreasing and wish to bank some sperm for future use.
Pre Chemotherapy sperm banking
Cancer patients needing chemotherapy have the opportunity of banking sperm prior to treatment. Chemotherapy may destroy the ability of the testes to produce sperm and therefore storing sperm prior to treatment may be suggested as a good option.
Quarantine of sperm for Surrogacy Couples
If you are having surrogacy treatment, the intended parent providing the sperm is treated as a donor and the sperm must be frozen for a period of quarantine whilst blood tests are carried out.
Many men may wish to store their sperm prior to a vasectomy as a backup if their circumstances were ever to change. A vasectomy should only ever be carried out after careful consideration, however we do see many men who have had a previous vasectomy and are now with a different partner. Vasectomy reversal is not always a successful procedure.
There is a growing awareness amongst military personnel that storage of sperm may be a sensible option. This can be the case for couples undergoing fertility treatment where the male partner may be away working at the time of treatment. This also may be a sensible option for those men who may be injured whilst in service. Some injuries result in damage to the ability to father a child and by freezing and storing sperm, they may still be able to do so after injury.