Comprehensive Evaluation of the Male Partner
It is common for a couple who is having difficulty conceiving a child to assume the issue resides with the female partner. Infertility is generally viewed as a female problem, but 1/3 of infertile couples have male infertility as a contributing cause, with another 1/3 of couples facing a mix of male and female infertility or struggle with unexplained infertility. As a result, it makes sense then to begin the fertility evaluation with a basic test of the male partner. Because significant sperm problems are generally treated with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), needless hysterosalpingograms, laparoscopies and clomiphene cycles can be avoided by early detection of significant dysfunction in the male partner. Couples can save a great deal of time and money by diagnosing male infertility early. IVF with ICSI has made it possible to successfully treat virtually all cases of male infertility, even with only a few moving sperm in the entire ejaculate.
The evaluation of the male partner starts with a semen analysis performed in a competent experienced Andrology lab. Non-specialized laboratories, such as LabCorp and Quest, perform a World Health Organization (WHO) semen analysis. This is a crude screening test and should be replaced by the stricter Kruger semen analysis that is done by most fertility clinics. The difference between the WHO and the Kruger test is that, with the Kruger test, sperm morphology is evaluated in a very stringent manner. The results of the Kruger test predict fertilization rates in vitro and presumably in vivo as well. The WHO does not predict outcome and will frequently miss subtle but clinically significant sperm abnormalities.
When male infertility is suspected and tests reveal abnormal semen parameters, the couple should be referred to a reproductive endocrinologist and/or urologist for further evaluation. Conditions warranting referral for male infertility are:
- A sperm concentration of less than 20 million per mL
- Motility less than 35%
- Morphology less than 5% (Kruger) or 30% (WHO)
Additional Male Infertility Testing
In addition to the semen analysis, anti-sperm antibody studies are commonly ordered. A direct anti-sperm antibody test should especially be done in cases where the male has a history of genital trauma, genital surgery or has never initiated a pregnancy. The direct antibody test is done on a semen sample and detects whether antibodies are attached to the sperm themselves. The cutoff for a positive test varies between labs but is usually considered positive when greater than 10%-20% of sperm are bound. Couples with anti-sperm antibodies should be referred to a reproductive endocrinologist for further evaluation and treatment.
Genetic evaluation of male infertility is indicated when there is a sperm concentration less that 5 million per milliliter. This male infertility evaluation should consist of a karyotype and a study to look for microdeletions on the long arm of the Y chromosome (Yq deletion study). An assay for DNA fragmentation in the sperm cells may also be helpful in select patients. If azoospermia is present, carrier status for one of the cystic fibrosis mutations should be ruled out. These men should, of course, be referred for a urological evaluation. If surgical treatment of the infertile male is not indicated, a reproductive endocrinologist can then complete treatment.
Hormonal evaluation of the infertile male is indicated when there is a history of sexual dysfunction, azoospermia or abnormal physical findings. This workup, which consists of testosterone, FSH, LH and prolactin levels, should be accompanied by urological consultation.
At the Center for Advanced Reproductive Medicine & Fertility, we offer a comprehensive semen evaluation, using the latest technology to determine the presence of sperm abnormalities and then counsel you on the appropriate fertility treatment to focus on. This allows for a more precise diagnosis and to fine tune your fertility treatment.
We also provide outside semen analysis to doctors who require male patients to undergo testing. For more information or to schedule an appointment, please call our Edison office at 732-339-9300 or contact us online.