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The ABC guide to male fertility

In light of #MensHealthWeek, we want to inform you about all things sperm and fertility!  


When you have fertility investigations at X&Y Fertility, we guide you through every step, so that you are fully informed of what is being tested. This includes what to expect from a semen analysis and a full explanation of what the results mean and what treatment options might help. 


This S.P.ER.M. blog provides a compact guide to information about semen analysis, factors that affect fertility and treatment options. We hope this helps you on your journey to parenthood.   


S is for Semen analysis


What to expect

You will be asked to produce a sample directly into a special sterile container. You may feel embarrassed or uncomfortable about producing a semen sample. Often the request to produce a sample “on demand” in a fertility clinic and then having to hand that sample over to clinic staff, can feel a little daunting. At X&Y Fertility, we ensure your privacy and dignity throughout. Furthermore, we arrange appointment times to ensure that you are the only client on-site at that time.






Below are some FAQs we get asked:  


1) Why can't I have sex with a condom to collect the sperm for testing? 

Condoms contain spermicide, a chemical that prevents pregnancy by killing sperm so they can't fertilise an egg. So, a sample produced in this way will not provide an accurate analysis of your sperm. You will be asked to ejaculate directly into a sterile container provided by the clinic. 


2) Why do I need to produce the sample at the clinic rather than in the privacy of my own home? 

Timing is crucial when assessing sperm, so the sample should be analysed as soon as possible after being produced. Sperm doesn’t have a long life outside of the body or in environments where temperatures fluctuate. Delays in delivering semen to the clinic and exposure to various temperatures during that time could result in a lower overall motile sperm count. We prefer if you could come to the clinic in the morning as this is when the sperm are at an optimal level. 


3) What if producing a sample is against my religious beliefs? 

We welcome people from all communities and faiths, so in these circumstances we can provide sterile condoms for you to use in the privacy of your own home. We have met with leaders from various religions to check that this is acceptable. 


4) What if I can’t produce a sample on the day? 

Our clinic has a purpose-built facility to ensure your complete privacy. However, if you are worried about your ability to produce a sample on demand, please discuss this openly with a member of the team ahead of your appointment. 


5) What if I don’t manage to collect all the sample? 

The first part of the ejaculate is the most sperm-rich, so any spills may affect the result. If you don’t manage to collect all the sample in the container, just let a member of the team know, so that this can be taken into account when reporting your test results. 


P is for parameters

                 

A semen analysis evaluates parameters of semen and the sperm within it. The report provides important information about your sperm’s potential to fertilise an egg. This helps us to come up with a treatment plan to give you the best chance of pregnancy.  


1) Sample Volume - An ejaculate should contain at least 1.4mls; a lower volume may indicate a blockage in the ducts that help contribute to the ejaculate. 

2) Concentration - AKA a sperm count, this is the number of sperm per ml. We want to ideally see at least 16 million sperm/ml. 

3) Motility - This is how sperm move and grades from good motile sperm down to completely non-motile sperm. 


4) Morphology - This is the sperm shape, and classifies the percentage of normal-shaped sperm. Most fertile men have a minimum of 4% sperm with the correct shape. 

5) Round cells - These are non-sperm cells. If they are white blood cells, this might indicate there is an infection somewhere.                                                   

6) pH - A semen sample should be slightly alkaline (pH 7.2 or higher). If it is acidic, this might indicate a problem with different ducts that feed in to help form the ejaculate. Alternatively, there might be an infection.                                                                    

7) Appearance - Semen should be white-greyish in colour. A red colour could indicate the presence of blood.   

8) Liquefaction - A normal ejaculate is usually viscous when first produced and then takes around 20 minutes to liquefy at body temperature. We use pre-warmed containers to ensure this test is correctly performed.


E is for Explanations

Understanding the terminology used in sperm test results is important.


A semen analysis report provides various information to help determine if any sperm parameters might affect your fertility. If any parameter is outside of the World Health Organisation ‘decision values’, then it is reported as sub-optimal. Any affected sperm are more likely to have difficulty reaching and penetrating the egg, making conception problematic.  


Let's look at the terms used to describe conditions in which one or more of these factors are sub-optimal. 


#1 Aspermia - No semen is visibly produced. This could be because the semen travels in a retrograde direction into the bladder, due to a possible weakness in the bladder neck or previous surgery in this area. 

#2 Azoospermia - No sperm is detected in the semen. We then need to perform further investigations to see what the cause is, e.g. is this is due to a possible blockage? 

#3 Oligozoospermia - The sperm concentration is lower than the decision limit of 16 million sperm per ml. 

  


#4 Asthenozoospermia - Less than 30% of the sperm are swimming progressively forward.


#5 Teratozoospermia - Less than 4% of the sperm are normally shaped. 





#6 Oligoasthenoteratozoospermia (OATS) - Less than 16 million sperm per ml with less than 30% being forward swimming and less than 4% being normally shaped. 






#7 Necrospermia - No sperm are alive. This is different to sperm that are simply not moving as a non-moving sperm could be alive and therefore viable for a fertility treatment such as ICSI). 

 

If sub-optimal results are reported, it is worthwhile producing a second sample for another assessment a few weeks later. This can confirm if this diagnosis is correct. If so, then additional tests can be considered to help understand the underlying cause.  


R is for Reasons

What factors can affect your sperm results?

When we provide your semen analysis report, it is important that we discuss the report with you. Healthcare professionals can explain factors that may lead to suboptimal results and, where possible, offer advice for lifestyle changes that could improve sperm health. 



Here are the top 15 reasons for altered sperm quality


#1 Hot testicles - The testicles are on the outside of the body for a reason - to keep them cool. Sperm production takes place at a lower temperature that body temperature. If testes are hot, e.g. from sitting in a hot bath or sauna, or wearing tight underwear this can reduce sperm quality. A simple change to cooling the testicles can help fertility.


 

#2 Injury - Trauma to the testicle can block the blood supply to the sperm producing tissue, and affect its ability to produce sperm. 


#3 Age - Sample volume and the quality of sperm tend to decrease with age. Semen from older men may have a lower volume, poor sperm performance, and increase in malformed sperm.  

 

#4 Illness - Any injury or operation (especially those involving the male sexual organs), or any infection (even a cold), or a high temperature can affect sperm function for up to 12 weeks. 

 


#5 Medication - Certain medications may suppress sperm production, lower sperm count and/or reduce their ability to achieve fertilisation. 

 

#6 STIs - Sexually transmitted infections can affect sperm production and motility, as well as cause inflammation of the tube at the back of the testicles which stores and transports sperm (epididymitis). 


#7 Exposure to toxins, chemicals or radiation - Chemical agents like lead, mercury, pesticides, etc. have been associated with decreased semen quality. Long exposure to radiation can decrease motility, and also sperm counts, viability and morphology.  

 

#8 Stress - A high level of stress hormones in the blood can lower sperm count, affect sperm production and also affect the sperm quality. 

 

#9 Genetic make-up & Karyotype - Many men have an extra X chromosome and are unaware. This condition, known as Klinefelter syndrome, can impact sperm production. We can provide a simple blood test to check if you are XY or XXY.  

 

#10 Weight - Being underweight or overweight has been linked to low levels of testosterone, loss of interest in sex and poor erections. Obesity can also overheat the testicles if there is an overhanging apron of fat. 

 

#11 Diet - A western diet tends to be high in carbohydrate and fat, and low in important elements, such as zinc and selenium. A healthy diet consisting of foods rich in nutrients like zinc and Vitamin B6, plus five portions of fruit and vegetables per day, may help improve sperm counts. 

#12 Recreational drugs - Drugs like marijuana and cocaine can cause lowered seminal fluid production, lowered blood supply to the penis, poor sperm quality and lowered sperm count.  

 

#13 Body-building - Anabolic steroids may shrink the testes, decrease the sperm count, and reduce sperm quality. Sperm production may even stop altogether.

Even protein supplements can impact on sperm production.

 

#14 Alcohol Alcohol can significantly reduce both the production and quality of sperm and the male hormone testosterone.  

 

#15 Smoking & vaping - Smoking and vaping can reduce the sperm count and motility, as well as significantly increasing the level of cadmium in the semen, and lowering zinc levels. Cadmium can damage sperm DNA. 

 

M is for Management

What are the treatment options for male infertility?


Management options are available for most issues highlighted by a semen analysis. Treatment depends on the underlying cause, which can range from problems with sperm production to the testicles' ability to transport sperm to the ejaculate.  


If no obvious problem has been identified - known as “unexplained infertility” - evidence-based treatments that improve fertility may be recommended. 


#1 Surgery - To correct or repair anatomical anomalies or damage to male reproductive organs. For example, a varicocele (where veins become enlarged inside the scrotum) can often be surgically corrected, or an obstructed vas deferens (tube transporting sperm to the ejaculatory duct) repaired, to help improve sperm counts. If a man has had a vasectomy, there may be a chance to repair this too. In cases of azoospermia (no sperm seen at analysis) it may be possible to retrieve sperm by surgical methods directly from the testes via procedures known as PESA, TESA or micro-TESE. 

 

#2 Surgical sperm retrieval - In cases of azoospermia, microsurgical sperm extraction may be an option. A urologist performs a surgical procedure to attempt to extract sperm directly from the testicles for use in assisted conception. Fertilisation then usually takes place in the IVF lab via a treatment called ICSI (intracytoplasmic sperm injection) to carefully inject a single sperm into each egg. 

 

#3 Assisted conception - The treatments involve obtaining sperm through normal ejaculation, surgical extraction, or from a sperm donor, depending on your specific case and choices. The sperm can then either be inserted into the female genital tract via intrauterine insemination (IUI), or fertilisation can take place outside of the body by performing IVF or ICSI.  

 

#4 IUI - For men who have sufficient or borderline numbers of healthy, motile sperm. This treatment involves semen sample production and laboratory preparation. The washed sperm is then inseminated through the cervix into the woman’s uterus. If donor sperm is used, then this procedure is called IUI-DI (donor insemination). 


#5 IVF - Like IUI, this treatment may work for men who have sufficient or borderline numbers of healthy, motile sperm.. However, this treatment requires the washed sperm to be added to several of your partner's eggs, for fertilisation outside of the body (in vitro). Any resulting embryos are carefully incubated under strict laboratory conditions, and the most promising embryo is transferred into your partner's womb.  

 

#6 ICSI - For men who have either few or no sperm in their semen, poor quality sperm, or have required surgical sperm retrieval. This is a type of IVF treatment whereby a single selected sperm is directly injected into an egg to overcome issues with the limited sperm movement or number, to encourage fertilisation. The fertilised egg is then transferred to the woman's womb.  

 

#7 Donor sperm - Certain sperm problems may be so severe that you need to consider using sperm donated by another man (sperm donor). Donor insemination is an alternative to ICSI, with very poor quality sperm or if there is a genetic disorder that could be passed on to any children. Donor sperm can be used for IUI (IUI-DI) or as part of an IVF treatment if required. 


Blog written by Aarabi Ketheeswaranathan

 


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