Infertility in men can be caused by a number of factors. The main problem that is common to all these factors is the sperm’s ability to fertilize the egg. Unlike female infertility, male factor infertility does not have the rapid rate of decline associated withg age. Male factor infertility can be broadly categorized in two main groups:
1- Problems making sperm, which means producing too few sperm cells or none at all. This category is further divided into the categories of obstructive azoospermia and non-obstructive azoospermia. Obstructive azoospermia is a condition where there exists sperm production, but the channels through which the sperm is carried outside to the ejaculate are blocked/damaged or restricted for a variety of reasons. In these cases, surgical sperm extraction methods often prove successful and men with obstructive azoospermia can often have their own biological children through the use of IVF/ICSI treatment.
Non-obstructive azoospermia refers to problems that have to do with the production or maturation of sperm cells. In these cases, we are mostly talking about genetic problems that cause production or maturation issues. Surgical sperm retrieval can sometimes yield success, however, in most cases IVF treatment using donor sperm can be necessary in order to achieve pregnancy.
2- Problems with the sperm’s ability to reach the egg and fertilize it, which could be the case where abnormal sperm shape or structure prevent it from moving correctly. Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men. The number and quality of a man’s sperm can also be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:
– Environmental toxins, including pesticides and lead
– Cigarette smoking.
– Health problems
– Radiation treatment and chemotherapy for cancer, or exposure to radiation at work.
In order to understand the cause and severity of the problem, a semen analysis is very important. A semen analysis will indicate very important parameters such as sperm volume, and sperm count which will in turn, tell us whether there are enough sperm cells in the ejaculate to fertilize eggs. However, having enough sperm cells is not a sufficient conditions. These sperm cells will also need to have a certain level of motility, which indicates the sperm’s ability to move freely and reach the eggs for fertilization to occur. Similarly, sperm morphology is another very important factor which shows what percent of the sperm cells have a normal structure and therefore, are viable. According to World Health Organization’s published standards for viability of sperm in 2010, the following parameters have been established for normal sperm:
Volume: > 2.0 ml
Concentration: >20 million/ml
Motility: > 50%
Morphology: >30% with normal morphology
White Blood Cells (Round Cells): < 1 million/ml
Please make sure that you allow for 3-5 days of abstinence before you provide your sperm sample for analysis for most accurate results. This is also important prior to providing a sample before a fertility treatment. In any case, if you are required to provide a sperm sample, it is best to have an abstinence period of 3 to 5 days unless otherwise specified.
For more information on what the numbers on a semen analysis mean, and how to categorize a sperm sample based on its parameters, please refer to our “Interpreting Test Results” section. In this section, you will find information about sperm classifications based on semen paramters.
In some cases, even if sperm production is not sufficient enough to produce sperm through ejaculation, minor surgical procedures like TESA and MESA can be used to retrieve sperm. These are relatively easy, quick and relatively painless. If live sperm cells are found during these procedures, fertilization may be possible. However, it should be kept in mind that fertilization rates with TESA/MESA sperm will be lower than normal sperm found in the ejaculate. Since the quality and maturation levels of surgically retrieved sperm cells will be lower compared to standard sperm cells, freezing surgically retrieved/extracted sperm is often not recommended.
In other cases where no sperm can be found or the quality is exceptionally low, using donor sperm becomes the only alternative. Please see our “Treatments” section for more information on IVF/ICSI treatment using donor sperm.