10 Frequently Asked Questions on Male Infertility

Male Infertility




Male infertility is real. An estimated 20 - 30 percent of men may not have the ability to father their offspring with their own genetic material. There exist diverse reproductive factors – which are both physiological as well as psychological, among men, which act as impediments barring them to emerge as parents by following the natural process of reproduction. Male infertility, hence, is quite common and in no way is simply restricted to women. In this article we’ll share ten questions (along with answers) our male patients keep asking our consultants during their reproductive counselling sessions.

·       What is Male Infertility?

The inability of a male to fertilize a fertile female and cause pregnancy is referred as male infertility. In humans it accounts for 40-50% of all infertility cases and population wise it affects 7% of all men.

·       How Is Male Infertility Diagnosed?

Semen analysis is the most common test we prescribe for diagnosing male infertility. Through this test, many attributes of the sperm and semen (the fluid containing sperm) can be measured. To be specific, the test measures the sperm concentration (the number of sperms present in 1 mm of semen), the sperm’s morphology (the percentage of sperms in normal shape), its motility (the percentage of sperms that are moving), and the volume of fluid.

·       What Is Normal Sperm Count?

According to WHO 5th manual, ideal sperm concentration should be 15 million/ml. Patient having sperm concentration less than this range will be called oligozoospermia. There are two types of sperm, motile and immotile. According to WHO 5th manual, normal semen sample have motile sperm either 32% progressive motile sperm or 40% progressive and nonprogressive motile sperm. Any patient having semen sample with less motile sperm not fulfilling the range stated in WHO will be called asthenozoospermia. If there is no sperm in the semen it will be called azoospermia. And if the morphology of sperm in semen is less than 4% normal then it is called teratozoospermia.

·       How Do I Know If I Have Low Sperm Count?

This is one of the most common questions we hear from anxious couples and mostly men, for the obvious reason.
If you and your partner are planning to conceive, then you have to try for one year without any protection. After that if you are unable to father your own child, then you must undergo a semen analysis test at any fertility centre to know your sperm count level.

·       Does Low Testosterone Equate To Male Infertility?

Low Testosterone level relates more to sexual dysfunction than to infertility except in hypogonadotrophic hypogonadism. In fact treatment of male infertility with testosterone supplements leads to further drop in sperm count.

·       How Is Sperm Morphology Assessment Done?

The morphology of sperms in a semen sample is determined by performing sperm morphology staining and then observing sperm cells under light microscope. Here in this process quick deep method is generally followed. Here are the steps-

1.  At first a thin smear of a semen sample is prepared into a glass slide and kept it in untouched condition to make it air dry for 20 – 30 minutes.

2.  After the slide is dried properly, fixative solution is added in that smear and then the slide is kept in untouched condition for 10 – 15 minutes.

3.  Then the slide is dipped in solution 1, for 8 – 10 seconds and then again the slide is dipped in solution 2, for 3 – 5 seconds. After that it is washed in distilled water very carefully and again the slide is placed for air drying.

4.  After drying, the slide is observed under light microscope under oil emersion at 1000X magnification.

While observation under microscope, in a semen sample – morphologically normal and four types of sperm abnormalities are found, those are Head defects; Neck defects; Tail defects and Cytoplasmic droplets. According to WHO 5th manual, at least 100 to 200 sperm cells are counted depending the morphology and count of the sperm. But sometimes more number of sperm cells is needed to get counted if those parameters are compromised. According to WHO 5th manual, if a semen sample having 4% or more than 4% normal sperm then that semen is called morphologically normal semen sample. But if the count is less than 4% then it is called teratozoospermia. Sperm morphology assessment should be compulsory to determine whether a couple should opt for In – Vitro Fertilization (IVF) for successful pregnancy.


·       How To Determine A Normal Shaped Sperm?

A normal shaped sperm can be determined on the basis of the following attributes:

1   An oval-shaped smooth head (having 2.5 - 3.5 micrometre width and 5-6 micrometres in length). Acrosome (i.e. a prominent cap covering around 40 to 70 % of the sperm head) is present and normal in shape.

2   No visible defect present on neck, middle section and tail.

3   Middle piece has 10-14 spirals of mitochondria surrounding axial filament in the cytoplasm. It provides motility, and hence is called the powerhouse of the sperm. It also has a ring centriole (annulus) with unknown function.
4   No vacuoles is/are present in the head of the sperm and are larger than on half of the head size.

·       Can Abnormal Shaped Sperms Fertilize Ovum?

Yes, fertilization is possible even through an abnormal shaped sperm but if the percentage of abnormal sperms is relatively higher than that of the normal shaped sperms in the semen, infertility can occur. It has been found that semen containing higher number of abnormally shaped sperms is usually associated with irregularities such as low sperm motility or low sperm count.

·        If An Egg Gets Fertilized By Abnormally Shaped Sperm, Does It Mean The Baby Will Have Higher Chances Of Having Genetic Abnormalities?

There’s no relation between the sperm shape and its genetic content. Once the sperm infuses with the ovum, there’s good chance of fertilization to occur. However, since due to genetic disturbances shapes of some sperm get affected, there lies a high probability of having male offspring who will inherit similar kind of morphological defects.

·        What Should Be Done To Improve Sperm Shapes?

Although researches haven’t proved a clear relationship between tobacco, alcohol, caffeine and abnormal sperm shapes but according to some studies, people who are heavy smokers or drinkers have been found to suffer medial problems including infertility. If you are planning a baby, it is better to avoid to quit smoking and drinking, as it might affect the quality of sperm DNA you’ll be passing on to your next generation.

Semen morphology analysis showing abnormality on sperm shape doesn’t always prove that you are infertile. It has been found that there are several cases where males with low semen analysis values have been successful in fathering children. In case you and your partner fail to conceive through unprotected intercourse over a period of 6 months - 1 year, opt for ART or Assisted Reproductive Technology. ART procedures like IVF or In Vitro Fertilization, ICSI, IUI, Surrogacy have opened doors to couples suffering from infertility, to experience the blessings of parenthood.

When in doubt contact a reputed infertility centre and ask for a consultation with a reproductive medicine specialist.

We hope we had your questions answered. If you have any questions on infertility and pregnancy drop in a mail to genomee@neotiahelathcare.com or inbox your questions to @lifeatgenome on Facebook.

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