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Male Fertility Examination

The complete investigation of male fertility includes the following examinations and tests:

  1. History: of previous pregnancy, cryptorchidism, any infections during childhood, diabetes, cancer, smoking, medications, and frequency of coitus or impotence are crucial points to evaluate the fertility capacity of a man
  2. Semen analysis: A semen analysis is the most common procedure when it comes to male fertility testing and seeking to determine if there is a male infertility factor. Sperm is collected into a specimen jar and presented to a lab technician who examines the sperm under a microscope in order to evaluate the count, shape, appearance, and mobility of the sperm. While determining the sperm count, the embryologist will also be checking to see if the sperm concentration is above or below 15 million sperm cells per millilitre of ejaculation fluid
  3. If the sperm count is found to be low, the fertility specialist will probably ask for a Hormonal test like blood Testosterone, FSH, LH, TSH and Prolactin levels
  4. Karyotype, Yq-microdeletion and Cystic fibrosis mutation are a common genetic test performed when sperm is below 1 million
  5. Then an Ultrasound of the scrotum will also be inquired to locate damage or blockages in the male reproductive tract, including the prostate, seminal vesicles, and ejaculatory ducts
  6. Urine analysis and semen cultures can be used to search for white blood cells–an indicator of possible infection. Urinalysis will also show the possible presence of sperm in the urine–an indicator of a possible problem with ejaculation known as retrograde ejaculation
  7. In some cases, additional tests are performed like DNA fragmentation and FISH analysis of the sperm, which shows the genetic damage of each sperm
  8. Rarely, agglutination test is performed to examine under a microscope whether the spermatozoa are clumping together (clumping prevents sperm from swimming through cervical mucus)
  9. Oxidative stress testing is common in cases of unexplained infertility or failed IUIs
  10. Eventually, FNA or microTESE is performed in cases of Azoospermia with more than 50% successful retrieval rate using also special enzymes


Semen Analysis

Sperm analysis is the first and most important examination for the investigation of male fertility. This examination can offer valuable data for assessing fertility, testing a wide variety of important sperm parameters. The only prerequisite before the examination is abstinence of 2-4 days. The sample may be collected at the IVF clinic, or at home, in a special sterilised beaker. In case of sperm collection at home, the sample must immediately be transferred to the andrology lab (within an hour) in temperature of 18 – 30o C.

The sperm parameters that are assessed in a sperm analysis is the total sample volume, the pH, the sperm concentration, the total sperm number, sperm motility and morphology, as well as the presence of “round cells”. The examination of the previous factors is in accordance with the strict criteria of the World Health Organization (WHO, 2010). A normal sperm sample is liquefied within 15-20 minutes and its minimum volume is 1.5 ml. The sperm concentration should exceed 15 millions /ml and the total sperm number should be over 39 millions, as these are the lower reference limits.

In order to assess the motility of the sperm, spermatozoa are considered to be divided in three categories. The first category includes spermatozoa with progressive motility, the second one includes those with non-progressive motility and the third category includes the non-motile spermatozoa. The lower reference limit in a normal sperm sample is 40% for spermatozoa of progressive and non- progressive motility in total and 32% of spermatozoa with progressive motility.

The assessment of the morphology is a really important factor for male fertility, as well, as it has been shown that is strongly associated with infertility cases.  The evaluation of the sperm morphology is possible after a specific staining and observation of the sample under the microscope. The abnormal morphology of sperm concerns the shape of the head, the neck and the tail. The lower acceptable percentage of normal spermatozoa in a semen sample is 4%. The evaluation of the previous factors in total is based on the assessment of quality and quantity parameters of the sperm. Sperm analysis is usually a necessary tool in the primary investigation of male fertility, as it provides useful information for a couple’s case.

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