6.2 Male Infertility

Question 1

What instructions do you give for men providing a sperm sample?

Answer 1

• Abstain from ejaculation for at least 3 days and at most 7 days
• Avoid hot baths, sauna and tight underwear during the lead up to providing a sample
• Attempt to catch the full sample
• Deliver the sample to the lab within 1 hour of ejaculation
• Keep the sample warm (e.g. in underwear) before delivery

Question 2

What factors can affect semen analysis?

Answer 2

Hot baths
Tight underwear
Smoking
Alcohol
Raised BMI
Caffeine

A repeat sample is indicated after 3 months in borderline results or earlier (2 – 4 weeks) with very abnormal results.

Question 3

What parameters are measured in a semen sample?

Answer 3

Volume
pH
concentration
total number
motility
vitality
percent normal

Question 4

What normal values would you expect in semen sample parameters?

Answer 4

volume >1.5ml

pH >7.2

conc >15million/ml

motile >40%

vitality >58% active

normal form >4%

Question 5

What counts as polyspermia?

Answer 5

Polyspermia (or polyzoospermia) refers to a high number of sperm in the semen sample (more than 250 million per ml).

Question 6

What are the values seen in oligozoospermia / oligospermia?

Answer 6

• Mild oligospermia (10 to 15 million / ml)
• Moderate oligospermia (5 to 10 million / ml)
• Severe oligospermia (less than 5 million / ml)

Question 7

What is cryptozoospermia?

Answer 7

Cryptozoospermia refers to very few sperm in the semen sample (less than 1 million / ml).

Azoospermia is the absence of sperm in the semen.

Question 8

What is asthenozoospermia?

Answer 8

when <40% are motil

Question 9

What is teratozoospermia?

Answer 9

when <4% have normal form

Question 10

Male fertility problems can be put into 3 groups of causes, what are they?

Answer 10

Pre-testicular
Testicular
Post-testicular

Question 11

What happens in pre-testicular causes?

Causes?

Answer 11

Testosterone needed for sperm creation. Hypothalamo-pituitary-gonadal axis controls testosterone. Hypogonadotrophic hypogonadism (low LH and FSH resulting in low testosterone).

• Pathology of the pituitary gland or hypothalamus
• Suppression due to stress, chronic conditions or hyperprolactinaemia
• Kallman syndrome

Question 12

What are some testicular causes of fertility problems?

Answer 12

DAMAGE:
Mumps
Undescended testes
Trauma
Radiotherapy
Chemotherapy
Cancer

GENETIC / CONGENITAL:
Klinefelter syndrome
Y chromosome deletions
Sertoli cell-only syndrome
Anorchia (absent testes)

(will see high FSH and low testosterone)

Question 13

What are some post-testicular causes of infertility?

Answer 13

• Damage to the testicle or vas deferens from trauma, surgery or cancer
• Ejaculatory duct obstruction
• Retrograde ejaculation
• Scarring from epididymitis, for example, caused by chlamydia
• Absence of the vas deferens (may be associated with cystic fibrosis)
• Young’s syndrome (obstructive azoospermia, bronchiectasis and rhinosinusitis)

(normal FSH and testosterone)

Question 14

After history, examination, repeat sample and ultrasound of the testes and there is abnormal semen results what is done next (by a urologist)?

Answer 14

• Hormonal analysis with LH, FSH and testosterone levels
• Genetic testing
• Imaging, transrectal ultrasound or MRI
• Vasography, contrast into the vas deferens and xray for obstruction
• Testicular biopsy

Question 15

5 ways to deal with sperm problems?

Answer 15

• Surgical sperm retrieval (if blockage, needle in epididymis)
• Surgical correction, repair vas obstruction
• Intra-uterine insemination, collect best sperm (unclear if better than UPSI)
• Intracytoplasmic sperm injection (ICSI); inject sperm into the egg (for poor motility or low count)
• Donor insemination