Male Infertility

Question 1

Semen analysis

Answer 1

Examine the quantity and quality of semen and sperm

Question 2

How to provide a sample for semen analysis

Answer 2

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 3

Factors affecting semen analysis

Answer 3

Hot baths
Tight underwear
Smoking
Alcohol
Raised BMI
Caffeine

Question 4

When is a repeat sample indicated

Answer 4

After 3 months in borderline results or earlier (2 – 4 weeks) with very abnormal results

Question 5

Results of semen analysis

Answer 5

Semen volume (more than 1.5ml)
Semen pH (greater than 7.2)
Concentration of sperm (more than 15 million per ml)
Total number of sperm (more than 39 million per sample)
Motility of sperm (more than 40% of sperm are mobile)
Vitality of sperm (more than 58% of sperm are active)
Percentage of normal sperm (more than 4%)

Question 6

Oligospermia

Answer 6

Reduced number of sperm in the semen sample - can be mild, moderate or severe

Question 7

Cryptozoospermia

Answer 7

Very few sperm in the semen sample

Question 8

Azoospermia

Answer 8

Absence of sperm in the semen

Question 9

Pre testicular causes of male infertility

Answer 9

Pathology of the pituitary gland or hypothalamus

Suppression due to stress, chronic conditions or hyperprolactinaemia

Kallman syndrome

Question 10

Testicular causes of male infertility

Answer 10

Mumps
Undescended testes
Trauma
Radiotherapy
Chemotherapy
Cancer

Question 11

Genetic causes of male infertility

Answer 11

Klinefelter syndrome
Y chromosome deletions
Sertoli cell-only syndrome
Anorchia (absent testes)

Question 12

Post-Testicular Causes of male infertility

Answer 12

Obstruction preventing sperm being ejaculated can be caused by:

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

Question 13

Young’s syndrome

Answer 13

obstructive azoospermia
bronchiectasis
rhinosinusitis

Question 14

Investigations for male infertility

Answer 14

History
Examination
Repeat sample
USS of testes

Abnormal semen is referred to the urologist

Question 15

Urology investigations

Answer 15

Hormonal analysis - LH, FSH and testosterone levels

Genetic testing

Further imaging- transrectal ultrasound or MRI

Vasography

Testicular biopsy

Question 16

Vasography

Answer 16

Injecting contrast into the vas deferens and performing xray to assess for obstruction

Question 17

Management of male infertility

Answer 17

Depends on the underlying cause :

Surgical sperm retrieval - obstruction

Surgical correction of an obstruction in the vas deferens

Intra-uterine insemination

Intracytoplasmic sperm injection (ICSI)

Donor insemination involves sperm from a donor