Male factor contributes equally as female factor. Hence evaluation of a male partner is very important.
Normal Semen Analysis (WHO 2010)-
- Normal Concentration – 15 million per ml / 39 million per ejaculate
- Normal motility – 40% (Rapidly progressing – 32%)
- Normal Volume – 2 ml
- Normal morphology – 4 %
Abnormalities
- Oligospermia – Reduced count of sperms
- Teratospermia – Abnormal morphology (<4% of normal sperms) – structure of sperms is defective. Problem can be at the level of head, neck or tail of the sperm.
- Asthenospermia – Abnormal motility (movement) of sperms.
- Oligoasthenoteratozoospermia (OATS) – Problem at all levels of sperms. ICSI is indicated in these cases.
- Azoospermia – No sperms in the semen.
- Cryptozoospermia – No sperms in the semen but found after centrifugation of semen in the lab.
- Hypospermia – Decreased volume of the semen.
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- Causes of Azoospermia (absent sperms in semen) –
- Testicular failure – Testes are not able to produce sperms. FSH hormone will be high in these cases.
- Hypogonadotropic Hypogonadism – The brain will not be able to stimulate the testes to produce sperms.
- Obstructive Causes – Sperms will be produced but will not be able to come in the ejaculate due to obstruction.
- Idiopathic – When no cause can be found. This is most commonly seen.
- Maturation defects – Sperm precursors are produced but are not able to mature.
- Genetic defects – Y microdeletions, Klinefelter’s syndrome etc.
- Causes of Sperm defects –
- Obesity
- Stagnated lifestyle
- Smoking
- Alcohol
- Drug abuse
- Excessive heat exposure (occupational)
- Poor nutrition
- Idiopathic – where no cause can be found
- Tests for male partner
- Usually if semen analysis is normal, no further evaluation is done.
- For minor issues medical treatment is tried for a few months, before advanced tests and treatments.
- In case of azoospermia, further evaluation is done which includes-
- Examination
- Ultrasound
- Hormonal evaluation
- FNAC – Fine Needle Aspiration Cytology – Some cells are extracted with the help of a thin needle and they are studied under microscope.
- If sperms are found on FNAC – ICSI (Intra Cytoplasmic Sperm Injection) is the best technique to have pregnancy. In ICSI, sperms are directly injected inside the eggs with the help of a very advanced machine and microscope.
- Other advanced treatments are based on requirement.
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