Male Infertility Evaluation

There are several tests that offer insights into various aspects of sperm functionality and quality and help to identify specific factors that might be contributing to male infertility and aid in tailoring appropriate treatment strategies. Based on the results, further evaluations and discussions with a healthcare provider can lead to appropriate treatment or interventions that should be pursued.

Semen Analysis

Semen analysis is typically the initial diagnostic step when assessing infertile couples and excluding male infertility factors. This test provides crucial insights into the quality and quantity of sperm present in the semen.

Semen samples can be collected either at a laboratory or at home. If collected at home, the sample should be transported to the laboratory within 30 minutes to ensure accurate results. Men are advised to abstain from ejaculation for 48 to 72 hours before collecting the semen sample to ensure that the sample contains an adequate concentration of sperm.

The first milliliter of the ejaculate typically contains the highest concentration of spermatozoa, so it’s important to include this portion in the sample. To account for natural variability in semen quality, at least two specimens should be examined on different occasions, several weeks apart. Parameters analyzed are as follows:

  • A healthy sperm concentration is considered to be greater than 20 million sperm per milliliter of semen.
  • The total count of sperm in the ejaculate should be above 60 million.
  • The volume of the ejaculate should be more than 2.5 milliliters.
  • More than 50 million sperm should exhibit motility.
  • At least 50% of the sperm should be viable (alive).
  • Over 60% of the sperm should exhibit normal morphology (shape).

Anti-sperm Antibody Assays

Antisperm antibodies are antibodies that target sperm cells. They can be present in either the male or female partner and may contribute to fertility impairment. These antibodies can interfere with sperm function and motility, making it difficult for sperm to reach and fertilize the egg. Assays to detect the presence of anti-sperm antibodies, semen, blood, and vaginal fluids that fight off sperms help identify this potential factor in infertility.

Hamster Egg Penetration Test (HEPT)

The HEPT is a laboratory test used to predict the fertilizing capability of spermatozoa. It involves exposing sperm to hamster eggs and observing their ability to penetrate the egg’s membrane. This test provides insights into whether sperm can successfully penetrate the egg, which might not be evident through a standard semen analysis. It evaluates factors related to the interaction between sperm and the egg’s outer layer.

Sperm DNA Fragmentation Assays

Sperm DNA fragmentation assays assess the integrity of sperm DNA. High levels of DNA fragmentation can indicate damaged genetic material within sperm cells. This damage could impact the development of normal embryos and lead to fertility issues. These assays help predict the likelihood of successful embryo development.

Post Coital Test (PCT)

PCT provides insights into the interaction between sperm and cervical mucus, which is important for transporting sperm through the reproductive tract. The test should not replace a comprehensive semen analysis but serve as a supplemental assessment to evaluate specific aspects of fertility.

The PCT is typically performed during the midcycle, the period in which there is high water content in cervical mucus and the midcycle estrogen surges. This timing is chosen because cervical mucus plays a crucial role in facilitating sperm transport. The couple should engage in sexual intercourse between 8 to 24 hours prior to presenting at the clinic for the test.

PCT examines cervical mucus under a microscope to determine the presence of several progressively motile spermatozoa per high-powered field. This assessment helps evaluate sperm’s ability to move effectively in the cervical environment. It can screen for the presence of anti-sperm antibodies and the adequacy of the couple’s sexual activity. For example, the presence of clumpy sperm or flagellate without motility might indicate the presence of anti-sperm antibodies originating from either mucus or semen. In cases where few or no sperm are detected, potential factors to consider include improper timing of the test, oligospermia (low sperm count), suboptimal coital technique, hypospadias, the presence of anti-sperm antibodies, or the presence of naturally occurring hostile cervical mucus.


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Human Reproduction: A Clinical Approach Copyright © 2023 by Dr. Hala Bastawros, M.D is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.