Causes of infertility - the male factor

The male factor is the cause of infertility in 42% couples who visit a specialist due to unsuccessful efforts to have a child. In a further 23% couples, the male factor is present at the same time as the female factor, meaning that semen quality problems affect as many as 67% patients of infertility clinics.

The essence of the male factor in infertility is reduced semen parameters, detected during the semen tests. The most common abnormalities include the following:

  • oligospermia - a sperm count below 15 million/ml (the lower limit of normal results, according to the latest standards set by the World Health Organisation in 2010);

  • asthenospermia - spermatozoa with reduced motility (less than 32% spermatozoa showing progressive movement, desirable for fertilisation);

  • teratospermia - a percentage of properly structured spermatozoa of less than 4%.

Although a semen test result below the so-called normal does not mean that there is no chance of conceiving a child, it does indicate a significant reduction in the likelihood of achieving a pregnancy. The absolute cause of infertility, however, is azoospermia, i.e. a lack of sperm in the semen.

In the diagnosis of male factor, a semen examination with an assessment of the morphological structure of the spermatozoa and the HBA test, which assesses the ability of spermatozoa to bind to hyaluronan, typical of mature spermatozoa, plays a key role. The semen examination should be performed twice, at least four weeks apart. During one of the examinations, the SCD test, which detects chromatin (DNA) fragmentation of the sperm, should also be performed.

The course of the next stage of diagnosis depends on the results of the examinations and tests performed so far. The patient usually undergoes blood tests (determination of FSH, testosterone, TSH, PRL, LH, oestradiol; test for the presence of anti-sperm antibodies) and testicular ultrasound. Urology and andrology consultation is recommended.

When semen abnormalities are severe, it is worth undergoing additional tests:

  • When azoospermia is diagnosed, an AZF test is performed, which detects damage to the Y chromosome, a karyotype test (genetic test) and a CFTR test (the CFTR gene is responsible for the formation of the vas deferens. Damage to this gene leads to the development of cystic fibrosis).

  • in severe teratozoospermia (no normal sperm in the semen), the MSOME-6600 test is carried out, which assesses the structure of the sperm under 6600-fold magnification.

  • Oligosthenozoospermia (less than 3 million sperm in 1 ml of semen) is an indication for AZF and karyotype testing.

How to treat male infertility?

If diagnostic tests have detected an endocrine disorder (e.g. FSH deficiency or hypothyroidism), the patient can expect to restore fertility after drug treatment. The treatment of conditions that interfere with fertility in men, such as infections in the epididymides or prostate gland (prostate), and the removal of certain urinary tract abnormalities, are also very successful. In other cases, drug treatment achieves a marked improvement in semen quality in only 15% patients - and this is a short-term improvement.

A male factor of a minor degree, i.e. a relatively small deviation in semen quality from the norm, is an indication for intrauterine insemination. This procedure involves the direct injection of the best, isolated sperm into the woman's uterus during ovulation. It is a painless procedure. In a single cycle, the success rate of intrauterine insemination is 12%, while after four treatments, the cumulative percentage of pregnancies achieved increases to approximately 22%.

Patients with moderate to severe male factor infertility can benefit from in vitro ICSI. This is an assisted reproduction technique that involves the precise selection of the best possible sperm and its injection into an egg to achieve fertilisation. The effectiveness of in vitro ICSI depends on the age of the partner.

If the semen examination reveals a lack of sperm with a normal structure, the couple qualifies for the in vitro IMSI procedure, which allows for similar results to in vitro ICSI despite the patient's very low sperm parameters. The high success rate of treatment here is due to the selection of sperm in as much as 6,600-fold magnification before injection into the egg.

Normal genetic and hormonal test results with a concomitant absence of sperm in the semen is an indication for a sperm retrieval directly from the testes (TESA) or epididymides (PESA). The biopsy is performed under general anaesthesia and is successful in approximately 86% cases. Sperm collected by biopsy can be used for in vitro ICSI or IMSI.

When an attempt at sperm retrieval has been fruitless, the couple may choose to use donor sperm. Gamete donation is also a good idea in cases of medical disqualification before IVF. It is recommended that the donor has the same blood type as the patient and has similar appearance characteristics. The success rate of IVF with donor sperm is 16-19% in a single cycle.