So you're ready to become a parent but you’re having difficulties conceiving? Fo rover half of all couples facing this reality, the problem is on the woman’s side, but for 40 - 45% of couples the problem lies with the man's infertility. In nearly 25% of couples struggling to conceive have issues on both sides. In this article, we will focus on the issue of male infertility, and what to do in these cases. 

How Male Infertility is Diagnosed


Medical History 


The evaluation of the "male infertility", i.e. the total or partial inability of a man to conceive, begins with the collection of information, a study of the medical history. The doctor will be looking to whether there have been diseases or metabolic abnormalities that affect sperm quality, such as hypertension or diabetes. Perhaps the reason why the male eggs are not viable is because of medication.  


Sexual History


Your doctor will need to gather detailed information about sexually transmitted infections, urological diseases and surgeries, even if they occurred during your childhood. The frequency of sexual activity, erection and ejaculation are also important. Are these activities painful or difficult to achieve?  


The following medical examination will tell you about the state of your secondary sexual characteristics: growth of body hair and body composition, the size and consistency of the testicles, and other features of the development of your genitals. 


Semen Analysis


The final piece of the puzzle: Do you need need IVF treatment, or do you need a sperm donor? This is determined by a complete analysis of the male seminal fluid. Of all the parameters studied, there are three are key indicators.  


1) Concentration - the amount of sperm in one milliliter.  


2) Mobility - how fast and how well they move? 


3) Morphology - do they look normal?  


Size and shape of sperm have an impact on their ability to fertilize an egg. Abnormal sperm have deformities such as a double or misshapen head, double body, double or crooked tail, too small, or too large. Deformities alone are not a cause for concern and are a common occurrence. The question is the number of abnormal sperm, because the severity of the problem is directly proportional to the amount of the observed abnormalities.  


 Male Infertility Testing at AVA Clinic


When specific tests for male infertility are required at AVA Clinic, we often use the Sperm DNA Fragmentation Testing and Sperm-Hyaluronan Binding Assay.  


Hormonal and genetic tests and ultrasound diagnostic tests are common practices. Keep in mind that the popular Prostate Specific Antigen (PSA) test is used for early diagnosis (screening) of prostate cancer and does not determine the fertility of men. 


Reasons for Male Infertility


There are many reasons for male infertility. These reasons include: 

  • Blocked transport of semen through the reproductive pathways (due to congenital defects, acquired defects from infection, previous vasectomy, etc.); 
  • Retrograde ejaculation (sperm is ejaculated back into the bladder); 
  • Testicles produce little or no sperm (due to varicocele, hormonal background, injuries, consequences of surgeries, effects of medications, chemistry, radiation, genetic diseases, etc.). 

This is not a complete list but most of these causes lead to low concentrations of sperm in the ejaculate- less than 15 million per milliliter- called oligozoospermia. It can even lead to azoospermia - no spermatozoa at all. 


Treatment Options


There are many infertility treatment options available at AVA Clinic. 


In mild cases of male infertility, the doctor may prescribe drug therapy or carry out an insemination procedure.  


In other, more extreme cases of male infertility, severe varicocele, or after a vasectomy, the patient may need urological surgery.  


However, the effectiveness of such operations to restore male fertility is questionable. Very often, even after surgery is performed, patients cannot conceive naturally and require In-Vitro Fertilization treatment. 


IVF is combined with Intracytoplasmic Sperm Injection (ICSI), a revolutionary technique that requires a significantly smaller amount of sperm to fertilize an egg than previous methods. This technique practically guarantees fertilization, even when the sperm is of low quality or when the sperm count in the ejaculate is very low.  


The doctors at the clinic extract very small amounts of sperm directly from the testicles, either through Testicular/Epididymal Sperm Extraction (TESE) or testicular biopsy. In turn, the resulting sperm cells are used for ICSI fertilization of female eggs in the IVF cycle.  


Other Solutions


When these methods are powerless, sperm donation is used. This is also the treatment used for single women, and lesbians. 


Depending on the cause of the infertility, a simple insemination, IUI with donor sperm or IVF with donor sperm, is used for these patients.  


Note: One thing to remember is that in Sweden, a woman’s right to use sperm from a donor is guaranteed by law only until the age of 42. However in Latvia, a woman can perform IVF with donor material up to age 50.  


In cases when the woman also faces fertility issues and cannot use her own eggs, patient may be offered fertilization using donor eggs (egg donation) and donor sperm (sperm donation).  


Here at AVA Clinic we look for all possible solutions to help you have a child. Contact us to learn more about solutions for male infertility.