Infertility diagnosis in men

The causes that can cause male infertility are numerous. These can relate to dysfunctions of the reproductive system itself as well as hormonal imbalances or have a genetic or developmental basis (e.g. dysgenesis arising during foetal development).

The first and basic test a man performs to assess fertility is the semen analysis. It is used to evaluate sperm concentration, quality and activity based on standards introduced by the World Health Organisation (WHO) in 2010.

Two methods are most commonly used to carry out semen analysis:

Basic seminogram – manual semen analysis

Semen analysis can be divided into two stages: macroscopic evaluation of the semen and microscopic evaluation of semen preparations. Macroscopic assessment includes analysis of: appearance, volume, viscosity, pH and liquefaction time of the ejaculate (seminal fluid). The microscopic evaluation includes an assessment of the concentration, motility and morphology (i.e. structure) of sperm. The presence of cells other than spermatozoa is also assessed: round cells (leukocytes and spermatogenic cells of earlier stages of spermatogenesis).

Computer-assisted semen analysis SCA

 The test is carried out using Sperm Class Analyser (SCA). By using the appropriate software, the following is possible:

•  Detailed assessment of sperm motility – during the test, the movement trajectory is determined as well as an assessment of parameters such as: VCL (curvilinear velocity) – total path of the sperm in a unit of time (µm/s), VSL (straight line velocity) – straight path of the sperm (µm/s), VAP (average path velocity) – mathematically smoothed path of the sperm in a unit of time; ALH – amplitude of lateral head displacement.
•  Accurate analysis of sperm morphology – based on precise measurements of the length, width of the head and midpiece, their shape, the angle of their junction and the size of the acrosome.

How to prepare for the examination?

One of the key factors that affect the reliability of a semen analysis is prior sexual abstinence, which should be up to 2 to 7 days. Too short a period since the last ejaculation (including by masturbation) can artificially lower sperm concentration, and too long a period can increase it while decreasing, among other things, their motility and morphology.

In the case of a repeated (subsequent) examination, the patient should maintain the same period of sexual abstinence.

 Knowing that you will be going for a semen test, you should maintain a minimum of two days of alcohol abstinence and also limit excessive physical exercise for at least a day before the test. 

Semen testing should not be carried out during antibiotic therapy, in which case you should wait 14 days after the end of the therapy.  The result is also negatively affected by an elevated temperature, e.g. the onset of fever – in this case, it is recommended to perform the test 2.5 to 3 months after its onset.

What does the examination involve?

Once the patient’s personal information has been confirmed on the basis of an identity card, he is given a sterile container for the semen sample. He is then directed to a special room where the material must be donated for analysis. During semen donation, the man may be accompanied by his partner. The room is equipped with a TV with films and erotic magazines. There is an analytical laboratory right next door so that the semen can be assessed as soon as possible.

The material for testing should be placed by masturbation directly into the container, after urinating and washing the genitals beforehand. It is necessary to donate all the material; if for some reason part of the semen has been donated outside the container, the testing staff must be informed. 

FAQs:

Can I take the material for testing outside the laboratory?

In extraordinary cases, material can be delivered to the clinic from home. You must then bring the sample to the laboratory no later than 40 minutes after ejaculation (please take note of the time of semen donation on the container). During transport to the laboratory, the semen should not be subjected to shocks or temperature fluctuations (optimum transport temperature is 20-37°C).

How long does it take to get the test result?

The results of the basic semen analysis are available on the same day – approximately 2 hours after the test. For the extended computer-assisted analysis, the DNA chromatin fragmentation test and the HBA, MAR and MiOXSYS tests, results are available within two working days.

What is the correct result of a seminogram?

According to the present 2010 WHO criteria, the normal result of a general semen analysis is:

• ejaculate volume: ≥ 1.5 mL,
• pH: 7.0–8.0,
• sperm count: ≥15 million/mL,
• sperm count in ejaculate: ≥39 million,
• percentage of spermatozoa with normal motility: ≥32% with progressive motility, ≥40% total motility,
• morphology (structure): ≥4% of spermatozoa with normal structure,
• leukocytes in semen sediment: <1 million/mL

What do I do when my result is abnormal?

It is important to remember that semen testing is of screening value and cannot usually be the basis for a diagnosis of complete infertility. In the event of an abnormal result, advice should be sought from a specialist and (in this case, an andrologist) who will extend further diagnostics (additional semen tests, hormone tests, physical examination and ultrasound of the testicles, genetic tests) in order to clarify the cause of infertility and possibly undertake causal treatment.

When the semen analysis result is of concern, the test should be repeated within 2-3 weeks, (maintaining the same abstinence period as with the first test). If abnormalities reappear, the semen diagnosis should be extended with further additional tests. The type and order of these additional tests is determined by your andrologist – it is better not to do these tests “on your own” as you may find that they have been done unnecessarily.

Additional semen testing:

• DNA fragmentation  – a test helpful in idiopathic infertility (when all other parameters are normal; it allows the real cause of infertility to be revealed), in the case of abnormal sperm morphology and in preparation for an in vitro fertilisation programme (it allows the appropriate method of sperm selection to be chosen), in doubtful situations (increased sperm DNA fragmentation argues in favour of treatment in an IVF programme and makes it possible to dispense with intrauterine insemination, which may then prove to be very ineffective). 
• Assessment of oxidative stress (MiOXSYS test) – a test helpful in cases of increased sperm DNA fragmentation, abnormal sperm morphology and motility and in idiopathic infertility). It enables indications for treatment with supplements to be made, the dose to be set and the effectiveness of such treatment to be assessed.
• HBA test – sperm functional maturity test: a test performed to determine the method of sperm selection in an in vitro fertilisation programme and to assess the chances of success of possible intrauterine insemination
• Semen antisperm antibodies (MAR test) – a test ordered when an immune factor is suspected in male infertility (as a result of a break in the blood-testis barrier).
• Semen culture – a test ordered when an infection of the male reproductive tract is suspected, e.g. after an increased presence of leukocytes in semen or other symptoms of infection are found.

If very poor semen quality is found, it may be necessary to carry out a karyotype test and a genetic test for microdeletions on the long arm of the Y chromosome (known as deletions of the AZF region of the Y chromosome).

In justified cases, testing is also performed for mutations in the CFTR gene that increase the risk of cystic fibrosis in the offspring