TESTS FOR MALE INFERTILITY

Tests for causes of infertility in the male is usually focussed on the semen analysis. Other tests like hormonal analysis and postcoital tests are carried out on the basis of the report of the semen analysis.

But it is essential that a thorough history of factors like weight, smoking, alcoholism, history of infections like mumps in childhood, history of any STD, history of the frequency of sexual intercourse and any difficulty in sexual intercourse should be taken. He should be specifically asked if he has a history of causing a pregnancy in any former partner.

The male partner should be examined for general health and weight. The testes should be examined by an urologist to assess the size, position - whether the testes is descended fully or partially or not at all, any pain and the presence of a varicocele or hernia - both of which can interfere with proper sperm development. The normal testicular volume is 20 ml. If volume is less than 10 ml, it usually indicates primary testicular failure.

Investigations/Tests for Infertility in the Male

Semen Analysis

The most important investigation in the male is Semen Analysis. The semen / ejaculate is collected by masturbation after at least 3 days of abstinence (no sex) in a special collection jar. Semen collected in a condom or from the vagina after intercourse does not give a reliable assessment.

The semen is examined within 2 hours of collection. If the semen sample shows any anomaly, another sample should be collected and examined after 1 month.

Fertilisation of an Ovum by a Sperm

Normal Semen Characteristics

There may be wide fluctuations in the semen analysis reports in the same individual at different times. The World Health Organisation has suggested the following for normal semen analysis values:

• Volume : > 2 ml
• Sperm concentration : 20 million / ml or more
• Sperm Motility : 50% or more with forward progression, or 25% or more with rapid progression within 60 minutes of ejaculation.
• Sperm Morphology: 155 or more normal forms.
• White Blood Cells : Fewer than 1 million / ml.
• Sperm mixed antiglobulin reaction (MAR) test : fewer than 10 % spermatozoa with adherent particles.

The table below is generally accepted for diagnostic purposes.

	Good Fertility	Moderate Fertility	Low Fertility
Volume of Fluid in ml	1.5 - 4.0	1.5 - 1.0	< 1.0
Sperm count in millions	> 60	40 - 60	< 40
Normal Sperm Morphology	> 80	60 - 80	30 - 60
Motility of sperms after 2 hours	> 80% motile	40 - 80 %	< 40 %
Total number of progressively motile sperm	> 120	50 - 120	< 50

The following terms are used for diagnosis in male infertility:

Oligospermia / Oligozoospermia - is diagnosed when the sperm count is less than 10 million per ml.
Azoospermia - when there is complete absence of sperm.
Teratozoospermia - high number of abnormal sperms.
Necrozoospermia - loss of sperm motility.
Pyospermia - Presence of pus cells in the semen sample usually denotes some type of infection. However pregnancy has occurred even in couples where the male partner has pyospermia.

Fructose Level - Fructose is secreted by the seminal vesicles and absence or decreased levels of fructose usually signifies blocked ejaculatory duct. Low fructose levels cause low motility of sperms.

Prostaglandin Levels - Low prostaglandin levels may impede motility of sperms.

Other Tests for Investigation of Male Infertility

• Hormonal assessment : About 10% of all men complaining of infertility have hormonal abnormalities. So blood must be examined for the levels of FSH, LH, Prolactin, Testosterone and TSH, T3 and T4 levels.

• Testicular Biopsy : Testicular Biopsy is carried out in cases of azoospermia to distinguish whether the absence of sperm in the semen is due to failure of production or due to a block in the passage.

• Cervical Mucus study : There are different types of cervical mucus tests. The two described below are the common types:
  
  
  • Sims-Huhner test : In this test, a drop of mucous is removed from the cervix not later than 12 hours (preferably within 2 hours) after coitus. The mucous is examined under a microscope for sperm and their motility, if any. The test is said to be positive if there are at least 5 motile sperms found in the cervical mucous.
    
    
  • Kremer Test : A drop of cervical mucous at the time of ovulation is collected and placed on a glass slide. A drop of the husband’s semen is placed near it. Invasion of the mucous by the sperm is examined under a microscope. Donor semen with the wife’s mucous and donor mucous with the husband’s semen can also be used for differential diagnosis.

• Bovine Mucus Test : Bovine mucus or mucus from a cow is available in a kit. The ability of human sperm to enter the mucus can be used to test for the health and fertility of the sperm.

• Sperm Penetration Assay test: In this test , the ability of the sperm to penetrate an egg ( a Hamster's egg is usually used) is tested.

• Antisperm antibody : Presence of antisperm antibodies in the semen or cervical mucus prevents or decreases the motility of sperms. Sperms are considered foreign by the body's immune system since they contain only half the number of chromosomes present in other cells of the body.

  So, if sperms come in contact with the immune system in injuries or infections of the testes, the immune system develops antisperm antibodies as a protective measure. These antibodies can pass into the semen and cause damage to the sperm.

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