There are many different causes of infertility in both women and men that may be identified.
- About 15%-20% of couples have more than one reason for their infertility.
- Up to 60% of couples who haven’t conceived after a year of trying, and who continue to try to get pregnant, will eventually conceive, with or without treatment, even in cases when no clear cause of infertility can be identified.
Male factors contribute to about 30%-40% of all cases of infertility and thus are an important part of the infertility evaluation.
To be considered fertile, the male partner “must be able to deliver an adequate quantity of healthy sperm to a woman’s vagina during intercourse. Many things can interfere with this process, several of which relate to variations in sperm quality or an absence of sperm.” Other factors include varicocele abnormality, retrograde ejaculation and lifestyle factors.
Assessment for male factor infertility starts with semen analysis.
- Variations of sperm quality
- Sperm obstruction
- Varicocele abnormalities
- Retrograde ejaculation
- Lifestyle factors
Semen analysis consists of collecting a sperm sample for use in a series of laboratory tests to evaluate the health of a male’s sperm. These tests assess sperm count, movement, shape, white blood cells and ejaculate volume. If any of these aspects are not normal, additional testing, such as a sperm wash may be recommended. An analysis based on 2-3 separate samples is more reliable because samples from the same man can vary greatly.
An analysis based on 2-3 separate samples is more reliable because samples can vary greatly. In a normal sperm sample semen volume is 2-5 millilitres. In a 1-millilitre semen sample there should be:
- More than 20 million sperm
- More than 50% of the sperm should be moving
- More than 50% of the sperm should have a normal shape
- Less than 1-million white blood cells
If any of these aspects are not normal, a sperm wash may be recommended to determine:
- The sperm’s ability to bind to and fertilize an egg
- Whether antibodies are present that may be working against the sperm
- The presence of infections