Male infertility 

Infertility is not a “woman’s problem” alone. Until recently, when a couple was unable to conceive, the woman’s was supposed to be responsible. Today, however, it is generally known that men are responsible in 35% of the couples with infertility, although a few reports mention the percentage to be 40% – 50%. In 35% of the most frequent cause of infertility is the inability of the testes to produce sufficient number of healthy spermatozoa. Infertility in men may be caused by inflammatory conditions, mumps, chryptorchidism, severe injury that may destroy or block the semen production, or sperm antibodies found in either man or woman. In addition, for the achievement of pregnancy, the semen volume should be sufficient, spermatozoa should be active, normal, regarding the shape and the size and they should not stick to each other or be affected by antisperm antibodies. Finally, they should be able to overcome the cervical mucus as well as other obstacles until they successfully reach the tubes and meet the egg. In their first visit to the doctor, men should give a detailed medical history and their current health condition.

Past diseases that may affect the fertilizing ability of men are:

• Mumps inlescence
• Hernia treatment
• Athletic injuries at the scrotum
• Chryptorchidism

It is possible that men’s sexual history may affect their fertilizing ability, such as:

• Sexually transmitted diseases
• Infections of the urinary system
• Prostatidis
• Impotence or problems with ejaculation.

Certain medicines, heavy smoking, drinking or recreational drugs may also affect sperm quality.

The physical examination of men should include the following:

• The hair growth pattern in the genital area (it should be diamond shaped and extend upward toward the navel).
• The examination of the penis for abnormalities.
• The examination of the scrotum to assess size and firmness of the testes for varicocele.
• The examination of the prostate.

Semen analysis. (Procedure – tests)
Semen analysis examines the sperm count, motility, velocity, morphology, total semen volume and semen liquefaction. Semen analysis is performed on site. In a quiet room, the man collects by masturbation the ejaculate into a sterile cup. In normal sperm, the mean total number of spermatozoa is between 40 and 400 million. In addition to spermatozoa, sperm contain fructose which provides energy, alkaloids which prevents the harmful effects of the acidity of the urethra and the vagina, prostaglandins which cause contractions to the uterus and the fallopian tubes enabling the sperm to move forward, vitamin C, zinc and a few more traces of elements. Sperm may also carry a number of diseases including AIDS, however a healthy sperm is void of any disease and is safe to be used.

Sperm evaluation:
What is considered normal sperm? According to the World Health Organization (WHO Laboratory Manual 1999, CUP, 4th Edn)

Liquefaction:
complete within 60 min. at room temperature

Appearance:
Homogeneous, grey opalescent

Volume:
2 ml or more is considered normal

PH:
7.2 – 8.0

Concentration:
20 X 10⁶ spermatozoa / ml or more

Total number of spermatozoa:
40 X 10⁶  spermatozoa per ejaculate or more

Motility:
50% or more with forward progression (categories ‘a’ and ‘b’) or 25% or more with rapid progression (category ‘a’) within 60min of ejaculation

Morphology:
15% or more of normal forms of spermatozoa. However, according to Kruger criteria, normal sperm is considered containing 14% or more of spermatozoa with normal head, whereas, less than 4% of spermatozoa with normal head may indicate a serious problem of infertility (Kruger strict morphology criteria)

Vitality:
75% or more of live spermatozoa (which do not get tinted by the special tint of the test)

White blood cells:
Fewer than 1 Χ 10⁶/ml