If you have been trying to conceive for a year, and are under 35, you may want to check out a fertility clinic in order to see what is standing between your sperm and your lover’s eggs. When you do so, be warned that you will be the first line of attack, as testing men’s fertility is easier and less invasive than the tests that will need to be performed on your female partner.
It is estimated that 40% of fertility problems are caused by the man in the couple, and another 20% due to joint problems between the male and female. Factors in infertility include low sperm count, reproductive organ dysfunction, or hormonal problems (although these are quite rare). Of these 40% of infertile men, half will be untreatably so. Furthermore, studies in the field have shown that male factor infertility is on the rise.
There are various theories about why this is, ranging from environmental and dietary effects on fertility to the trend of older men trying to conceive. Studies in the US have shown that the amount of men trying to conceive over the age of 35 rose 20 between 1980 and 1995 alone, and anecdotal evidence shows that this trend is continuing, if not growing.
What to Expect: Testing
When you go in for fertility testing, the doctor will be looking at your sperm production, your anatomy (the structure of your reproductive organs), and your immune system for signs of infertility. The most common testing will consist of a discussion of your medical history, a physical examination, and a sperm test.
The doctor will begin with a discussion of your medical history to determine if there are any childhood illnesses, medications or physical trauma (for example testicular trauma or torsion) that could account for possible infertility. The doctor will likely ask if you have a history of diabetes or cystic fibrosis (which could account for the absence of some organs such as the vas deferens—the tubes that store and transport sperm from the testes—or the epidydimis–which links the vas deferens with the penis).Thyroid disease, liver problems , sickle cell anemia, STDs or seizure disorders can also affect fertility in men.
The doctor will likely ask about any past surgical procedures, particularly hernia or bladder. Either of these procedures can cause scar tissue or even knicks that could affect the course of the sperm through your system. Past treatment such as chemotherapy or radiation could affect your sperm health, as can misuse of drugs, including recreational drugs, anabolic steroids, or excessive alcohol consumption.
A physical examination of your external reproductive organs may enlighten the doctor to some possible causes of infertility. Underdeveloped sexual organs, such as testicles, could indicate a hormonal disorder that is contributing to infertility, or indicate a testosterone deficiency. A physical exam could also reveal a lack of some organs, such as the vas deferens.
The physical examination could also reveal a cause of possible obstruction or defect due to the absence of one or both testicles, or crytorchidism, a condition in which one or both testes did not drop into the scrotum during development.
The sperm testing may be the most revelatory of all tests. In order to perform sperm testing, the doctor will likely ask you to provide a sperm sample. This will most likely be done on site, as the sperm must be tested within 2 hours of ejaculation, and you will be asked to abstain from sex for 2-3 days prior to the sample. You will be asked to provide a minimum of three samples for comparison.
Once they have your sample, it will be tested for several qualities:
- Sperm volume, or sperm count: This will be tested in two parts. First, the concentration of your sperm (how many sperm per milliliter of semen) and the total volume of the whole sample. A healthy sample will be equal to or above 2 milliliters of ejaculate, with a minimum of 20 million swimmers per milliliter.
- Sperm motility: This is a measure of how well your little guys are swimming, in terms of what percentage of the total are moving forward, as well as the how well as how fast and straight they are swimming. A normal percentage is 50% of the sperm that are moving forward, and doing it well. A few factors can affect sperm motility. One is the viscosity of your semen, that is, how thick is the liquid that the sperm is swimming in. Logically, if the semen is thicker, the sperm has a harder time forging ahead. Another factor can be clumping of the sperm. One cause of this can be the presence of sperm antibodies. Due to an immune system malfunction, or perhaps due to some trauma to the testes, your body can sometimes produce antibodies that fight against its own sperm, making it difficult for them to maintain a forward trajectory, toward the goal.
- Sperm morphology: Morphology is basically a fancy way to say the shape of the sperm. The ideal is that 30% of your swimmers have normal oval heads, straight mid-piece and a tail that moves in a wave-like motion.
A total absence of sperm in the seminal fluid is called azoospermia. As long as there is sperm present in your reproductive system, even it is not moving forward, there are some options for you and your partner to conceive without the use of a sperm donor.
If there is sperm present in the system, your doctor might recommend a few options. All of these procedure involve, at their most basic level, removing a healthy sperm from the male and injecting it into the healthy egg of the woman.
Sperm retrieval can be done surgically (micro epididymal sperm aspiration, or MESA), where the doctor removes sperm form the epididymis in the scrotum through a small incision, or non-surgically, where the sperm is removed using a fine needle (percutaneous epididymal sperm aspiration, or PESA). Once the sperm is removed, it usually goes through a process of “sperm washing,” where matter affecting motility is separated form the sperm in a centrifuge.
Once washed, sperm can be introduced to the egg in vitro (sperm and egg are combined in a laboratory, creating optimum fertilization conditions, then implanted in the woman’s uterus once the embryo starts its cell reproduction). Using in vetro fertilization, usually 50-80 % of the eggs are fertilized. Of that number, 30% result in a little baby.
Just because your doctor chooses to examine you first, do not automatically assume the problem is with you. If you do have fertility problems, however, the science of fertility has come a long way in the past 30 years. Sadly, it does not yet come cheap, so be prepared to invest in your reproductive system if your desire is strong to have a child naturally. A better investment, however, can scarcely be found.