3. MALE FACTOR
Fertility problems affect both men and women. As many as
two out of every five couples with fertility problems require treatment of both spouses, and in 25 percent of the couples their fertility problem rests with the husband alone. Fertility diagnosis and treatment is lengthy, time
consuming and expensive. The process can frequently be eased and shortened by both partners working together with their fertility physicians from the beginning. In addition to the tests done on a woman, it is often necessary to
perform a semen analysis to be sure a husband has sufficient normally functioning sperm for fertilization to occur. Human conception is a difficult and complex process, even under the best conditions. Normally functioning sperm
will ultimately complete the path to fertilization. This means first breaking through cervical mucous, traveling up the length of the uterus and entering the fallopian tube. Once in the fallopian tube, sperm must meet an egg,
penetrate the eggs protective coating and inner membrane, and finally, fertilize the egg. Then, and only then, has fertilization occurred. To increase a couple's chances for conception it may be necessary for the husband to
undergo special sperm studies. Sometimes a semen condition will not respond to medical treatment. In these circumstances, it may be possible to treat the sperm in the laboratory in an attempt to enhance fertilization. In
order to obtain an optimal semen specimen, the husband may be requested to refrain from ejaculation for at least 48 hours prior to providing a specimen. DO NOT ABSTAIN for longer than 5 to 7 days, as the quality of sperm decreases
with prolonged storage in the body. A private room is provided for the collection of semen specimens. The wife may accompany her husband if he wishes. Many factors affect the quality of sperm produced by an individual at any
given time. These factors include items such as: unusual stress, fever, certain medications, or any injury to the testicles. Therefore, the husband will be asked to complete a brief reproductive history as well as note any
temporary conditions which may affect sperm quality. When making an appointment for semen analysis, please inform us if there has been a fever or illness within the last three months as this may affect the specimen. If the wife's
ovulatory cycle is being monitored for purposes of follicular maturation studies, artificial insemination, in vitro fertilization or gamete intrafallopian transfer, our centre should be alerted if any conditions occur which may
affect sperm quality, such as illness or extreme stress. This will enable us to evaluate the condition for potential adverse effects upon the husband's sperm production at the time of his wife's ovulation. During ovulation, one or
more "fresh" semen specimens may be needed to increase chances of conception. Since fertility problems affect the couple, we want to remind you that husbands are welcome, and encouraged to attend all consultations and
appointments with their wives. Semen analysis (sperm count) Semen microbiology "Trial wash" Karyotyping and molecular genetics Antisperm antibodies Tests for agglutination or spermtoxic antibodies can be performed on semen, cervical mucus or blood serum. A positive cytotoxicity result indicates the need for titration
of specific sperm-immobilizing antibodies. However, antibodies causing neither biological action may also be present and can only be detected by tests such as the Immunobead Test (IBT). To test for antisperm antibodies produced
by the male partner, this test is performed directly on ejaculated spermatozoa. To test for antibodies prodced by the female partner, the test is carried out indirectly, by adding the test fluid (cervical mucus or blood serum) to
prepared donor spermatozoa in the lab. Unique tests are available that can test for IgG, IgA and IgM antibodies simultaneously. Isotype-specific testing is also available. If a screening test is positive for the presence of
antibodies, a "sperm antibody isotyping" may be performed. Sperm-cervical mucus in-vitro interaction tests - Post-coital (Sims-Huhner) test. Ultrasound examination of the male genital tract Electroejaculation
Semen analysies are assessing qualities such as: appearance, odour, liquefaction, viscosity, pH, volume, sperm concentration, motility, vitality,
differential morphology, clumping, debris and description of other cellular elements, particularly leukocytes.
Sometimes, an infection in the genital tract can cause problems with sperm performance.
A trial wash is a semen-preparation evaluation for assisted conception, distinguishing
suitability for intrauterine insemination (IUI), gamete intrafallopian transfer (GIFT), conventional in vitro fertilization (IVF) or intracytoplasmic sperm insertion (ICSI).
Special testing is advisable before assisting conception for men with severely depressed sperm production or with bilateral congenital absence of the vas deferens. This is because there is a possibility that the condition may be
passed on to male children.
Antibodies against spermatozoa showing agglutinating, cytotoxic (immobilizing), or coating activity can be present on the ejaculated spermatozoa as well as in
either semen, cervical mucus, or blood (male or female).
This test investigates the compatibility of the female
partner's cervical mucus with the male partner's sperm, and determines which element (if either) has a problem.
Testicular biopsy (fine needle or open): Obtaining sperm directly from the testis for ICSI and MESA: Microsurgical epididymal sperm aspiration. Obtaining immature sperm cells from the epididymis (which joinds the testis to
the vas), above an obstruction giving rise to absent sperms from the ejaculate; the recovered sperm can be used for ICSI, either immediately or after cryostorage.