by Dr Agilan Arjunan, Fertility Specialist, KL Fertility Centre (Malaysia)
Have you ever gone through a fertility assessment before? For couples who had done it , you would know that it can sometimes look very complicated with all those internal ultrasound (transvaginal) scans, blood tests, x-ray tests and sperm test for a male partner.
In this article, I will simplify the fertility tests for a male partner. I’ll start with sperm test and go on to other tests required when a man has no sperm (azoospermia).
For a man , the most important test is a semen analysis (sperm test). About a third of couples, the problem lies with the male partner and thus it is very important to do this test.
“A 70 year old man can still reproduce, so this can’t be a major issue right?” . Its a yes and a no. It is true that a man continues to produce sperm but the QUALITY of the sperm deteriorates as he ages. Low sperm quality equals to lower chance to conceive.
What is a sperm test ?
In a well equipped andrology laboratory, there are 4 basic parameters that are of concern. These parameters are reported according to WHO standards (World Health Organisation)
- Sperm concentration : The lower range of normality is when at least 15 millions sperms for every millilitre (ml) of semen is found. Sperm concentration above this value is considered “normal”.
- Vitality : This means what is the percentage of life sperms in the sample. It should be at least 58% ( at least 58 out 100 sperms are alive).
- Motility : This parameter looks at the movement of the sperm. At least 40% of the sperms should be moving. The movements are further graded according to how fast it moves and direction of the sperm movements.
- Morphology : This parameter looks at how normal a physical shape of a sperm looks like. This is done under high powered microscope. At least 4% ( you read it correctly!) of the sperms should be normal-looking to be considered “normal”.
What about men with no sperm in their ejaculate , or know as Azoospermia ?
Azoospermia can be due to either production problem (i.e. sperm not produced by testis) or obstructive problem ( i.e. sperm is produced but there is obstruction in the sperm exit pathway).
How do we know what causes azoospermia ?
Generally, I will do a physical examination to look for any signs of testosterone (male hormone) deficiency.
Blood test for hormones ( i.e. FSH,LH,testosterone) are done.
If it’s an obstructive problem, sperm can be retrieved via a minor procedure called TESA/TESE . This is a minor surgical procedure where a small needle is inserted into the testis to retrieve testicular tissue which contain the sperms. The procedure is done under anaesthesia / sedation.
If it’s a complete production problem, there is no sperm to retrieve. However, it is very rare to have a complete production problem, more often there are some sperms which can be retrieved.
Sometimes oral medications can be used to boost up sperm production, but this can be determined after the examination and blood test results.
When sperm is retrieved via TESE/TESA or by ejaculation, IVF/ICSI is the next appropriate step towards a successful pregnancy.
I hope after reading this article, you have a better understanding of male fertility tests .
Good luck !