Introduction

When a couple are unable to conceive after trying for one to two years the cause could be due to either one partner or both or unexplained. Male related problems directly cause 20% of infertility while it contributes to another 30-40% of cases. In most circumstances it is defined based upon abnormal sperm parameters while it still can be a result of other problems such as erectile dysfunction, premature ejaculation etc..

The abnormality in the semen analysis could be mainly low sperm count, reduced movement, and markedly reduced normal shape. Other abnormalities seen are reduced semen volume, presence of increased white cells, red blood cells. Occasionally no sperms are seen in repeated semen analysis.

Risk factors

Many factors influence sperm parameters. They include smoking, obesity, unhealthy lifestyle, hazardous environmental factors, recreational drugs, and certain medicines. The two main reasons for this is the effect of the toxin directly onto the sperm and the other is due to the increased temperature resulting in reduced movement of the sperm.

Toxins are caused by smoking, drugs, inhalation or exposure to chemicals, hazardous fumes, as well as exposure to radiation. While increase in temperature is due to obesity, prolonged exposure to heat like frequent long distance driving/ cycling / spa, certain occupations. The other main cause is sexually transmitted disease resulting in obstruction or abnormal sperm parameters. In some patients it can be genetic in origin and there is a risk this can be present in the offspring.

Basic evaluation

The semen analysis is usually the only test that is needed. It is advised to have the semen collected after three to five days of abstinence preferably in the facility where the testing is to be done. If collected elsewhere it must be sent to the laboratory within one hour and must be kept at 37’C. In the event the result is abnormal usually a repeat testing is advised in three months.

 Those with abnormal results are usually seen by the doctor for clinical assessment which includes an examination of the genitalia primarily the testes. Based upon this, further testing maybe advised. This might be blood tests for hormones, ultrasound assessment, genetic screening, or advanced sperm testing.

Diagnosis

The possible diagnosis could be slightly reduced sperm quantity(oligospermia), markedly reduced sperm quantity(severe oligospermia), absent sperms (azoospermia). These are usually associated with other abnormalities in the semen parameters.  

This includes maintaining a healthy life style, weight loss, regular exercise, a well-balanced diet andto stop smoking / recreational drugs. It is advisable to avoid prolonged exposure of the scrotum to heat. This may be required in certain jobs. Anti-oxidants and health supplements may be helpful in certain circumstances. The patient may need to discuss with the doctor regarding alternative drug therapies for medical illness.  

Treatment

If it is only mild reduction in sperm quantity then natural conception or intrauterine insemination is still possible. For more severe forms assisted reproductive technology is required that is ICSI (intra-cytoplasmic sperm injection). In some cases of azoospermia a direct extraction of sperms from the testis is done via a small surgery at the scrotum. It must be remembered that not all forms of male infertility can be treated.