Infertility is a “couple” disease. About 20% of couples are considered infertile in the United States. Of these, male factors alone account for about 30%, and a combination of male and female factors account for another 20%.

The causes of male infertility may be divided into the following categories:

1. Deficiency in sperm formation.
2. Decreased sperm concentration.
3. Absence of sperm production.
4. Problems with transportation.

Seventy percent of the conditions can be diagnosed rapidly, with a history, physical exam, hormonal tests and a semenanlysis. More invasive, sophisticated tests can be saved for later evaluation.

The semenanalysis evaluates the count, motility and morphology. There are 2 classifications used to assess the sperm.

The World Health Organization(WHO) classification is used by most commercial laboratories. (Labcorp, Quest). The Strict Kruger criteria are used by most infertility clinics and recommended by the American Society for Reproduction (ASRM).
 

The normal ejaculate is as follows: (Kruger criteria).

1. Volume. 1.5-3.5cc.
2. Count. 20million/cc.
3. Motility. 40-50%.
4. Morphology. >5%.

Newer tests of sperm function are now used by infertility clinics. These include: tests for sperm antibodies, the sperm fragmentation assay to assess DNA, and the HBA (hyaluron binding assay) to select the most normal sperm for fertilization.

Factors affecting sperm function:

 Several intrinsic and external factors can affect sperm.

1. Genetic causes. These include conditions such as undescended testicles, an absent testis, chromosomal abnormalities or hereditary diseases such as cystic fibrosis.
2. Hormonal causes. Thyroid dysfunction, decreased testosterone production, diabetes, and other chronic conditions may decrease sperm production and function.
3. Anatomic causes. Varicocele (varicose veins of the testes), obstruction or absence of the vas deferens (the tubes that transport the sperm from the testis), previous vasectomy, lead to abnormal semenanalyses.
4. Age. Testosterone production decreases with age. This results in decreased sperm parameters.

Treatments:

1. Surgical.

Correction of a varicocele, correcting an obstructed vas deferens or an undescended testicle, or a vasectomy reversal.

1. Hormonal.

Treatments to boost testosterone production such as clomid or injections of hcg. Supplemental testosterone added may have the opposite impact and actually inhibit the spermatogenesis.

1. ART. (Assisted Reproductive Technology).
    

These include intrauterine insemination (IUI), or in vitro fertilization (IVF).

ICSI (intracytoplasmioc sperm injection), or even pICSI (physiologis ICSI) are additional methods of identifying sperm for normal fertilization.

It is important to have a complete evaluation of both partners. A reproductive specialist should be consulted so all issues may be addressed adequately. Ninety percent of male infertility may be due to poor semen quality. However, studies of infertile couples have shown that, even without treatment 23% conceived within 2 years, and 10% in 4 years, if the female partner was below the age of 32.