40% of infertility problems are male related.
Male infertility is any condition that interferes with a male’s ability to initiate a pregnancy with the female partner. Essentially it is due to the fact that a man has too few healthy sperm in their semen that are capable of fertilizing an egg through sexual intercourse. There are a wide range of causes that can be tested for and are due to genetics, hormonal disorders, sperm function or sperm quantitative/qualitative features.
Male Infertility Tests
Assesses the ability of sperm to penetrate an egg. In the fertilization process, sperm must first fuse to, then penetrate, the female egg in order to fertilize it. Typically fusing to the egg is not an issue, but penetrating the egg’s hard shell (zona pellucida) can be difficult for sperm. For this reason, sperm cells go through a process known as acrosome reaction. Shortly before penetration of the egg, the tip of the head of a sperm cell (the cap) will rupture releasing enzymes responsible for breaking down the eggs hard shell in order to gain access to the egg and fertilize it. In cases where sperm fail to undergo the acrosome reaction, they typically have a severely reduced chance of penetrating an egg. This information may be used to help determine the most appropriate ART (Assisted Reproductive Technology) procedure.
Anti-sperm antibody (male)
This test looks for antibodies in semen that can damage or kill sperm resulting in reduced motility, interfering with egg fertilisation or even infertility. Normally, the testes contain a natural barrier that acts as a protective layer by preventing immune cells from gaining access to sperm within the male reproductive tract. However, the barrier can be broken when testicles are physically injured, after a surgery (biopsy or vasectomy) or after a prostate gland infection. This allows sperm to come into contact with the immune system resulting in the production of the antibodies. If a high number of sperm antibodies come into contact with a man’s sperm, it may be hard for the sperm to fertilize an egg.
Chromosome Analysis Karyotyping
One or both of the parents may be the carrier of an abnormal chromosome. Karyotyping is the analysis of the number and shapes of chromosomes in individual cells. Abnormal karyotypes are a significant cause of recurrent miscarriage, or infertility. Chromosomal abnormalities include: extra or missing chromosomes, alterations to the normal structure of specific chromosomes or cases where sections of one chromosome will be relocated to another chromosome where it does not belong (translocation). A chromosome analysis can identify these abnormalities and determine the anatomical, physical and physiological problems associated with it.
A small amount of estradiol is produced by the male testes. It has been reported that high levels of estradiol in men is associated with infertility characterized by low sperm production and quality.
Follicle Stimulating Hormone (FSH-male)
A hormone produced by the pituitary gland that is located in the brain. It plays a key role in the development and release of sperm in the testes. If the reason for the azoospermia is testicular failure, then this is reflected in a raised FSH level. This is because, in these patients, the testis also fails to produce a hormone called inhibin (which normally suppresses FSH levels to their normal range). A high FSH level is usually diagnostic of primary testicular failure, a condition in which the seminiferous tubules ( a coiled mass of tubes which makes up the bulk of the testes ) in the testes do not produce sperm normally, because they are damaged.
Hyaluronan Binding Assay (HBA)
Hyaluronan is a naturally occurring protein found in all human cells, including the gel layer surrounding the oocyte (egg). This test is based on the ability of mature, but not immature, sperm to bind hyaluronan. A low level of sperm binding to hyaluronan indicates a low proportion of mature sperm in the sample. The results of the HBA assay may provide information as to the most appropriate ART (Assisted Reproductive Technology) procedure.
Inhibin B (Male)
A hormone test used to assess the reproductive capacity of males. This hormone is a direct product of the testes and is found to be higher in those men with normal fertility and lower in those who have abnormal sperm production. Inhibin B levels can be used to distinguish between obstructive (normal levels) and non-obstructive (low levels) causes for a lack of sperm. In the case of an obstruction, men typically have normal sperm production but their pathway is blocked due to some physical obstruction. In non-obstructive cases there is no physical obstruction, sperm production is simply low or nonexistent. Non-obstructive lack of sperm is typically due to some type of genetic abnormality.
LH (Luteinizing Hormone – male)
In the man LH is necessary for spermatogenesis (sperm production) and stimulates the testicles to produce testosterone (Leydig cell function). Low levels of LH indicate a hormonal cause for low sperm production.
A hormone involved in the production of testosterone. Too much of this hormone in the blood stream can cause infertility by: interfering with the pituitary production of FSH and LH, adversely affecting the function of testicles, causing decreased testosterone levels, or causing abnormal sperm. High prolactin levels can be caused by tumors or certain medications. Prolactin levels are used with other tests, to help: Diagnose prolactinomas (tumors of the pituitary gland that produce prolactin), investigate potential infertility issues and erectile dysfunction in males.
The examination of semen under the microscope. The purpose of this assessment is to measure the volume of semen, approximate number (sperm count), morphology (shape of the sperm) and motility (how well they swim). White blood cells are also measured to detect any possible infection.
Sperm DNA Decondensation (SDD)
Used to assess how well a population of sperms DNA functions once it has fertilized an egg. Once a sperm has fertilized an egg, there are several processes its DNA goes through in order for it to pair up with the egg’s DNA. There are many factors that may impair this process. An abnormal results indicates the general sperm populations DNA will not act normally once inside the egg. This test may provide useful information that will direct couples to the most appropriate ART (Assisted Reproductive Technique) procedure.
Sperm DNA Fragmentation (SDFA)
A test used to assess the quality of DNA in sperm by measuring the amount of “breaks” or “fragmented” DNA in a sample. These DNA “breaks” are indicative of damaged DNA. Significant DNA damage may indicate the general sperm populations reduced ability to fertilize an egg. It also may provide information as to the most appropriate ART (Assisted Reproductive Technique) procedure to be selected.
Sperm Penetration Assay (SPA, Hamster Test)
A test of the ability of sperm to penetrate a hamster egg that has been stripped of the Zona Pellucida (outer membrane of the egg). This is another test used to examine the relative health, fitness and fertilizing ability of sperm.
This hormone is produced by the testicles and is responsible for the development and release of sperm, secondary physical characteristics and sex drive. It is present in two forms: free and bound to Sex Hormone Binding Globulin (SHBG). The amount of testosterone in a man’s body is controlled by the pituitary gland. At low levels, the pituitary gland typically releases luteinizing hormone (LH), which tells the testicles to make more testosterone. In cases where this process is impaired, consistently low testosterone levels can lead to low sperm counts and quality. There are several reasons for low testosterone levels including: hypothalamic or pituitary disease, damage to the testes (such as alcoholism, physical damage, or viral diseases), genetic diseases, or testicular failure. Total testosterone measurement does not indicate a problem until end stage testicular failure is reached. Free testosterone is an earlier indicator and more informative.
Y Chromosome Microdeletion
Mainly used for men who have very few (oligospermia) or no (azoospermia) sperm present in a semen sample and do not have any type of physical obstruction. This test identifies small missing segments of DNA from specific genes located on the Y chromosome. The functionality of these genes has been linked to male infertility. There are 3 basic deletions: AZFa – is rare and the most severe. There is no chance of being able to produce sperm, AZFb – there have been no documented cases of finding mature sperm with surgical procedures, AZFc – is the most common deletion. Successful extraction of sperm with surgical procedures occurs in ~ 2/3 of cases.