Infertility is classified as female factor, male factor, both male and female factor or idiopathic cases. Female factor is accompanied by male factor in around 35% of infertile couples, while male factor is the only identified cause in approximately 10% of cases.
Oligozoospermia – count of sperm in ejaculate lower than the accepted normal range - or azospermia – total absence of sperm in ejaculate – is detected in a certain percentage of men with infertility, while sperm count is within normal ranges in others with infertility. Sperm concentration is low along with poor sperm quality, low motility (astenozoospermia) and/or count of sperms with abnormal morphology are more than healthy sperms in 80 percent of infertile men. In a low percentage of infertile men; there are normal sperm concentrations, with low quality sperms having normal sperm count, morphology and motility, although these cases are rare.
Male infertility can be caused by insufficient production of sperm in testes, poor functioning of sperms and blockage in tubes that pass sperm in the body. Other potential causes of infertility are chronic diseases, endocrine disorders, genetic problems, congenital anomalies, past history of infection, trauma, varicocele (dilated veins around testicles) and surgical operations.
Infertile men may not have a complaint other than failure of pregnancy in partner. However, others may suffer from signs that point to chromosomal or hormonal problems, such as sexual dysfunctions (e.g. problems in erection or ejaculation, low sex drive), testicular swelling, redness and pain as well as recurrent respiratory tract infections, anosmia (inability to sense one or all smells), abnormal enlargement of breast (gynecomastia) and loss of scalp or body hair. Evaluation requires review of detailed medical history, physical examination and semen analysis. They can be supplemented by hormone tests, imaging of accessory gland and channels and genetic tests, whenever required.
Sperm analysis is a relatively simple test to evaluate etiology of male infertility and it requires sexual abstinence for 2 to 7 days. Generally, patient is asked to ejaculate into a sterile container through masturbation in a private room. However, the sample should be obtained at home and transferred to the clinic within 30 minutes, if the former approach is not feasible. It is recommended to do semen analysis at least twice due to inter-sample variability.
Semen specimen is evaluated according to the criteria set by World Health Organization (World Health Organization Laboratory Manual for the Examination and Processing of Human Semen).
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