It is considered that that a fertility problem exists when a couple has been having regular sex, without using contraceptives, for over a year and hasn’t conceived a pregnancy. In the case of couples over 35 years old, this is reduced to six months. In both cases, it is advisable to visit a clinic to undergo the relevant tests, identify any problems and find the solution as soon as possible.
It is fundamental that the couple is united and they are both committed to the process. Fertility problems usually affect approximately the same percentage of men as they do women. In up to 30% of cases, both sexes present a problem of some kind. Causes can be very varied, but a good fertility study, performed in time, mak es it easier to find the most suitable treatment to achieve the long awaited pregnancy.
WHAT ARE THE CAUSES OF MALE INFERTILITY?
In the situations where the problem lies with the man, it is generally due to the quantity and quality of the sperm. This could be a result of genetic causes or even factors such as daily routines and habits. In the first case, the male cannot avoid it, but in the latter, it is possible to make lifestyle changes to improve habits and increase his fertile capacity.
- Low sperm production or quality, whether this be for poor motility or morphological abnormalities
- Absence of sperm in the ejaculate, usually related to an obstruction in the male ducts. In this case, although the sperm is of good quality, the egg cannot be fertilised.
- Health problems. Illnesses such as renal or hepatic insufficiency, diabetes, thyroid problems, varicocele or cardiovascular diseases can negatively influence the reproductive capacity.
- Hormonal imbalances. In some cases, hormonal problems can affect the production of the gonadotropin hormones or testosterone.
- Some medical treatments can be detrimental, such as chemotherapy. In these cases, freezing sperm samples before the treatment is one of the ways to prevent such side effects.
- Hereditary diseases or genetic alterations such as cystic fibrosis, Klinefelter syndrome, Kartagener syndrome or Kallmann syndrome. Factors such as DNA fragmentation can also lead to implantation failure of the fertilised egg or miscarriages.
- Poor habits and environmental factors. Exposure to industrial chemical agents, radiation, alcohol consumption, drugs, tabaco and even caffeine can impact fertility. The same is true for stress, which can negatively influence sperm production and motility.
What tests are performed in a male fertility study?
The male fertility study starts in a consultation with an andrologist, who will perform an interview and basic examination, including an analysis of the medical and reproductive history. It will also involve questions about lifestyle, exercise, smoking habits, drug use, alcohol consumption and dietary habits. Different tests will also be conducted, to determine any possible causes of infertility, the most common being:
semen analysis
The aim of the semen analysis, sometimes called a sperm count, is to evaluate its quality. Various components are studied and macroscopic aspects such as pH, viscosity, appearance, liquification time and volume are observed. Microscopic factors are also evaluated, including the sperm concentration (number of sperm per mm3), morphology and motility.
total motile sperm count
With any assisted reproduction treatment, it is essential to perform sperm capacitation and a total motile sperm count (TMSC). This test is based on processing the semen sample to recover the sperm which have the best motility, which will then be selected for the different reproductive techniques. If the semen analysis returns pathological results, it is this combined with the TMSC that will determine which assisted reproduction treatment is the best option to achieve the pregnancy.
SEROLOGY
From a blood draw, tests can be performed to detect the presence of antibodies in the blood, due to the presence or exposure to particular pathogenic microorganisms. HIV, hepatitis B and C and syphilis are tested for in this way.
HAEMOGRAM
This is a blood test which measures three types of cells found in the blood, both overall and proportionally: erythrocytes (red blood cells), platelets and leucocytes (white blood cells).
KARYOTYPING
This test, from a blood draw, is conducted when men present with highly abnormal semen qualities (such as oligo-astheno-teratozoospermias) to check the chromosomal make-up of the patient, to rule out any possibility that chromosomal abnormalities could be the cause of infertility. Furthermore, in those cases where the sperm samples are found to be highly abnormal, it is possible to order further tests for a more precise evaluation, such as a meiosis study, DNA fragmentation analysis or a sperm FISH test.