How can we assess male factor fertility?

Male factor problems contribute to at least 35% of infertility and male infertility is the sole cause of infertility in about 20-25% of infertile couples.

There are many causes of male factor infetility. A story of mumps in adult life may indicate the possibility of problems but most male factor problems are identified from microscopic assessment of a fresh semen sample (semen analysis / male fertility test).

The volume of semen produced at ejaculation should be greater than 1ml. There is debate about the minimum concentration of healthy motile (freely moving) sperm required to achieve pregnancy. The count varies according to Frequency of intercourse and from day to day. As an approximate guide, there should be at least three million actively motile sperm per ml.

Sperm Quality and Male Factor Infertility

  • No sperm (azoospermia) accounts for 3-4% of male infertility.
  • Poor sperm quantity (oligospermia) or quality e.g. low motility (asthenozoospermia) or a high percentage of abnormal sperm (teratozoospermia). Antisperm antibodies, etc. This subgroup may account for about 90% of male infertility.
  • Sperm dysfunctional, where there is a normal semen analysis but the sperm lack or have a defective fertilizing capacity, resulting in complete failure of fertilization or poor fertilization of the eggs in IVF. This accounts for 3-6% of male infertility.

In the majority of men suffering male infertility, physical and genital examinations reveal no cause of infertility, but in a few cases, it may reveal abnormalities such as poor facial and bodily hair, enlarged breasts, undescended testis, small testes or varicocele.

As an example, a semen sample has a volume of 2mls this is normal. There is a count of 30 million sperm per ml and 33% are motile total motile count is 10 million. Of these, 50% are actively motile actively motile count is 5 million per ml and the result is normal. 

The use of cell phones may have an adverse effect on semen quality.0801

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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
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