How can we assess male factor fertility? Semen Analysis

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 infertility. 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

Related Medical Abstracts - Click on the paper title:-

What is the purpose of a postcoital test (PCT)?

A post-coital test involves taking a sample of the mucus from the cervical canal between eight and twelve hours after intercourse around the time of ovulation (days 13-14 in a 28 day cycle). The mucus is placed on a glass slide and then examined under a microscope. You should have the opportunity of looking down the microscope for yourselves.

There is debate as to the value of the test. A positive test will show reasonable numbers of actively motile sperm and confirms that ovulation is taking place, that the male partner is producing reasonablequality sperm and that the mucus is not inhibiting sperm movement. A positive test also confirms that intercourse is resulting in semen being deposited on the cervix.

It has been estimated that 6% of infertility is related to coital difficulties and it seems entirely appropriate to me that this should be checked by such a simple test particularly as other fertility tests and treatment can be expensive. The cervical mucus may be hostile to sperm even during ovulation and cervical factor has been considered to be responsible in up to 10% of couples presenting with infertility. Whilst a positive test is reassuring, a negative test is more difficult to evaluate. On several occasions we have seen a negative test in a conception cycle. Another argument against the post-coital test is that the most common form of treatment, whether the test is positive or not, is intrauterine insemination (23).

The majority of our patients find it reassuring to know that this potential cause for otherwise unexplained infertility has been checked. There are occasions when the post-coital test identifies an unexpected coital problem. The test may be of greater value in units that use treatments specifically for the cervical factor such as pre-ovulatory oestrogen or pre-coital sodium bicarbonate douching (22)

In vitro cross testing, utilizing donor mucus and sperm can indicate the origin of an abnormal PCT. A drop of the partner's sperm and donor sperm are placed on a glass slide in contact with the woman's cervical mucus and also with donor mucus from another woman. Penetration of the mucus is evaluated microscopically. These tests have become less popular now that we have more advanced treatments.

Related Medical Abstracts - Click on the paper title:-

Male Factor Infertility Treatment

Effective treatment for male factor infertility is dependent on the source of the problem. Lifestyle changes alone may prove successful to correct alcohol, tobacco or other illicit drugs use. Surgical treatment may be required in for example vasectomy reversal.

Twenty years ago, the only major successful treatment for 98% of couples with male factor infertility was artificial insemination with donor sperm (AID). Nowadays, the advent of assisted conception techniques such as IVF and ICSI provide potentially highly successful options for 98% and male infertility has become a highly manageable condition.

Intrauterine Insemination

Intrauterine insemination (IUI - artificial insemination AI) of your partner's sperm has a place when there is:-

  •  known to be a coital problem, either elucidated from the history or perhaps from repeated observation of absence of sperm on post-coital testing.

     mildly reduced male fertility, as recognised from semen analysis. Even when there is moderate male subfertility, treatment using ovulation induction and IUI would seem to be a valuable initial treatment before contemplating more expensive and invasive assisted reproductive techniques. Severe male factor infertility does not usually respond to IUI.

  •  cervical hostility demonstrated by post-coital testing or mucus penetration tests.

     unexplained infertility.

At one time, untreated semen was used but adverse reactions sometimes occurred. These days, sperm for insemination are prepared by washing or swim-up to improve success rates and reduce possible complications. The swim-up preparation involves washing the sperm with culture medium, and, after centrifugation (controlled rapid spinning), the supernatant (fluid) is removed. The pellet of sperm is covered by 0.5ml of culture media. In the swim-up preparation, the sperm in the pellet are incubated at body temperature for 30-60 minutes. The supernatant subsequently carries a relatively high concentration of motile sperm and this is used for the insemination procedure. A variety of swim-up techniques and media such as Percoll have been used in an attempt to improve success rates.

Clearly artificial insemination should be undertaken around the time of ovulation. The relationship between the day of insemination in relation to the last day of hypothermia (low temperature) on the basal temperature chart and conception rates in a donor insemination protocol has been studied. The over-all conception rate was 12% and the best results were obtained for insemination 3 days (20%) and 1 day (21%) before the last day preceding the temperature rise that is typical following egg release. LH predictor tests can be used to indicate the fertile phase for a woman with irregular cycles, perhaps increasing the success rate. Success rates with artificial insemination depends on the age of the female partner and the total motile sperm count.

Artificial insemination with donor sperm (AID) has been the most successful treatment for male factor infertility although, not withstanding economic considerations, more modern treatments with IVF and ICSI (25) have an increasing role to play. Success rates in donor insemination programmes of 70% over six cycles have been reported. Frozen samples are now recommended to allow adequate testing of donors for HIV although fresh donor samples have achieved pregnancy rates of 19% per cycle compared to frozen samples giving 5 ?10 % per cycle.

In the past 20 years, various recommendations have been made about the maximum number of intrauterine insemination (IUI) cycles that should be performed, because evidence underpinning a possible limit is lacking. A multicentre, retrospective cohort analysis was performed with couples treated with IUI up to nine cycles. Primary outcome measure was ongoing pregnancy rate (OPR) per cycle. Overall, 3714 couples with male, cervical or unexplained subfertility underwent 15,303 cycles of IUI. In 70% of cycles, controlled ovarian hyperstimulation (COH) was used (51% clomiphene-citrate, 19% gonadotropins). Mean OPR rate was 5.6% per cycle. OPR in the seventh, eighth and ninth cycle were 5.1%, 6.7% and 4.6%, respectively. Taking censored patients into account, the calculated COPR was 18% after the third cycle, 30% after the seventh cycle and 41% after the ninth cycle. If censored patients were considered to have no chance of conception, a crude COPR of 25% after nine cycles was found. Multivariable regression analysis showed no significant impact of age, type of subfertility, diagnosis, use of hyperstimulation or cycle number on OPR after the sixth treatment cycle. It was concluded that OPR in high-order IUI cycles are acceptable, and do not offer a rationale for cancellation before nine cycles. Using this type of very mild COH, it may be reasonable to conduct up to nine cycles.0801

Infertility Support Groups

Members of a support group, provide each other with various types of help and information for a particular shared difficulty.

The support may take the form of providing relevant information,

  • relating personal experiences,
  • listening to others' experiences,
  • providing sympathetic understanding and
  • establishing social networks.

A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy.

Support groups maintain interpersonal contact among their members in a variety of ways.

Support groups also maintain contact through printed information rich newsletters, telephone chains, internet forums, and mailing lists.

Support groups offer companionship and information for people coping with diseases or disabilities. Support groups may not be appropriate for everyone, and some find that a support group actually adds to their stress rather than relieving it.

There are some support groups specifically for people experiencing infertility, some of which have local groups and/or sub-groups specialising in particular issues.

Evaluation of the quality of Web sites is discussed in (internet information). You may find that several general women's health sites may help you (internet information). The following are more specialised relevant Web sites:- Au/community/aisg Australian Infertility Support Group
http://www. The American Fertility Association, 305 Madison Avenue  Suite 449, New York, NY 10165 Au
http://www. The InterNational Council on Infertility Information Dissemination (INCIID ? pronounced "inside") is a nonprofit organization that helps individuals and couples explore their family-building options.
http://www. The IFC Resource Centre was set up as an independent facility to provide graphical information, books and CD-ROMs in the field of Reproductive Medicine.
Resolve RESOLVE: The National Infertility Association, established in 1974, is a non-profit organization with the only established, nationwide network of chapters mandated to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders.Headquarters: 8405 Greensboro Drive, Suite 800, McLean, VA 22102-5120
http://www. British Infertility Counselling Association, 69 Division Street, Sheffield, S1 4GE Aspx ISSUE (The National Fertility Association), 114 Litchfield Street, Walsall, WS1 1SZ


Women's Health

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.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.


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.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - - to provide detailed
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