Problems With Sperm

A semen analysis, the main screening procedure for male infertility, is needed. For this procedure, men are often asked not to ejaculate for 2 to 3 days before the analysis. The reason is to make sure the semen contains as many sperm as possible. (However, research suggests that daily ejaculation does not reduce the sperm count in men unless there is a problem with sperm production.) The men are then asked to ejaculate by masturbation into a sterile jar, preferably at the laboratory site. For men who have difficulty producing a semen sample this way, special condoms that have no lubricants or chemicals toxic to sperm can be used to collect semen during intercourse.

Because the number of sperm varies, the test requires at least two samples obtained at least 1 week apart. When several samples are tested, results are more accurate than when only one is tested.

The volume of the semen sample is measured. Whether the color, consistency, thickness, and chemical composition of semen are normal is determined. The sperm are counted. A low sperm count may mean that fertility is reduced, but not always. Sperm are also examined under a microscope to determine whether they are abnormal in shape, size, or movement.

If the semen still seems to be abnormal, the doctor tries to identify the cause. If there are too few or no sperm, doctors measure levels of certain hormones, such as testosterone and follicle-stimulating hormone (which stimulates production of sperm in men), and genetic testing may be done. Also, urine may be checked for sperm after ejaculation to determine whether retrograde ejaculation is occurring.

Sometimes a biopsy of the testes is done to help identify the cause of infertility.

Other tests, which use a sample of blood or semen, can be done to evaluate sperm function and quality if routine tests of both partners do not explain infertility. These tests may check for antibodies to sperm, determine whether sperm membranes are intact, or assess the sperm's ability to bind to an egg and penetrate it. However, how useful these tests are is unclear.

Hormone tests are done if results of semen analysis are abnormal, especially if the sperm count is very low. Levels of follicle-stimulating hormone (which stimulates the testes to produce sperm) and testosterone are measured. If the testosterone level is low, luteinizing hormone (which stimulates the testes to produce testosterone) and prolactin (which stimulates milk production in men and women) are measured. A high level of prolactin suggests that the cause of infertility may be a pituitary tumor or use of certain medications.

Genetic testing is done if doctors determine that there are too few or no sperm. For genetic tests Genetic Screening Before Pregnancy Genetic screening is used to determine whether a couple is at increased risk of having a baby with a hereditary genetic disorder. Hereditary genetic disorders are disorders of chromosomes or... read more , almost any tissue, including blood, can be used. Tests include chromosome analysis (called karyotyping). The polymerase chain reaction Polymerase chain reaction (PCR) Genetic diagnostic technologies are scientific methods that are used to understand and evaluate an organism's genes. (See also Genes and Chromosomes.) Genes are segments of deoxyribonucleic... read more (PCR) may to used to produce many copies of a gene or segments of a gene, which makes studying the gene much easier. Doctors check for the gene that causes cystic fibrosis Cystic Fibrosis (CF) Cystic fibrosis is a hereditary disease that causes certain glands to produce abnormally thick secretions, resulting in tissue and organ damage, especially in the lungs and the digestive tract... read more . Before a man with this gene mutation and his partner attempt to conceive, the partner should also be tested for the gene.

Clomiphene Clomiphene Women may have infertility if the ovaries do not release an egg each month, as usually occurs during a menstrual cycle. Ovulation problems can result from dysfunction of the part of the brain... read more , a medication used to stimulate (induce) ovulation in women, may be used to try to increase sperm counts in men. However, whether clomiphene improves the sperm’s ability to move or reduces the number of abnormal sperm is unclear. It has not been proved to increase fertility.

If sperm count is low or if clomiphene is ineffective, the most effective treatment is usually in vitro fertilization In vitro (test tube) fertilization (IVF) Assisted reproductive technologies involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. (See also Overview of Infertility.) If treatment... read more , often with intracytoplasmic sperm injection Intracytoplasmic sperm injection Assisted reproductive technologies involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. (See also Overview of Infertility.) If treatment... read more (the injection of one sperm into one egg)—an assisted reproductive technology Assisted Reproductive Technologies Assisted reproductive technologies involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. (See also Overview of Infertility.) If treatment... read more .

An alternative is intrauterine insemination Intrauterine insemination Assisted reproductive technologies involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. (See also Overview of Infertility.) If treatment... read more (placing semen directly in the uterus) using only the most active sperm. The most active sperm are selected by washing a semen sample. Doctors try to place these sperm in the uterus at the same time as ovulation. With this procedure, pregnancy usually occurs by the sixth attempt if it is going to occur. Intrauterine insemination is far less effective than in vitro fertilization but is much less invasive and less expensive.

Doctors can sometimes identify and retrieve a few sperm for intracytoplasmic sperm injection by doing a biopsy and examining the sample with a microscope to find the sperm. If no sperm are found, inseminating the woman with sperm from another man (a donor) may be considered. Because of the danger of contracting sexually transmitted infections, including infection with human immunodeficiency virus Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS). HIV is transmitted... read more (HIV) and hepatitis C Hepatitis C, Chronic Chronic hepatitis C is inflammation of the liver that is caused by the hepatitis C virus and that has lasted more than 6 months. Hepatitis C often causes no symptoms until after it has badly... read more , fresh semen samples from donors are no longer used in the United States. Risk of disease transmission is minimized by freezing donor sperm for 6 months or more, then retesting donors for infection. If their test results remain negative, the sample is thawed and used. Semen collection is postponed for 3 months if donors have been infected with the Zika virus Zika Virus Infection Zika virus infection is a mosquito-borne viral infection that typically causes no symptoms but can cause fever, rash, joint pain, or infection of the membrane that covers the white of the eye... read more or if donors have lived in or traveled to an area where the Zika virus is being transmitted.

The partner of a man who has fertility problems may be treated with human gonadotropins Human gonadotropins to stimulate several eggs to mature and be released while in vitro fertilization or intrauterine insemination is being tried. This approach may make pregnancy more likely.