It constitutes approximately 40-50% of the couples who apply with the complaint of infertility due to the male factor. Therefore, the man should also be examined. In particular, it should be evaluated whether the testicles are located in the normal sac, their dimensions, the presence of a history of surgery for the undescended testicle, the presence of varicocele, whether he had surgery for varicocele, whether he had mumps in adulthood, and whether sexual intercourse is normal.
How does the male reproductive system work? Click to watch.
Semen is formed by mixing the sperms produced in the testicles, the liquids secreted from the prostate and some glands. Sperm production occurs as a result of a process that takes about 75 days. For this reason, the drugs that the man has used in the last 75 days and the toxic substances (such as cigarettes) to which he is exposed can affect the quality and number of sperm. For this reason, it is necessary to perform a sperm analysis test 2-3 times at 2-3 month intervals before the definitive diagnosis.
|Causes of Infertility||Ratio(%)|
|No reason can be given||48.5%|
|Unexplained defective sperm||26.4%|
|immune system disorders||3.1%|
|Congenital (genetic) disorders||2.1%|
InfertilityTests to detect causes:
Sperm analysis is the most important test in determining the causes of male infertility. Since the sperm analysis test is a cheap, easy and effective test, it is a test that should be done in the first place. It should be given after 3-6 days of sexual intercourse. A sterile container is given by the laboratory where sperm analysis will be carried out and semen is given to this container by masturbation method. No lubricant should be used during masturbation. If possible, semen should be given in special rooms within the laboratory. The process of giving semen can put a man in a very stressful situation. For this reason, problems such as erection problems can be seen normally during the semen delivery process. In such cases, the husband of the man can help or if there is an erection problem, drugs such as Viagra can be used. In some cases, semen delivery can be done at home. However, the semen should be brought to the laboratory within a maximum of 1 hour in the appropriate temperature range (body temperature).
What is the structure of sperm? Click to watch.
How is sperm analysis (evaluation) done? Click to watch.
|Semen Volume (ml)||1.5-7 ml|
|Sperm Count (Million/ml)||Sperm Count (Million/ml) >20 Million|
|Motile Sperm Rate (%)||>50%|
|Forward Motile Sperm Ratio (%)||>25%|
|Number of Cells of Rounds (Million/ml)||> <5 Million|
|Leukocyte Count (Million/ml)||<1 Million|
|Shape (according to Kruger classification)||>14% Normal 4–14% Subfertile <4% Infertile|
|aspermia||absence of semen|
|Oligospermia||Low sperm count in semen|
|Azoospermia||Absence of sperm in the semen|
|asthenospermia||Fewer motile sperm|
|teratospermia||Fewer normally shaped sperm|
|necrospermia||Absence of viable sperm in the semen|
|leukocytospermia||Presence of white blood cells in the semen|
|hematospermia||Presence of blood cells in semen|
|Globozospermia||Presence of sperm without acrosome|
Detection of normal sperm values is usually a sufficient indicator of the absence of the male factor. However, in abnormal cases, it is necessary to perform a sperm analysis test 2-3 times at 2-3 month intervals before the definitive diagnosis.
Raretests used as
Sperm analysis is usually sufficient to evaluate male infertility and no further testing is required. The following tests are done very rarely.
mixedAgglutination Reaction Test
A test in which the presence of antisperm antibodies is detected. It has no place in routine clinical practice.
FSH, LH and testosterone values can be measured in men with azoospermia. While FSH is normal in patients with obstructive azoospermia, FSH is elevated in non-occlusive azoospermia. If the FSH value is low, problems in the pituitary gland in the brain should be considered.
It has no place in routine clinical practice.
In patients with no sperm in the semen (azoospermia), a biopsy can be performed from the testis by surgical application and it can be determined at what stage sperm production is interrupted. However, today, biopsy is definitely not recommended, except for the biopsy performed during IVF. With the biopsy performed in patients with azoospermia, the testicular tissue, which is very valuable, is removed and even if sperm is found in this tissue, it cannot be used at this stage. For this reason, instead of performing a biopsy in patients with azoospermia, it is most appropriate to prepare the spouses of these patients for in vitro fertilization and to apply one of the sperm retrieval methods (TESE, TESA) to the patient with azoospermia, and to perform microinjection directly if sperm comes out. Excess tissues can be sent to pathology for examination. If it is necessary to repeat, testicular biopsy is definitely not recommended except for in vitro fertilization.
Click for methods of obtaining sperm from men
It may be needed to determine whether there is a varicocele or hydrocele.
It should be done in cases with azoospermia or very low sperm count. Chromosome analysis of the male and whether he has a Y microdeletion should be determined.
Treatment is planned according to the degree of male problem. In severe problems, in vitro fertilization with microinjection is necessary, while in mild cases, vaccination is done first. If the success of the vaccination treatment is not achieved, in vitro fertilization treatment should be started.
Surgical removal of varicocele should only be performed in the presence of pain and when it deteriorates the aesthetic appearance. Although removal of varicocele due to infertility slightly increases sperm values, it does not increase pregnancy rates. In the presence of varicocele, treatment is usually vaccination or IVF.
Please click for detailed information about varicocele.