What Are Male Factor Issues?

When a physician informs a patient that he has male factor issues that are contributing to a couple’s infertility many people leave that conversation extraordinarily confused.

So really what are male factor issues?  They are subtle and sneaky because they often go undetected.  Why do they go undetected?  Because they are often not evaluated until enough time has gone by with a couple actively trying to conceive.  Male factor issues don’t normally have outward symptoms or signs that indicate there’s anything amiss or wrong.

Did you know that almost half of infertile couples around the world have some sort of male factor issue that’s impairing their fertility?

You might think that obtaining a sperm count is the way to detect male factor issues but really that’s not accurate.  Sperm counts while a good way to tell a patient what their actual count is can’t tell you what a semen analysis will tell you.  A semen analysis will tell you how sperm are actually formed and their ability to actually fertilize an egg.

For you guys who haven’t ever been required to give a semen sample it’s quite simple.  Your doctor or your lab will instruct you on their protocol but really it’s easy.  Typically, a semen sample or semen collection will require masturbation and collection of the semen being tested in a sterile container the lab will give you.  Most of the time semen samples are collected in a designated room at your fertility clinic – however, if you live close enough to your fertility clinic and can transport your semen collection within an hour then some men choose to perform the collection in the privacy of their own homes.

Results are typically ready within 2-3 days depending on the lab processing the sample.

You might be wondering what this all might mean – counts, morphology, concentration, motility etc., below you will find a chart that shows normal and variable values for semen analysis.

If you find that you have a low volume in regards to semen that might indicate that you have a blockage somewhere in one of your accessory glands, ducts, or it could mean that a complete sample wasn’t provided – meaning you missed getting all of your “stuff” in the container – and sometimes that happens due to performance anxiety – regardless keep the lines of communication open with your clinic in the event you need to retest.  The accuracy of your results is important.

When doctors talk about concentration of sperm or density that means the number of sperm per milliliter of the sample, anything below 20 million per sample is low.  Please don’t panic – slow sperm counts are very common in couples with male factor issues.  Typically it’s not the only problem it generally it’s found to be part of a combination with other issues.

Motility means simply how well sperm are swimming around. A normal sample will show that 50% or higher of the sperm are swimming rapidly and pretty much in a straight line.  We don’t want sperm swimming in circles.  If sperm are slow and lazy and not moving really in any direction that’s not good either – again we want them swimming quickly and in a straight line honing in on the awaiting egg.

The other piece to this that’s incredibly important is what labs refer to as “morphology” – some labs get a bad rap because the industry sometimes thinks this is often ignored so heads up as I explain morphology 101.

A sperm is technically a “sperm cell” and consists of a head with a cap (referred to as an acrosomal cap), then there’s the middle or the mid-piece and finally the tail that looks like a miniature whip.  Think of the tail as a fin or a propeller.  It helps the sperm swim in that fast and rapid motion we like to see in the lab.  Not all sperm are created a like – some have a tail that’s bent, crooked, or shaped in an abnormal way.  When sperm are formed like that they aren’t going to swim and more often than not – not fertilize the egg. The middle of sperm or the mid-piece is commonly referred to at the engine room of sperm.  Why is that?  Because the mitochondria provides all the energy for cell function of sperm, and last but not least is the head of the sperm or the acrosomal cap – this piece has all the information needed to make a baby. Many refer to the head of the sperm as a detonator as the sperm will unite with the egg to create life.

I am sure you’ve all seen photos of sperm fertilizing an egg, not only does it look easy, it’s fascinating.  In order for the chromosomes of the sperm to get to chromosomes of the egg, they must enter the egg.  That’s why the acrosomal cap or the head of the sperm is vital. The head of the sperm contains special enzymes that change the sperm cell membrane that cover the head of sperm. When the sperm cell membrane changes due to the acrosomal reaction the real action can take place and the sperm cell marries the egg cell membrane which creates a perfect opening for sperm chromosomes to enter the egg.

This is why it’s important to have morphology included in a semen analysis.

There are several tests that are performed during a semen analysis that are incredibly important to detect male factor issues.  Aside from sperm function there are tests that can determine if a single sperm has the capability of entering the egg.  This is called “Sperm Penetration Assay” If for instance the head of a sperm is not covered appropriately by the acrosomal cap then it can’t penetrate an egg appropriately and fertilization will not occur.

Below is a list of other tests that examine the male side of things?

  • Sperm agglutination: A laboratory test involving the examination of sperm under a microscope to determine if the sperm are clumping together. Clumping prevents sperm from swimming through the cervical mucus.
  • Sperm penetration assay: A laboratory test utilizing hamster eggs to evaluate a sperm’s capability of penetrating the egg. This test is rarely used.
  • Hemizona assay: A laboratory test in which a non-usable human egg is cut in half. The purpose of the procedure is to see if the sperm are able to penetrate the outermost protective layer of the egg.
  • Acrosome reaction: A laboratory test that helps determine if sperm heads are able to go through the chemical changes necessary to dissolve an egg’s tough outer shell.
  • Hypo-osmotic swelling: A laboratory test that uses a special sugar and salt solution to evaluate the sperm’s tail and ability of the sperm to penetrate the egg. The tails of healthy sperm tend to swell in the solution in contrast with dead or abnormal sperm where the tails do not swell.
  • Testicular biopsy: A small piece of tissue is removed from the tubules in the testes and examined to determine how well sperm are being produced.
  • Vasography: An x-ray exam is used to determine if there is blockage or leakage of sperm in the vas deferens.
  • Ultrasonography: An exam used to locate damage or blockages in the male reproductive tract, including the prostate, seminal vesicles, and ejaculatory ducts.

The good news is that the treatment of male factor issues is advancing every day.  In the old days all physicians could offer men with male factor problems was using donor sperm.  But now days the options are many and hope in many cases is restored.

 

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