Male Infertility

Various sperm production disorders can lower male fertility. Sperm production may be impaired or completely absent or the sperm’s motility may be poor.

Semen analysis shows the fertility of the semen

Investigation of male infertility usually begins with a semen analysis from a semen sample aimed at determining the man’s ability to conceive. Felicitas Mehiläinen’s sperm laboratory analyses the sperm count, sperm motility, structure and possible antibodies from the sample.

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Semen disorders may be congenital or transient. Infections, various pharmaceutical substances, heavy alcohol consumption, stress or other temporary factors may strongly affect sperm production and, therefore, any abnormal findings must be controlled before further examinations.

Male infertility can be caused by an undescended testicle that is corrected too late, as sperm production can only occur at a lower temperature than the body temperature. Other causes of poor semen quality include varicose veins in the testicle, antisperm antibodies as well as any diagnosed genital disorders, such as chlamydia, in the man’s medical history.

Male fertility starts declining if there are fewer than 15 million sperm per millilitre of semen. In some men, the semen contains no sperm. If there are fewer than 10 million sperm per millilitre, additional examinations are carried out. These additional examinations include blood tests, an ultrasound examination of the scrotum and, if necessary, a tissue sample from the testicle to verify the complete absence of sperm.

Unhealthy lifestyles undermine male fertility

Smoking, alcohol, stress and obesity can cause poor male fertility. Smoking reduces the sperm count and motility and decreases the quality of sperm. The results of fertility treatments are also poorer if the man smokes regularly. Heavy alcohol consumption directly affects the testes and reduces sperm production.

Learn more: Effect of lifestyles on fertility

Intense, prolonged stress is accompanied by many hormonal changes that affect metabolism. Consequently, prolonged stress can impair sperm production. In overweight men, abundant adipose tissue forms excess oestrogen, which in turn can inhibit sperm production.

It is recommended to avoid smoking, keep alcohol consumption at a moderate level at most, control normal weight and avoid intense mental and physical stress. It is also important to tell your doctor about the medications you are taking as certain substances can impair fertility. Anabolic steroids used in bodybuilding form a separate group as they inhibit testicular sperm formation very strongly and with long-lasting effects.

Lifestyle changes improve male fertility

Even a small improvement in the quantity and quality of sperm can improve the success of fertility treatment. Even if the reduced quantity or quality of sperm is an indication for micro-injection therapy (ICSI), it is a good idea to prepare for the treatment by adjusting your lifestyles. Some sperm may have lesions that lead to poor male fertility. Corrective treatments are being developed. One of them is antioxidant therapy (vitamin E and C supplementation), which has shown promising results in some cases. With regard to the formation of semen, changes are expected in the case of both lifestyle changes and corrective treatments within 2–3 months, at the earliest.

Rare anomalies behind sperm disorders

In some rare cases, the underlying cause of the sperm disorder may be DNA fragmentation, Y deletion or other chromosomal abnormalities.

Sperm DNA Test

DNA is located in the cells as a strand-like formation. The DNA strand must be intact so that the cell can read the genes located in the DNA strand correctly. If there are breaks in the strand, the reading of DNA and, as a result, the functioning of the cell will be disturbed. The sperm can fertilise the egg even if there is fragmentation in the sperm DNA. However, the fragmented DNA can affect the fertilised cell and the development of the embryo formed from it and cause a miscarriage. Because of this, it is recommended to find out the fragmentation index describing the amount of fragmentation of sperm DNA in cases where the cause of the couple’s infertility has not been determined and there are several failed treatments or miscarriages.

Sperm DNA fragmentation can occur for many reasons. It has been found that cancer and cancer treatments increase the fragmentation of sperm DNA. Also, heavy physical exertion, exposure of the testicles to high temperatures and other environmental and lifestyle factors can increase the DNA fragmentation index. The DNA fragmentation index study examines the proportion of fragmented sperm in the semen sample.

Sperm DNA tests are carried out on a fresh semen sample. If more than 30% of the sperm have fragmented DNA, it will significantly complicate the onset of pregnancy and the risk of miscarriage is higher. If the factor causing the fragmentation cannot be eliminated, the use of donated sperm may be considered. A doctor’s referral is needed for a sperm DNA test.

Y deletion

Several gene regions have been found in the Y chromosome that control sperm formation and the deficiency or deletion of which is associated with a strong decline in or complete absence of sperm production. In most cases, the cause of impaired sperm fertility remains unexplained.

The man’s Y chromosome has a region in which several genes that affect spermatogenesis, i.e. sperm production, are located. This region is called the Azoospermia Factor (AZF) region.

Y deletion is a condition in which there are deletions in the region important for sperm production. There are regions within the AZF region (AZFa, AZFb and AZFc) where the deletions affect sperm production differently.

Klinefelter syndrome

In Klinefelter syndrome, the man has an extra X chromosome. Thus, he has 47 chromosomes, including two X chromosomes and one Y chromosome (47, XXY).

Klinefelter syndrome is often accompanied by a reduced testicular volume, due to which the testes do not produce a normal amount of testosterone and sperm production is impaired. For this reason, most XXY men suffer from infertility. In some cases, however, it is possible that sperm is formed in the testicles and the semen is fertile.

Most XXY men do not know about the existence of an extra chromosome until they start thinking about having a child. Based on the abnormal result of a semen sample analysis, the infertility specialist may order chromosome studies for the patient, in which case the presence of an additional X chromosome can be detected in a cell culture sample. Even if no sperm are detected in the semen sample, in some cases it is possible to look for them in the testicular tissue samples for fertility treatment.