Generally semen analysis is performed following 2-5 days of abstinence for proper standardization. The sample is obtained by masturbation. The semen analysis normal values should be considered as the minimal standards of adequacy rather than a perfect test of male fertility. As a matter of fact except for complete absence of sperm (azoospermia) in the specimen, there are still no absolute cut-off values to define male infertility in a strict fashion.
For instance 5% of fertile men may have sperm concentration lower than 20 million/ml. Nevertheless the values below these threshold values may be alarming for further work up and each semen analysis should be evaluated within the context of each couple's history and other findings.
Problems & Solutions
Sperms are produced in the seminiferous tubules of the testes. Hereon, they move to be matured and stored in the epididymis. This process takes approximately three months to complete. During sexual intercourse, sperms are released from the epididymis and travel through the vas deferens where they are mixed with fluids secreted from various glands. This mixture of sperm and seminal fluid (semen) is then deposited in the vagina of the female partner following ejaculation. A hindrance in this process or functional problems with any part may lead to infertility. Male infertility can be caused due to various reasons such as testicular damage, low sperm production or poor quality sperm. They can be compartmentalized as follows:
Problem: Aspermia is the complete lack of semen expulsion (not sperm cells in the semen) at the time of ejaculation. Males with this condition experience the sensation of ejaculation but at the time of its occurrence there is no penile secretion of semen. This condition is mainly caused by retrograde ejaculation or ejaculatory duct obstruction. Treatment: While there is oral medication available for Aspernia, the success rates are extremely low and can take a prolonged period of time to determine any improvement. It is best for such individuals/couples to choose donor sperms for successful conception.
Problem: Reduced sperm motility refers to a condition known as Asthenozoospermia (or asthenospermia). Sperm motility is the ability of the spermatozoa to move towards the egg – a vital criteria for reproduction. A condition of complete asthenospermia exists when the sperm in the ejaculated semen is 100% immotile. This could be triggered by metabolic deficiencies, testicular injuries, lifestyle habits such as smoking, etc.
Treatment: The best solution for successful conception when the male has Asthenospermia is to opt for Intracystoplasmic Sperm Injection (ICSI). ICSI is very similar to IVF treatment, whereby the male partner receives fertility drug injections. This is a commonly practiced method for male infertility problems. An alternate option is also to accept donor sperms for fertilizing the female partner’s eggs
Problem: Azoospermia is a condition whereby there is complete absence of sperm in the ejaculated semen. This could be due to non-production of sperm in the testes (Non-Obstructive Azoospermia) or non-deliverance of produced sperm during ejaculation (Obstructive Azoospermia). Lack of sperm production may be due to hormonal problems, testicular failure or varicocele. While sperm delivery problems may be due to ductal absence or blockage.
Treatment: The problem may sound grave but it is treatable in most of the cases. The cause of Azoospermia is detected through Biopsy and treatment is rendered accordingly. Cases of obstruction are repairable through micro-surgical or endoscopic reconstruction. Conception in cases of non-obstructive Azoospermia is mostly possible only by sperm retrieval through Assisted Reproductive Technology (unless it is due to some reversible and correctable condition).
Erection and Ejaculatory Problems
Problem: Two major sexual problems faced by men are associated with erectile dysfunction or difficulty in ejaculation. Erectile dysfunction is the term for difficulty attaining or maintaining an erection. Ejaculatory problems pertain to the inability to ejaculate semen at the right point of time. The ejaculation could be delayed, early or retrograde. While these problems are physical and very common, they also have psychological implications on the effected male or couple
Treatment: Depending on the problem being faced by the individual, varied treatments can be proffered upon the patient. This could entail medicinal courses, therapeutic healing or a combination of both. A more feasible approach in certain cases may also be resorting to methods such as Intra Uterine Insemination (IUI).
Problem: It refers to a condition in which there is low concentration of sperm in the semen. Examination of the semen may also display abnormalities in the morphology and motility rate of the sperm. A reassessment by the World Health Organization (WHO) has corrected the definition of low sperm count from 20 million/ml of less than 15 million/ml. There are range references to classify the level of Oligospermia:
Mild: 10-15 million sperms/ml
Moderate: 5-10 million sperms/ml
Severe: <= 5 million sperms/ml
Treatment: Sperm concentration can be improved with medical or surgical correction. However, the best option for males with this condition is Intrauterine Insemination. In Vitro Fertilization (IVF) or Intra-cytoplasmic sperm injection (ICSI) can also be looked at as a viable option in case of fertility problems in both partners.