A male cause for a delay in conceiving happens in about one in three couples. In many more there are both male and female reasons behind a delay in conceiving. It is important to check the semen analysis early in the investigation of a couple. The semen analysis or sperm test remains the first and most important investigation for men. Increasingly other investigations are now available and will give more information than a single sperm test.
A semen analysis test is not only a sperm count. It’s important to assess other characteristics including the ejaculate volume, sperm movement and how many normal looking sperm cells there are. In fact most sperm are reported as looking abnormal, something that intuitively feels a bit strange but that is nature! A man will need to abstain from ejaculation for three days prior to the sample. The sample can be produced at home but needs to be processed by the lab within the hour- so a production room is available at the lab. The results of semen analysis take about four days to come back.
A long standing or “chronic” infection of the testicles can cause problems. These can range from minor sperm cells abnormalities to blood in the semen. Specimens (swabs) will help identify the bacteria causing the infection. A course of antibiotics over several weeks is sometimes required. If an infection is identified then it may have been there for some time.
Investigation for Very Low or Zero Sperm Counts
Unfortunately some men will have very low or zero sperm in their ejaculate. I normally recommend retesting the semen count after 6 to 8 weeks in such situations. The reason behind investigating is to try and see if a cause can be found that is treatable (such as low hormone levels), or if sperm can be directly removed from the testicle to be used in fertility treatment. When sperm counts are very low then I would organise hormone and genetic blood tests as well as an ultrasound of the testicles.
Sperm DNA Fragmentation
DNA is the genetic code that instructs our bodies on how to function. DNA is carried in sperm and eggs. At fertilisation a new and unique set of genetic material is created in the early pregnancy. Sperm DNA can be degraded and this may cause problems with natural fertility, fertilisation at IVF and possibly miscarriage. The evidence behind these associations is disputed by some. Sperm DNA fragmentation can be caused by many reasons, including cigarette smoking, infection and a diet low in anti-oxidants. It is possible to measure sperm DNA fragmentation, and further investigation and treatment may be necessary for instance checking for infection.