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Male Infertility
In 40-45% of couples experiencing difficulty conceiving, pregnancy does not occur due to factors related to the male partner. While some problems identified in men, such as hormonal causes like hypogonadotropic hypogonadism and anatomical causes such as blocked sperm ducts, can be corrected with treatment, other problems have no chance of improvement. However, in many cases pregnancy can still be achieved with treatment.
In evaluating the male partner, a detailed history is taken first. This history covers the frequency and timing of intercourse, illnesses experienced in childhood or later in life (such as mumps), chronic conditions (diabetes, lung disease, etc.), previous surgeries (vasectomy), any history of sexually transmitted disease, occupational exposures, and the use of toxic medications.
Sperm evaluation is carried out in the laboratory through what we call a spermiogram, or sperm analysis. Sperm analysis is performed by masturbation after 3-5 days of sexual abstinence. The semen sample obtained is collected in a sterile container and examined under a microscope. Count, motility, and the proportion of normal morphology are all important in sperm analysis. Since sperm production takes 6-8 weeks, this length of time must be allowed to pass before a second analysis is performed.
World Health Organization
Fluid volume: between 1.5 and 5ml
Sperm concentration: at least 15 million/ml
Total motility: over 40%
Progressive motility: 32%
Normal morphology: over 4%
If an abnormality is detected in the sperm analysis;
Detailed physical examination: During this examination, testicular size, blockage or dilation of the sperm ducts, and the presence of redness or a mass are evaluated.
Hormonal evaluation: Sperm problems due to low hormone levels are not commonly encountered. However, in cases of azoospermia (no sperm at all in the semen) and reduced sexual desire (decreased libido), blood levels of FSH, LH, testosterone, and prolactin should be checked.
Ultrasonography: Requested when an undescended testicle or varicocele is suspected.
Genetic Tests: In men with a sperm count below 5 million/ml on analysis and in those found to have azoospermia, genetic blood tests (peripheral karyotype analysis) must always be performed. Structural/numerical chromosomal problems are found in 2.5% of men with a severe count/motility problem on sperm analysis, and in 10-12% of men with azoospermia.
The genetic tests that can be performed in men in the risk group can be listed as follows:
Peripheral karyotype (basic genetic code)
Y chromosome microdeletion (partial or complete loss of the genes located on the Y chromosome that control sperm production)
Cystic fibrosis gene mutation (the presence of a faulty gene structure carrying cystic fibrosis)
Sperm FISH (determining the rate of chromosomal anomalies in the sperm in a semen sample)