Male Infertility
In approximately 40–45% of couples who have difficulty conceiving, pregnancy does not occur due to male-related factors. Some male infertility problems, such as hormonal causes like hypogonadotropic hypogonadism or anatomical issues such as blocked sperm ducts, can be corrected with treatment. However, certain conditions cannot be reversed. Despite this, in many cases, pregnancy can still be achieved with appropriate treatment.
The evaluation of the male partner begins with taking a detailed medical history. This includes assessing the frequency and timing of sexual intercourse, childhood or later illnesses (such as mumps), chronic diseases (e.g., diabetes, lung disease), previous surgeries (such as vasectomy), history of sexually transmitted infections, occupational exposures, and the use of toxic medications.
Sperm evaluation is performed in a laboratory setting through a semen analysis, also known as a spermogram. The semen analysis is carried out after 3–5 days of sexual abstinence and is obtained via masturbation. The semen sample is collected in a sterile container and examined under a microscope. Key parameters assessed in sperm analysis include sperm count, motility, and the percentage of normally shaped sperm. Since sperm production takes approximately 6–8 weeks, this interval should be observed before performing a second analysis if required.
World Health Organization (WHO) Reference Values
Semen volume: 1.5 to 5 ml
Sperm concentration: at least 15 million/ml
Total motility: over 40%
Progressive motility: 32%
Normal morphology: over 4%
If abnormalities are detected in the sperm analysis:
Detailed physical examination: During this examination, testicular size, obstruction or dilation of the sperm ducts, redness, or the presence of masses are evaluated.
Hormonal evaluation: Sperm problems due to low hormone levels are uncommon. However, in cases of azoospermia (absence of sperm in semen) and decreased sexual desire (low libido), blood levels of FSH, LH, testosterone, and prolactin should be assessed.
Ultrasonography: Requested in cases of suspected undescended testis or varicocele.
Genetic tests: In men with sperm concentrations below 5 million/ml and in those diagnosed with azoospermia, genetic testing (peripheral karyotype analysis) must be performed. Structural or numerical chromosomal abnormalities are detected in approximately 2.5% of men with severe sperm count/motility disorders and in 10–12% of azoospermic men.
Genetic tests that may be performed in men in the risk group include:
Peripheral karyotype analysis (basic genetic profile)
Y chromosome microdeletion analysis (partial or complete loss of genes on the Y chromosome responsible for sperm production)
Cystic fibrosis gene mutation testing (presence of defective genes associated with cystic fibrosis)
Sperm FISH (determination of chromosomal anomaly rates in sperm cells within the semen sample)