Testing for Male Infertility

Infertility testing begins with the male because it is less complicated than the female. Sperm count is not the only factor that causes male infertility. Men with low sperm counts can sometimes have children and some men with normal sperm counts can find themselves infertile. Initially a physical examination is done to check for testicular irregularities, hormonal disorders or testosterone deficiency. This is followed by an assessment of reproductive fertility history. If a sperm appears abnormal because of distortion or multiple heads or tails, then there are chances of infertility. A semen may also lack sperms because of the absence of sperm-producing tissues in the testes or an obstruction. This problem is called azoospermia.

A semen analysis is used to test the complete ejaculation. The semen is usually collected at home after refraining from ejaculation for 2 to 3 days. The semen must be presented to the lab in an hour's time for analysis. Any problem in the seminal fluid can affect the sperm functioning and movement. If the fluid is very thick, the sperm movement towards the cervical mucus slows down. This obstructs the fertilisation process.Three samples of semen are taken at different intervals and checked for the following:

• Concentration of sperms

  - number of sperms per millimetre.

• Morphology or appearance of sperms

  - More than 14% of sperms must have normal shape and structure.

• Mobility or motility of sperms and % of sperm movement

  - 50% of the total number of sperms.

• Progressive motility or % of sperms moving rapidly

  - 25% of the total number of sperms.

• Total motile count

  - total number of sperms that are moving.

• Volume of ejaculation

  - 40 million sperm per ejaculate.

• Consistency

  - The seminal liquid should not be very thick.

The sperm mucus test or bovine cervical mucus test is used to check if the sperm is capable of moving through the female reproductive tract. The ability of the sperm to do so is called forward progression. The day after intercourse during a mid cycle, the woman's mucus is checked for the following:

• Enough semen for fertilisation have moved to the cervix.
• Sperms are healthy and have life.
• Sperms are moving actively through the cervical mucus.

If either the man's sperm or a donor sperm cannot pass through the cervical mucus, the problem may be with the woman. However if the donor sperm alone is able to pass through the cervical mucus, there may be some problem with the man's sperm.

The sperm viability or sperm survival test is used to check the movement capability of the sperms. The sperms are washed and cultured in a laboratory incubator for a day. After this, they are checked under the microscope. If the sperms are swimming actively, this means that they can survive in vitro for this period. If none of the sperms are alive after 24 hours, they may be functionally incompetent.

The immunobead or antisperm antibody test analyses semen for the presence of antibodies that damage the sperms. Some men have antibodies against the sperm, which immobilize or kill them and prevent them from swimming up towards the egg. You can test for the antibodies in the seminal liquid and also your partner's cervical mucus. Various laboratories carry out this test in different ways.

The sperm penetration assay (SPA) or sperm-oocyte interaction test is used to determine if the sperm is capable of penetrating the egg and fertilising it. However, this test is not available in India.