Overview of Male Infertility
About 25% of all infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the main cause, or a contributing cause.
It can be hard to determine whether the sperm problem is the only cause, or just a contributing cause to infertility. We know that men with very low sperm counts can sometimes have children - and some men with normal sperm counts can be infertile.
Male infertility treatments begin with testing, analysis and diagnosis of the cause to restore fertility.
Examination & Testing
Physical Examination & History
Semen Analysis
SCSA Testing
Genetic Testing
Diagnostic Tests
Physical Examination & History
Before starting any treatment, a physical examination of the male partner is performed in addition to a thorough evaluation of the patient’s history and habits.
Semen Analysis
Our semen analyses are performed in a laboratory using a semen sample collected from the patient within the past hour. For accurate diagnosis, we ask the patient to abstain from sexual activity for two to five days preceding the collection. The analysis will give information about the following criteria determining male factor:
- Volume (amount of ejaculate)
- Concentration (sperm count)
- Motility (ability to move)
- Morphology (size and shape)
- Clumping
- Presence of white or red blood cells
- Hyperviscosity (thickening of seminal fluid)
We recommend to have the semen analysis performed by one of the following laboratories:
Fertility Center of California - San Diego Office
Cost for complete semen analysis (CSA): $110 (As of 05/01/2006)
6475 Alvarado Road, #109
San Diego, CA 92120
Ph: 619-265-0102
Web: www.fertilityctr.com
Email: info@fertilityctr.com
Quest Diagnostics (formerly also UniLab locations)
Quest Diagnostics has over 30 locations in the San Diego area. Call for the location nearest you: 1-800-848-4225
or go to www.questdiagnostics.com and select "Patient Service Centers"
Dr. Bastuba offers interpretation of Sperm Chromatin Structure Assay (SCSA®) testing to his patients. SCSA® testing evaluates the level of DNA fragmentation in sperm, which is not detected by a conventional semen analysis (SA). Even sperm that appears to be normal in a routine SA may have extensive DNA fragmentation. Couples that have been idiopathic infertile for years and have shown high DFI values have then turned to a sperm donor with success.
During a semen analysis, human eye measurements of the outside shape of sperm are taken. This sperm morphology is like the outside shape of an airplane and may relate to how easily it moves through a substance. SCSA® looks at the “cargo” inside the plane and how the DNA integrity may relate to early embryogenesis that has been shown to be associated with miscarriages.
These heart-breaking events can have a significant impact on the overall success rate for couples undergoing IVF. Extensive research is now ongoing in this country and throughout the world to further determine the relationship to abnormal SCSA® testing and fertility potential in various situations. While this testing is ongoing most authorities already agree that it is likely to be an important test for the future and it will become more useful as more information is gathered. For more information go to www.SCSAdiagnostics.com.
While it is not currently the standard of care, many IVF programs are looking at this information closely before proceeding to IVF in couples. As the DFI is elevated, sometimes male-side evaluation is warranted to see if the DFI can be lowered beneath what is felt to be the statistical threshold level of ~30%. A DFI of <15% has been shown to provide the highest fertility potential.
SCSA® Testing vs. Semen Analysis
The SCSA® test does not replace the traditional semen analysis, but rather complements it with additional information. The principle of the SCSA® is that a DYA dye, acridine orange, binds to fragmented DNA and produces a red color while sperm without DNA fragmentation are green in color. SCSA® testing is done by passing 5,000 sperm through a narrow glass channel intersected by a laser beam. The laser beam causes the sperm to produce a green to red color. The nature and extent of sperm DNA fragmentation is determined by two independent measurements of the same semen sample. The precision of measurements is extremely high with only a variation of ~1% between measurements. The details of the SCSA data are calculated by SCSAsoft® software specifically designed to handle such a large amount of complex data. The two primary measures are: 1) % DFI, i.e., the percent of sperm with fragmented DNA. At this time from data accumulated on thousands of semen samples, a statistical threshold level of 30% DFI has been set. If a man has >30% DFI, he is placed into a statistical group of men that have been shown to take a longer time to natural pregnancy, more IVF cycles or more embryos transferred per cycle, a near doubling of spontaneous miscarriage rate or no pregnancy. Thus, samples above 30% DFI does not preclude a full term normal pregnancy, but it provides an indicator for increased patient management to maximize a pregnancy. 2) High DNA stainable (HDS) sperm. These sperm are immature sperm that have some irregularities that inhibit fertilization in vivo or routine IVF. A high percent of such sperm in a semen sample may suggest the use of ICSI for maximizing as pregnancy.
Sperm Chromatin Structure may be altered by various abnormalities such as varicoceles, poor nutrition, life-style activities such as smoking, hot tub use, poor nutrition, heat to testis, air pollution, exposure to pesticides, various prescription or over the counter medications, high fever and diseases such as cancer. The DFI may also be elevated by infections of the prostate and epididymis. Therefore Dr. Bastuba often recommends both semen analysis and SCSA® Testing since the tests analyze different aspects of the sperm and may lead to a more effective diagnostic and therapeutic regiment.
What to do with a high DFI?
A high DFI can sometimes be lowered through adjusting to a healthier lifestyle. There is also evidence that nutritional supplements, especially antioxidants, may lower a high DFI. Often, interventions such as antibiotic therapy for prostatitis, varicocelectomy, and discontinuation of thermal insults such as hot tubs use will lower DFI for higher fertility potential. In addition, use of medications that may adversely affect sperm should be discontinued if found to be present. Exposure to chemicals such as pesticides or chronic low-grade exposure to radiation are other potential causes of a high DFI.
Genetic Testing
Genetic factors may interfere with the reproductive processes by affecting either the number or quality (or both) of sperm production and may affect the structure or function of the male reproductive tract. At this time, only a limited number of genes are available for diagnosis. The identification of any genetic defect provides important, and possibly definitive, information about the cause of male infertility. In addition, patients who are considering in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) can be counseled about the risk of passing on genetic defects to their offspring. Detection of any of these genetic abnormalities will allow us to better diagnose and treat causes of male infertility.
Testicular Biopsy
Testicular biopsy involves taking a small piece of tissue from the testis while the man is under either local or general anesthetic. The tissue is carefully prepared and assessed under a microscope to determine the presence of sperm-producing cells and whether the sperm production process is normal. In a man with a zero sperm count, this test is done to determine if a blockage is present or if poor sperm production is the cause. In men with severe sperm production problems, this test can also determine whether small areas of sperm production are present in the testis, in which case sperm from the biopsy tissue may be used in infertility treatment. Even just a few normal sperm found in the biopsy tissue can be used in the assisted reproductive technique called intracytoplasmic sperm injection (ICSI) where a single sperm is injected into the egg by piercing the shell of the egg.
There are two types of testicular biopsy procedures:
A needle biopsy is a technique that can be performed under local anesthesia that involves passing a small needle into the testis to obtain a sample of tissue about half the size of a match head.
An open biopsy involves removing a larger fragment of tissue about the size of a couple of grains of rice after cutting through the skin and the thick outer covering of the testis. This procedure is typically performed while the man is under general anesthesia.
Other tests might be necessary such as:
- Strict Sperm Morphology
- Endocrine Tests
- Sperm Penetration Assay (SPA)
- Antisperm Antibody Measurement
- Vasography
- Scrotal Ultrasonography or Venographys
Male Fertility Specialists
6699 Alvarado Road, Suite 2207
San Diego, CA 92120
(619) 286-3520
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