There can be many reasons for difficulty in conceiving, and these are just as often due to factors relating to the woman as to the man. When looking for the causes of infertility, it is therefore worth focusing on the couple as a whole from the outset, rather than limiting the diagnosis to the woman alone. What are the causes in men, and what types are there? We’ve provided the answers to these questions below!
A general semen analysis provides basic information about semen quality. It involves analysing a semen sample for key parameters, such as sperm count, liquefaction and ejaculate volume. The test also makes it possible to assess a man’s reproductive potential and to accurately diagnose the underlying causes of any fertility problems.
You should abstain from sex for 2 to 7 days prior to the semen analysis. The sample is collected via masturbation and should ideally be provided directly at the INVICTA Clinic, in a special, private room. This will enable us to ensure the best storage conditions, thereby guaranteeing that the sample is of the highest diagnostic quality. It is possible to collect the semen at home, in a sterile container which can be purchased from a pharmacy. In this case, the sample must be delivered to the laboratory within 30 minutes of collection at the latest. It is important that the patient submits all the sample he has managed to collect for testing, as the test also assesses semen volume.
How should the results be interpreted? In 2010, the World Health Organisation (WHO) revised the reference values for the various parameters of a semen analysis. The current values are set out in the table below.
| Parameter | WHO up to 2010 | WHO from 2010 |
| Abstinence | 2–7 days | 2–7 days |
| Liquidation | 30–60 mins | 30–60 mins |
| Volume | 2 ml | 1.5 ml |
| Sperm count in ejaculate | 40 million | 39 million |
| Sperm count per 1 ml | 20 million | 15 million |
| Motility | 50% | 40% |
| Progressive movement (A+B) | 50% | 32% |
| Service life | 75% | 58% |
| Morphology not applicable to general semen analysis |
30% | 4% |
A standard semen analysis does not always provide all the necessary information to determine a man’s fertility. Sperm DNA fragmentation testing allows for a detailed assessment of the quality of the genetic material as a prognostic parameter for the success of fertilisation, the development of a pregnancy and the birth of a healthy child.
Embryos resulting from the fertilisation of an egg by sperm with an abnormal (high) level of DNA fragmentation have a poor prognosis as early as the blastocyst stage (5-day-old embryo). When transferred to the uterus, they implant significantly less successfully, and pregnancies resulting from them are more likely to end in miscarriage, abnormalities and an increased susceptibility of the offspring to cancer.
Elevated levels of sperm DNA fragmentation are associated with infections, fever, increased temperature in the testicular region, smoking, an unhealthy diet, substance abuse, exposure to environmental pollutants, as well as advanced age.
Treatment – or, more precisely, minimising the level of fragmentation – depends on the underlying cause. If the damage to chromatin (the fibrous substance found in the cell nucleus) was caused by oxidative stress, lifestyle changes and a balanced diet may help to reduce the extent of DNA damage. The use of antibiotic therapy in cases of infection should also result in a reduction in the level of fragmentation. The effectiveness of the measures taken should be verified by reassessing the quality of the genetic material 2–3 months after the last analysis.
The ROS test is a comprehensive semen analysis that enables the assessment of oxidative stress levels – that is, a state of imbalance in male reproductive cells – based on just a few drops of sample. In the event of visible abnormalities, the doctor may plan appropriate treatment, including medication, supplementation and dietary changes, aimed at improving the oxidising-reducing potential of the semen. Reducing oxidative stress can have a positive impact on fertility and increase the chances of natural conception. High levels of oxidative stress disrupt the fertilisation process, may adversely affect embryo development, and may also reduce the chances of success in in vitro fertilisation (IVF) treatment programmes.
MSOME (Motile Sperm Organelle Morphology Examination) is an advanced examination of the morphology of motile sperm at high magnification. It enables the detection of vacuoles (a type of defect) in the heads of male gametes and the determination of their size. This is because there is a link between the presence of vacuoles and damage to nuclear chromatin (the substance filling the cell nuclei of male gametes). Large vacuoles may suggest abnormalities in the semen or DNA damage. The test is carried out, amongst other things, to assess a patient’s suitability for the IMSI-MSOME procedure.
The HOS (Hypo-osmotic Swelling Test) is an extended semen analysis which allows for the assessment of sperm viability, as well as an analysis of the structural integrity of their cell membrane. In viable sperm, within a hypo-osmotic environment, water passes through the semi-permeable cell membrane into the interior of the sperm, causing the tail to curl. This reaction is only possible in healthy semen, where the sperm have an intact cell membrane.
The SOME+HOS extended semen analysis is carried out under very high magnification. It involves assessing the morphology of the sperm head and its internal structures, as well as observing the reaction of the tail in a hypoosmotic environment. SOME+HOS male fertility tests are carried out, amongst other things, to assess a patient’s suitability for in vitro fertilisation.
The HBA test enables the quality of sperm and their degree of maturity to be assessed. The procedure involves binding the male gametes to hyaluronic acid (hyaluronan). As this substance is present in significant quantities in the environment surrounding the egg, the ability of sperm to bind to hyaluronan is extremely important from the perspective of fertilisation. Analyses also show a link between this process and the morphology and quality of male genetic material.
The hyaluronan binding test can be carried out on sperm that demonstrate normal motility, provided there is an adequate sperm count in the semen. It is recommended in cases of suspected idiopathic infertility (of unknown origin) and where further diagnostic investigation is required prior to any further medical intervention.
Sperm used in in vitro fertilisation require appropriate preparation. The process of isolating sperm from semen involves: separating them from the seminal plasma (semen), removing substances that inhibit their ability to fertilise, initiation of processes that facilitate fertilisation of the egg, selection of sperm with normal morphology and motility, and the removal of bacteria and viruses. This enables us to obtain healthy male gametes – with no damage to the genetic material.
The most commonly used method is separation via centrifugation in a discontinuous Percoll gradient (Density Gradient Centrifugation), which allows a homogeneous population of normal sperm to be obtained and separated from the other morphological components of the semen. This method also carries a negligible risk of sperm loss when sperm numbers in the ejaculate are low. The isolated sperm are used in the insemination process via the procedure of intracytoplasmic sperm injection (ICSI).
A diagnostic testicular biopsy is a procedure involving the removal of a tissue sample for histopathological examination. The procedure is carried out via percutaneous fine-needle aspiration (by suctioning fluid) or by open surgery. The biopsy is carried out under general or local anaesthesia. The sample is examined for the presence or absence of spermatogenic cells and sperm. A testicular biopsy is most commonly performed in cases of azoospermia (absence of sperm in the semen) to differentiate between azoospermia caused by obstruction and azoospermia without obstruction of the seminal ducts. Sperm retrieved via testicular biopsy can be used in in vitro procedures.
At the INVICTA Clinic in Wrocław, patients have access to an advanced testicular biopsy method – Micro-TESE. We are one of the few centres in Poland to use this procedure. It is an innovative modification of the classic open (surgical) biopsy, which utilises a microsurgical loupe or surgical microscope, significantly increasing the precision of the procedure. As a result, the chances of finding sperm are 1.5 times higher compared to the standard procedure. Micro-TESE requires specific skills and specialist facilities. At our clinic, the procedure is performed exclusively by experienced doctors.
The hormone AMH (Anti-Müllerian Hormone) is present in the serum of both women and men. In men, unlike in women – where AMH is only detected after puberty – it is present from infancy. Once boys reach sexual maturity, AMH is found mainly in semen. It is considered a marker of the functional maturity of Sertoli cells in the testicles and of the development of spermatogenesis (the formation and maturation of sperm).
The indication for an AMH test in boys is a suspicion of congenital defects of the reproductive system, which may lead to infertility or sterility in the future. In adult men, anti-Müllerian hormone levels are usually checked to assess the effectiveness of treatment for testicular cancer or to rule out a recurrence of the disease.
Prolactin, also known as lactotropin, is a hormone produced mainly in the pituitary gland. It performs over 300 functions in the body, including influencing the proper functioning of the reproductive system, regulating the immune system, and affecting behaviour and well-being. In men, it stimulates the testicles to produce testosterone. Too low a level of prolactin can cause erectile dysfunction and ejaculatory disorders, a deterioration in semen quality and a reduction in androgen levels. Conversely, excessively high levels can negatively affect libido and lead to the development of various other disorders, such as gynaecomastia (enlargement of the breast glands in men) or osteoporosis.
The basic fertility test for men is a semen analysis, also known as a spermiogram or seminogram. When determining the cause of infertility, it is necessary to carry out additional hormonal tests and genetic tests. INVICTA Laboratories were the first in Poland to introduce modern fertility tests for men, enabling a comprehensive and advanced assessment of semen. Thanks to these tests, we are able to identify the cause of conception problems more efficiently and quickly, and then take the appropriate steps to help infertile couples in their efforts to conceive.
