July 17th, 2024 | 5 min. read
Ask Monica is a Q&A video series hosted by Nurse Practitioner Monica Moore.
In this article:
Unpacking everything you need to know about sperm function and health, as well as what’s involved with fertility testing for men.
Understanding Male Factor Infertility
Monica Moore:
Hi, everyone. Monica Moore, nurse practitioner at Illume Fertility, and in this edition of Ask Monica, we are going to be talking about male factor infertility.
This topic is important to talk about, especially when it comes to heterosexual couples. In up to 50% of infertility cases, the male partner is either the sole source of or a partial contributor to the couples' challenges conceiving. Because of this, it's incredibly important that the male partner also gets evaluated early on.
Infertility has historically been viewed as simply a "women's issue," when in reality, the male partner's fertility is key to the entire process.
If there is a male infertility factor, we have to determine if it's mild, moderate, or severe, based on semen analysis results and a couple of other things. When there is a more severe male fertility issue, the female partner's treatment plan is often adjusted accordingly, regardless of what they may have going on themselves.
What causes male factor infertility?
We don't always know the reason for male factor infertility. In fact, up to 30% of the time, we can't find a clear reason for fertility issues at all. Frustratingly, this can result in a diagnosis of "unexplained infertility."
The good news? The same treatment options (for example, IUI and IVF) are often able to help these couples conceive as successfully as their formally diagnosed counterparts.
What does a semen analysis evaluate?
When a semen analysis is performed, the sperm being analyzed are actually two to three months old. If any lifestyle changes need to be made, such as quitting smoking, and the male partner makes adjustments, we wouldn't expect those to be reflected until two to three months afterwards.
I want to show you quickly, using our board here, what we're looking for in a semen analysis:
Volume
The first important factor we're looking at is the volume (amount of milliliters) available in the sample produced on that day.
For reference, the male partner will either go into their clinic to produce a semen sample, or if produced outside the office, the sample needs to be delivered in a reasonable amount of time to maintain the correct temperature.
At most clinics, that time frame is somewhere between 45 minutes and one hour.
Concentration
The second factor we look at is sperm concentration, which refers to how many million sperm there are per milliliter. A question I often get asked is, "Why do we need so many sperm?"
If we're talking about millions and millions of sperm, and someone only has four million sperm, that seems like a lot - but it's not. That's because many sperm get lost in the process.
When sperm are deposited in the vagina during regular intercourse, you lose a lot of them in the acidic environment in the vagina, as well as the cervix. The remaining sperm then have to travel up to the fallopian tube, where fertilization takes place. So although many, many millions of sperm are deposited, probably only 200 reach the fertilization site.
Due to that huge attrition rate, we need to start off with a lot of sperm. So sperm concentration really matters when trying to conceive.
Sperm Motility vs. Sperm Morphology
Two other factors that are crucial to male fertility include:
- Sperm motility, which is the ability of sperm to move through the female reproductive tract to reach and fertilize an egg.
- Sperm morphology, which refers to the shape, size, and appearance of the sperm.
Meet Joe
A father through IVF shares his journey through male factor infertility, becoming a father, and why he's decided to be open about his story.
What do normal, healthy sperm look like?
Normal sperm have an oval head and a long tail called a flagellum, which helps them swim effectively and fertilize an egg. Abnormal sperm may have defects in the head or tail, such as being too large or misshapen, or having a crooked or double tail.
We also look at how many of those sperm, in terms of morphology, look "normal" to us. If the morphology is low, it doesn't necessarily mean that the chromosomes in the sperm are bad. What it does mean is that the sperm may have a defect that prohibits it from reaching or breaking through the outer shell of the egg.
What is total motile sperm (TMS)?
The most important parameter in terms of semen analysis is total motile sperm, which is a combination of volume, concentration, and total motility. We never look at a single parameter and deem all of the sperm "abnormal" - we take everything into account together.
If the total motile sperm and/or sperm morphology is very low, this may guide our decision-making process and make the journey a bit different than if the semen analysis was normal.
Men's Fertility Matters
As you can see, male fertility is a little bit of a complicated and nuanced factor, but it is very important. So if I can leave you with one message today, it's to make sure that if you have a male partner, they have a semen analysis performed early on in your fertility journey.
Have a question about fertility?
Submit it here and we'll answer it in a future episode of Ask Monica!
What is a semen analysis?
Learn what this common test can tell us about male fertility and how its results may impact treatment.
