Semen analysis is probably the first test you will be asked to perform. Semen is the fluid that is released when a man has an orgasm. Semen carries the sperm in fluids that should nourish and protect it. You will typically be asked to provide a semen sample by masturbating into a sterile glass jar. If masturbation is not culturally acceptable, your doctor can provide you with a special condom in which to collect semen during intercourse.
The semen analysis provides a lot of information about the quantity and quality of both semen and the sperm it contains. Some of the things that are measured are:. Mayo Clinic does not endorse companies or products.
Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis Many infertile couples have more than one cause of infertility, so it's likely you will both need to see a doctor.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Diagnostic evaluation of the infertile male: A committee opinion. Fertility and Sterility. Strauss JF, et al. Male infertility. In: Yen and Jaffe's Reproductive Endocrinology. Elsevier; Accessed Nov. Mayo Clinic; What is male infertility? Urology Care Foundation. After the diagnostic evaluation is completed, treatment may involve medical or endocrinologic treatment, surgical correction or a decision to manipulate or process sperm to achieve a pregnancy.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. Sperm can be prompted to undergo AR in the presence of an artificial inducing agent, ionophore A, or natural physiological inducers, progesterone or ZP3 57, Figure Again, these are very specialized tests, and are recommended only in the event of multiple IVF failure Analysis of sperm hyperactivation motility is also critical to determine fertilization potential.
Hyperactivation parameters include curvilinear velocity and lateral head displacement of the sperm. These parameters are difficult to assess manually, both because they are difficult to quantify accurately by observation and also because the heightened movement speed of the sperm which means they often leave the microscope's field of view. In order to accurately evaluate hyperactivation, computer-assisted sperm motility assessment CAMA is used which assesses the sperm hyperactivation parameters , CAMA measurements have been positively correlated with IVF fertilization rates ; however, it has been shown that assessment of sperm motion characteristics alone cannot be a reliable predictor of fertilization outcome Intracytoplasmic sperm injection has emerged as the essential therapeutic modality for sperm fertilization defects.
In ICSI, a single spermatozoon is injected directly into the oocyte cytoplasm, bypassing many of the natural steps involved in fertilization such as capacitation, hyperactivation, ZP binding, and AR.
The recent innovation of sophisticated diagnostic testing, achieved in the field of Andrology, has improved our understanding of sperm defects in male infertility. Couples facing unexplained infertility are characterized by being childless despite presence of normal semen parameters and normal female partner evaluation.
Although detailed history taking and physical examination are always crucial to disclose erectile dysfunction or infrequent intercourse, more novel expensive tests are required to scrutinize hidden sperm functional defects. ICSI may help solve the problem of unexplained male infertility and bypass all the natural barriers that a dysfunctional sperm must overcome to induce fertilization.
However, such therapy is not without risks and complications. The successful pregnancy achieved by using a dysfunctional sperm carries a risk of transmission of the same infertility traits to the male offspring. Furthermore, the paternal part of the embryonic genome is actively expressed at the four- to eight-cell stage in human embryos. Therefore, sperm DNA strand breaks that can not be repaired by the oocyte DNA repair system may adversely affect the later stages of embryonic development.
Aitken and Krausz recognized that sperm DNA damage is promutagenic and can give rise to mutations after fertilization Mutations sustained at the very early stage of embryonic development will be fixed in the germline and may give rise to the induction of infertility, childhood cancer and higher risk of imprinting diseases in the offspring So far, however, short term follow-up studies of children born after ICSI compared with children born after conventional IVF have not been conclusive regarding the risks of congenital malformations, imprinting diseases and health problems in general.
Long term studies on the risks and complications of ICSI on the produced offspring are critically required. Taking this risk into account mandates frequent conduction of sperm function testing to elucidate the basic sperm molecular defects which should be rectified by utilizing molecular targeted therapies before using of the dysfunctional sperm in ICSI.
Although these types of therapies are still under investigations, exploring the presence and frequency of metabolic targets may help specifically direct the therapeutic research plans on correcting these metabolic alterations. In addition, identifying certain abnormalities in these tests e.
Normal semen analysis results, as routinely assessed, do not guarantee fecundity. This premise is important for all clinicians involved in the management of the subfertile men. Currently, one of the chief objectives of male infertility research is to invent a diagnostic test that efficiently correlates with sperm fertilizing potential. Proper understanding of the in vivo process of human fertilization and sperm egg interaction in vitro is the key to envisage the sperm functional alterations with tremendous influence on diagnosis and treatment of male subfertility.
Abrir menu Brasil. International braz j urol. Abrir menu. Alaa Hamada Sandro C. The importance and limitations of routine semen analysis in unexplained infertility Currently, routine semen analysis remains the backbone of the evaluation of the male factor infertility, besides detailed medical history and thorough physical examination 7.
Clinical evaluation of the subfertile male It is important that the initial assessment of subfertile male patients is rigorous and detailed in order to rule out any evident cause of infertility before delving deeper into evaluating the potential etiologies of unexplained male infertility. Etiologies Immune infertility Spermatogenesis does not occur until the onset of puberty and sperm are kept separated from the immune system by the blood-testis barrier. Reactive oxygen species Reactive oxygen species ROS are unstable oxygen derived molecules that are formed as byproducts of oxidative metabolism.
Genetic defects Genetic damage in sperm can occur at several levels, all of which have the potential to cause infertility in men. Fertilization defects Fertilization of the oocyte involves multiple complex and intricate processes. Hum Reprod.
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Am J Reprod Immunol. Cervical mucus antibodies and postcoital test. Am J Obstet Gynecol. Am J Reprod Immunol Microbiol. J Immunol. Biol Reprod. J Assist Reprod Genet. Arch Androl. Francavilla F, Santucci R, Barbonetti A, Francavilla S: Naturally-occurring antisperm antibodies in men: interference with fertility and clinical implications. An update. Front Biosci. Lack of complement activation in the seminal plasma of men with antisperm antibodies associated in vivo on their sperm.
J Lab Clin Med. Sikka SC: Relative impact of oxidative stress on male reproductive function. Curr Med Chem. FEBS Lett. Esteves SC: Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: a prospective study. Int Braz J Urol. Plante M, de Lamirande E, Gagnon C: Reactive oxygen species released by activated neutrophils, but not by deficient spermatozoa, are sufficient to affect normal sperm motility.
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