In the Male Fertility Support blog we looked at what can be done to try and improve male sperm health for fertility. Here we will look at what happens when a semen analysis does not meet the minimum criteria and male factor is contributing to infertility.
Whilst a semen analysis gives us a lot of information, it is important to remember that as sperm is continually changing each sample represents that day only. And whilst a semen analysis gives us a lot of information, it doesn’t actually identify the true quality of the sperm. If there are irregularities, the test is repeated and if any abnormalities found you should be referred to a urologist for a physical examination to determine if any further testing is needed. It should be noted that you should abstain from sex for a few days before a semen analysis, but your doctor will confirm how many.
Other tests include:
Hormone screening test - is a blood test to check hormone levels involved in sperm production.
Infection screening - a blood test to check if there are any underlying viral infections that may impact fertility.
Testicular ultrasound is carried out to check for blood flow to each teste, infection or tumour.
Retrograde ejaculation – if you have a low ejaculate volume, it can indicate that you have a condition known as retrograde ejaculation. This occurs when the semen is pushed back into the bladder and can be associated with conditions such as diabetes, bladder or prostate surgery, nerve damage or even some medications to treat high blood pressure. A urine sample is taken post orgasm to determine if you have this.
Genetic screening – is testing for genetic anomalies that could cause the count to be low or that may impact fertilisation or recurrent miscarriage.
SOS (Sperm Oxidative Stress) – a semen analysis is done to check the levels of oxidative stress in the sample as high levels have been linked to abnormalities within the sperm affecting pregnancy rates and higher risk of miscarriage.
DNA fragmentation testing – done from a sperm sample which shows lesions, damage or breaks in the genetic material of the sperm. The greater the damage to the sperm the higher risk of spontaneous miscarriage, failure to achieve pregnancy and potentially more IVF cycles. It should be noted that this test is not routinely offered to couples receiving fertility treatment.
Testicular sperm aspiration (TESA) - TESA is a procedure performed for men where little or no sperm is found in the sample. It assesses if there are sperm and is used when a couple are having sperm retrieved for IVF/ICSI. It is done with local anaesthesia where a needle is inserted in the testicle and tissue/sperm are aspirated.
Hopefully this information will help when considering what tests may be needed to help you on your journey.
Resources
Andrology Solutions (2022) https://www.andrologysolutions.co.uk/services/fertility-testing/comprehensive-semen-analysis/
Care Fertility (2022) https://www.carefertility.com/treatments/fertility-assessment/male-fertility-tests/
Ian Stones (2021) Hove Fertility and Wellness