Diagnosing Male Infertility

Every 6th couple in active reproductive age is faced with the problem of infertility. The reasons for this are almost equally distributed amongst both sexes. The archaic belief that infertility is a predominantly female condition has long since been rejected: male infertility has become especially relevant in the last couple of decades. The wrong belief that male infertility is somehow connected to his sexual abilities, has been a hurdle for the correct and on time diagnostics. The rapid advances of andrology medicine now allow us to detect and treat a large proportion of male reproductive problems. Spermatogenesis is a long process, approximately 72 days, and is controlled by the complex interactions between the hypothalamus, hypophysis, and the testes. There are many diseases that can lead to the impairment or serious difficulty of a man becoming a biological father, some of which are:

  • disorders in the production and functionality of sperm cells: hypogonadism, cryptorchidism, varicocells, infections, antisperm antibodies, testicular torsion, etc.;
  • disorders in the delivery of sperm: erectile dysfunction, retrograde ejaculation, congenital lack of vas deferens,
  • prostate surgery, testicular trauma, etc.;
    pathological abnormalities in some glands with internal secretion: thyroid, pituitary, posterior, or supine;
  • chronic illnesses or treatment with medications (some antibiotics, steroids, etc.);
  • infectious diseases;
  • genetic factors, such as deletions in the Y-chromosome or an abnormal number of normal chromosomes (e.g. monosomy, trisomy);
  • adverse effects due to the profession and/or the environment: occupational hazards, pesticides, chemicals, radiation, heavy metals or other industrial agents;
  • anatomical problems (obstruction or anomalous external genitals);
  • abnormal sperm morphology;
  • common health problems and lifestyle: diabetes, kidney and liver disease, hypertension, testicular and male cancers, chemotherapy, hypovitaminosis, obesity, smoking, alcohol abuse, drug use, etc.

Tests: Spermogram (sperm analysis) – a basic test for determining the fertilization capabilities of sperm cells. The test is easy, quick, painless and extremely informative. The spermogram includes many factors, but it is not necessary that a deviation in one of them means an underlying disease. Only the complex evaluation of the received data for all parameters and their dynamic allows to make correct evaluations for a man’s fertilization ability. Basic parameters that are being evaluated are the volume, viscosity, pH of the collected sample, the concentration, mobility, and morphology of the sperm cells. It is recommended to obtain the probe through masturbation in a designated room in the clinic. If that proves to be impossible, the material can be delivered to the lab in a time span of 20-30 minutes after ejaculation. The test results are usually ready in a day.

Indications for carrying out a spermogram:

  • assessing the reproductive capacity of men trying to become biological fathers;
  • suspected secondary infertility;
  • Sexually transmitted infections and other infections of the reproductive tract;
  • diseases of the genitourinary system;
  • mumps, complicated by orchitis (testicular inflammation);
  • cryptorchidism (retained testis) or lift testis;
  • monochirism (one testicle);
  • congenital genetic syndromes that are relevant to reproductive capacity, e.g. Klinefelter Syndrome, Kalman Syndrome, Carthage Syndrome;
  • general diseases that are at risk for infertility, such as diabetes, hypertension, testicular cancer, varicocele;
  • before chemotherapy or radiotherapy for malignant neoplasm, regardless of its location, to evaluate sperm pre-treatment and possibly freeze sperm;
  • before surgery of the testis, epididymis, prostate gland, seminal vesicles, bladder and other pelvic organs, as well as postoperatively;
  • for athletes who take anabolic steroids and supplements with a negative effect on spermatogenesis;
  • for athletes who practice contact sports, cycling, weightlifting, rowing, and others with a detrimental effect on reproductive capacity;
  • after injuries in the genital area, pelvis and anterior abdominal wall, as well as spinal cord injuries;
  • exposure to environmental risk factors, e.g. pesticides, radiation, heavy and non-ferrous metals, varnishes, paints, etc.;
  • relatives with reproductive problems, with proven or suspected heredity;
  • pre-application methods for assisted reproduction;
  • before cryopreservation of sperm;
  • if you wish to donate sperm;
  • if you are concerned about your reproductive health.

Basic requirements for doing semen analysis:

  • Sexual abstinence for 2 – 5 days;
  • Do not take antibiotics for a minimum of two weeks prior;
  • Do not consume alcohol / drugs in the days of abstinence;
  • The ejaculate container has to be sterile and disposable;
  • It is necessary to inform a lab assistant if you are taking any medicine / dietary supplements;
  • It is necessary to inform a lab assistant if the sterile container does not contain all of the ejaculate. A loss in ejaculate would mean incorrect results;
  • Please book ahead, prior to the test;

The results of a single test could be not enough to diagnose a problem accurately, especially if it concerns men, whose ejaculate parameters vary greatly. A number of reproductive clinics in Europe and abroad recommend performing 3-6 tests in a specific time interval, in order to collect sufficient and accurate information, concerning the patients’ health.

Other tests connected to semen parameter evaluation:

DNA Fragmentation of sperm cells – analysis, which provides information on the structural completion of the chromatin in sperm cells. The entirety of the sperm’s DNA is an important fertility marker. The chromatin’s quality is an important factor for male infertility, especially in its contribution of genetic material to the early embryonic development. Studies on the structure of chromatin can provide a prognosis for the fertilization development and the success rate of Assistive Reproductive Technologies. The degree of disruption of genetic material is quantitatively deduced as DNA Fragmentation Index (DFI). The disruption of sperm cells’ DNA can occur in both fertile and infertile men. The results from the SDI test are independent from the sperm analysis markers. This is recommended in the following cases:
idiopathic (unexplained) maturity;
after many unsuccessful attempts at artificial fertilization;
poor embryo quality;
for patients with multiple recurrent spontaneous abortions;
the presence of varicocele (an increase in size of the veins of the testes);
men over the age of 45;
when the ejaculate is frozen (with the aim to guarantee that the sample is frozen at the acceptable level of DNA fragmentation);
increase in body temperature in the last 3 months.

MAR test for finding antisperm antibodies (ASA) – determines the % of available IgA and IgG antisperm antibodies, whose raised numbers could mean an immunological problem when it comes to infertility. The sperm are relatively protected from the immune system by a natural defense mechanism called the blood-testes barrier. A special type of tight junction connections between the cells lining the male reproductive tract does not allow the cells of the immune system to penetrate the testes. If this barrier is broken, then the cells of the immune system penetrate into the testes and antibodies form. Anything that damages the normal blood-testes barrier can lead to the formation of antisperm antibodies. Reasons for this may be: recovery after vasectomy, varicocele, testicular biopsy, testicular cancer, infection (orchitis, prostatitis), surgery of inguinal hernia before puberty, etc. Antisperm antibodies can prevent the interactions between the egg and the sperm that occur during fertilization. In some cases, these antibodies can damage sperm formation within the testes.

NGOs (Grém-Nuallurón Vining Agau) text - through this text will send out the financial resources of the project. Xia Xia Xana Xana Xana Xana Xanax During the last stage of maturation, sperm acquire the ability to bind to hyaluronan. A number of studies show that the ability to recognize and attach to hyaluronan is an important indicator of demonstrating the maturity and fertility of male gametes.

NBA (Ѕреrm-Нуаlurоnаn Віndіng Аѕѕау) Test: this test determines the sperm cell’s functional maturity. Hyaluronan is a type of sugar – glucoseamineglycan with a high molar weight, which is found in many parts of the body and is a key component of a group of cells that surround the oocyte (cumulus oophorous). During the last stage of maturation, sperm acquire the ability to bind to hyaluronan. A number of studies show that the ability to recognize and attach to hyaluronan is an important indicator of demonstrating the maturity and fertility of male gametes. During normal conception, the sperm’s attachment to hyaluronan, located in the cell layer surrounding the egg, appears to serve as a natural mechanism for selecting healthy and mature sperm. The sperm’s attachment to hyaluronan may be an indicator of how well the cells that are being tested can lead to a successful pregnancy.

SAT: For the first time in Bulgaria, the genetic test for sperm chromosome anomalies SAT is being applied in SBALAGRM “Sofia”, in cooperation with the leading company in reproductive genetics Igenomix.

ЅАТ (Ѕреrm Аnеuрlоіdу Теѕt) is a diagnostics method for determining the genetic origin (etiology) of male sterility and is being recommended for patients with a higher risk of sperm cell aneuploidy. Such cases are usually found in men with disrupted semen parameters, mainly oligospermia, unobstructed azoospermia, and severe teratozoospermia. Through this test analysis of the percentage of sperm cells with hormone anomalies can be conducted. This evaluation gives us the ability to judge the risk of transmitting those anomalies to your offspring. The test analyses the chromosomes that are most often connected to spontaneous aborts (chromosomes 13, 18, 21, X, and Y). In terms of clinic, a higher number of sperm cells with chromosomal anomalies means a lower pregnancy success rate and a higher risk of spontaneous aborts in couples that have to use ICSI procedures. On an embryonic level, different defects in terms of the chromosome anomaly type can be observed in sperm cells. For example, the increase in percentage of disomic sperm cells can lead to a parallel increase of aneuploidic embryos with syndromes that are compatible with life (Down, Patau, Edwards, Klinefelter, Turner, or X- and Y-chromosome trisomies). The increase of diploid sperm cells leads to an increase in probability to develop triploid embryos and, most of all, abortions. For these reasons, the SAT test is useful for genetic consulting in males that are suffering from infertility, and for finding the optimal method for the application of assistive reproductive technologies. Other indications for applying the test, which are not necessarily connected with abnormalities in the semen parameters, include:

  • Repeating number of abortions with unclear etiology;
  • In couples with many unsuccessful IVF cycles;
  • In couples with a previous pregnancy with hormone therapy.

Vitality test: necessary in the cases where there is a large percentage of stationary sperm cells in the sample. The test gives us the ability to determine how many of these sperm cells are able to live.
Sperm cell biological survival rate test: examines the percentage of mobile sperm cells after processing with a special nutrient medium and incubation for a period of 24 hours. This test aims to examine the most probable survival rate of the sperm cells in the uterus or the genital tract in the woman after normal sexual intercourse or insemination.
Sperm cell cryotolerance: this test evaluates the survival rate of sperm cells after freezing and consequent thawing. This is a necessary test that accompanies the freezing of sperm cells. It gives us information and enables us to decide which is the suitable ART procedure.


Treatment of basic endocrine diseases, antibiotic treatment after infection, removal of harmful environmental factors;
Hormonal or surgical treatment can sometimes help with the abnormal number and mobility of the sperm cells;
The development of the assistive reproductive techniques gives the couples a new opportunity in solving the problems with pregnancy. In the last couple of years, as a basic method for treatment of infertility, caused by the so-called male factor, has stimulated the application of the intracytoplasmic spermal injection (ICSI).

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