Infertility is a very intimate matter and it may take a long time for some couples to muster enough courage and see a medical specialist with this problem. However, centres of assisted reproduction employ professionals – people who encounter these problems on a daily basis and one certainly needs not to be afraid of them. After all, it is a medical issue like any other and it can be tackled or cured in more than 90% of cases and at the end of the process there is a beautiful new little baby and that certainly makes the whole procedure worth it.
Diagnosis and treatment of male infertility
At present, as much as 50 % of all couples have a confirmed medical issue which is related to semen analysis results. Today, male infertility is regarded as an equally serious factor causing infertility of couples as the female factor. In centres of assisted reproduction, it is the andrology office that deals with treatment of male infertility.
Parameters of semen analysis and sperm production disorder
Male infertility or male issues related to inability to conceive a baby are most often demonstrated by decline in sperm quality. Parameters of semen analysis in today’s population are getting worse and the semen analysis standards had to be repeatedly lowered in comparison to mid 20th century levels. In general, we could conclude that the increased infertility is a result of the world that we currently live in – too much work, air pollution, food that we eat, smoking and, naturally, too much stress.
When it comes to treatment of male infertility factor, during examination, the physician needs to check the patient to rule out inflammatory diseases, chronic infections, varicocele, or hormonal issues. In a smaller share of male population, hormonal treatment is indicated – most often with antiestrogen medications.
Basic semen analysis
Parameters of semen analysis change upon every examination, that is why specialists evaluate the data in a comprehensive manner taking into account also other tests and examinations. Differences between the respective samples can be substantial and therefore it is always necessary to examine a new sample of ejaculate. We do not recommend drawing an early conclusion from a single test. Semen analysis can be performed after 3 to 5 days of sexual abstinence.
Basic semen analysis:
- The volume, look and the ejaculate liquefaction time
- Sperm count (the number of sperms per millilitre)
- Sperm motility and morphology examination
Specialised tests of ejaculate:
- Trial wash test – separation of sperms from seminal plasm (i.e. other parts of ejaculate). Depending on how many sperms we can get, we can make a better decision as to which method of assisted reproduction is most suitable.
- Examination of sperm antibodies in ejaculate – if antibodies are present in the ejaculate, the chance of spontaneous conception is lower even if the basic semen analysis results are all within standard levels.
- HALOSPERM – sperm DNA integrity test, which determines the presence of sperms with damaged genotype. These sperms have a reduced ability to fertilise the egg.
- Oxisperm – test for diagnosing of sperm damage by oxidative stress. Recommended for smokers, males with varicocele (enlarged veins near testicles), obese males and those suffering from negative influence of the environment.
- Vital Test – differentiation of dead and alive non-motile sperms. During a standard semen analysis, we cannot differentiate whether the sperms are alive but only lack capability to move or they are dead.
Severe spermiogenesis disorders
In very severe cases of spermiogenesis disorders, in vitro fertilisation is recommended. The methods of assisted reproduction can tackle the male infertility factor with a high rate of success and it is a common practice that even men without a single sperm in their ejaculate can have their (genetically) own child after a surgical collection of sperms from their testicle followed by in vitro fertilisation. The success rate of IVF in male infertility factor is higher compared to cases when the infertility is caused by a medical issue of the female partner.
Unless a serious issue is detected, lifestyle measures may be sufficient
Studies show that 30 to 80 % semen analysis-related disorders are caused by oxidative stress and a reduced antioxidative capacity of the ejaculate. When a couple strives to conceive a baby, it is immediately necessary to stop smoking, pay enough attention to healthy diet and avoid stress. Among antioxidants, we recommend using vitamins C and E, coenzyme Q10, as well as zinc, selenium, carnitine, folic acid, N-acetyl cysteine and a number of other preparations.
Infertility is not a purely male or female problem – it is always a problem of the respective couple
There isn’t any fertility test examining a male or female patient and producing a clear and unambiguous conclusion as to which of the partners is the ‘source’ of the problem. Fertilisation is a very complex process and infertility can be caused by male factor even when the basic semen analysis delivers fully standard results.
Treatment using oocyte, sperm, and embryo donation
Pursuant to applicable Slovak legislation, treatment using donation of reproductive cells (oocytes and sperms) and embryos can only be provided to a woman with a male partner. The legislation does not set any upper age limit for a woman receiving the treatment, however, considering the ethical reasons, Gyncare – Centre for Assisted Reproduction accepts the limit below 52 years of age in female patients receiving this treatment. The patient must be in healthy condition enabling her to carry and give birth to a baby.