Abnormal Semen Analysis
Part of the basic workup for all couples is a semen analysis. We find abnormalities in approximately 40 percent of all the couples that we treat. Different degrees of sperm problems exist, and the treatment will vary according to the severity. If the issues are mild, then timed intrauterine insemination is the treatment of choice. If the problem is more severe, then we usually recommend a consultation with a urologist to determine if treatment can correct the sperm abnormalities. The most common abnormalities that we see are hormonal, or something known as a varicocele, which a urologist may address with surgery.
Any hormonal problems are treated via medical therapy. The medications used to improve testicular function, testosterone, and sperm counts are Clomid, tamoxifen, letrozole, similar medicines that induce ovulation in women. Other causes of an abnormal sperm test include exposure to extreme temperatures such as saunas/hot tubs for long periods of time, certain drugs and other medications, and steroids. People taking testosterone supplements for various reasons, including body building, can show signs of impaired sperm production. If after treatment and evaluation, the sperm quality won’t work to fertilize an egg with intercourse or insemination, then in-vitro fertilization with intracytoplasmic sperm injection (ICSI) is necessary.
Intracytoplasmic Sperm Injection (ICSI)
During ICSI, one sperm will be inserted into the egg since the sperm is unable to penetrate the egg on its own. This process bypasses the sperm issue completely. For more information on ICSI, see IVF procedures
The technical term for this is azospermia and rarely occurs. Very low counts or motilities are common, but having no sperm doesn’t happen as often. One of the main reasons for this problem would be blockage from previous infections or a congenital blockage that the individual is born with.
With an evaluation by a urologist, any blockage can be easily detected. If the urologist finds a blockage, then fixing the blockage is one of the options. If the blockage is not correctable, sperm can be removed from the testicle itself, or from the epididymis. These options are used in conjunction with in-vitro fertilization and ICSI because sperm obtained in this fashion are rarely motile enough to penetrate an egg. The last option is donor sperm, which can be used in the case of severe male-factor infertility or for patients with azospermia.
Low sperm count and abnormal semen are among the most common causes of male factor infertility. Available treatment options include:
- Percutaneous Epididymal Sperm Aspiration (PESA): If the semen has no sperm, a needle can be inserted through the scrotum and into the epididymis to extract the sperm for IVF/ICSI. With a local anesthetic, the procedure is essentially pain-free and takes only 10 to 20 minutes to complete.
- Testicular Sperm Extraction (TESE): For men who have a blockage that prevents sperm from entering the epididymis, a small piece of testicular tissue can be removed using a needle, and sperm is then extracted from the tissue. Patients are treated with an anesthetic, and any post-operative pain or soreness can be controlled using medication.
- Microepididymal Sperm Aspiration (MESA): Using microsurgery, sperm can be collected from blocked portions of the epididymis. The procedure is performed through a tiny incision in the scrotum, under general anesthesia. Your doctor can prescribe pain medication to treat any post-operative pain.
After collection of the sperm, the specimen will be prepared to improve the odds of conception. Sperm washing, a technique in which the sperm is removed from the seminal fluid to maximize its mobility, is one option. If none of these options are available, or if they are unsuccessful, your doctor may talk to you about using a sperm donor, or considering adoption, to help build your family.