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Male fertility evaluation

Budaörs Corvin Pasarét

We talk about infertility when pregnancy does not occur after 1 year of regular sexual activity.

In cases of difficulty conceiving or infertility, 40% of the time the issue is with the male partner, 40% with the female partner, and 20% with both partners. Therefore, it is very important that, even before trying to conceive, the male partner undergoes an evaluation.

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Here are a few questions that you may have already thought about:

What could be the problem?

The most common issue is a decrease in sperm count or a complete absence of sperm. Additionally, there can be abnormalities in the shape of the sperm or in their movement: they may become slower or exhibit aimless wandering.

The examination is straightforward: it only requires providing a sample (which, let's be honest, is less uncomfortable for a man than a tubal patency test for a woman).

What tests can be performed on the sample?

The most common issue is a decrease in sperm count or a complete absence of sperm. Additionally, there can be abnormalities in the shape of the sperm or in their movement: they may become slower or exhibit aimless wandering.

The examination is straightforward: it only requires providing a sample (which, let's be honest, is less uncomfortable for a man than a tubal patency test for a woman).

What should be considered when providing the sample?

  • The sample should be given after 3-7 days of abstinence, in a sterile specimen container (available at pharmacies). Longer periods of abstinence typically result in more pronounced abnormalities in sperm motility, while shorter periods may lead to inaccurate sperm counts.
  • During the abstinence period, avoid using saunas, taking hot baths, and excessive alcohol consumption.
  • Before providing the sample, it is important to wash your hands and thoroughly clean the genital area.
  • Sample collection is usually done through masturbation, but seeking assistance is not prohibited. However, it is important to ensure that the first portion of the ejaculate is collected in the container, as it contains a significant amount of sperm.
  • Please clearly write your name on the container.
  • Please wrap the container in aluminum foil and, if possible, keep it at body temperature (under a sweater). Deliver it to us within 1-2 hours.

More detailed information on male fertility testing and related issues

During the examination, we first evaluate the macroscopic data of the ejaculate (semen volume, pH, viscosity, color, liquefaction time), and then, through microscopic analysis, we determine the sperm count, motility (movement) characteristics, and morphological (shape) features.

This basic examination is essential for assessing fertility, but often it is not sufficient even if the results are normal, as the biological and biochemical characteristics of the sperm also play a significant role in fertilization beyond these physical properties.

The HBA test is a method used to determine the proportion of mature sperm.

It allows us to estimate the fertilizing potential of the sperm. During the test, a drop of semen is placed on a special slide containing hyaluronic acid, and we observe what percentage of the sperm can bind to the hyaluronic acid. In nature, only mature sperm can bind to the hyaluronic acid in the egg's outer layer, which is necessary for successful fertilization.

After the classic spermiogram (SPG) and the HBA (which shows the sperm’s ability to bind to hyaluronic acid), this is the most important test. In fact, these three tests are desirable to perform in all casesif a couple has not conceived within six months to one year (age-dependent), or immediately after the desire to have children arises, particularly from the age of 40.

Everyone knows that the quality of a woman’s eggs deteriorates with age, which is one reason why it is necessary to screen embryos for Down syndrome and other developmental disorders.

However, fewer people know that men can also have issues with the quality of their genetic material, i.e., DNA.

Certain factors, such as stress, obesity, smoking, inflammation, and older age, can damage the genetic material in sperm, causing the DNA to become fragmented. Unfortunately, this can be the case even if the basic spermiogram (SPG) shows normal values.

The DNA fragmentation test reveals what percentage of sperm have damaged DNA. It's similar to when we used to check the fragmentation of a Windows hard drive and it would display a bar graph. Unfortunately, this doesn’t get fixed with just a push of a button. However!

Fortunately, there are solutions! An andrologist may recommend various medications and antioxidant treatments, and during ART (assisted reproduction) procedures, it is possible to filter the sperm through a special sieve where sperm with damaged DNA are separated from those with healthy DNA, allowing us to work only with the healthy ones afterward.

Who should have this test done and when is it important?

Practically, anyone experiencing fertility issues should have this test done:

  • difficulties conceiving
  • everything was found to be normal on the female side
  • previous tests have not revealed the cause of infertility
  • failed insemination or IVF cycles
  • miscarriages

Evaluation:

The lower the number, the better! :)

  • Below 15% is an excellent value
  • Between 15-20% requires individual assessment
  • Above 20%, definitely consult a reproductive specialist to discuss further treatment options

Immunological testing allows us to detect antibodies against sperm cells in the semen. The presence of these antibodies can hinder sperm from reaching the egg, reducing the chances of fertilization.

With this test, we examine the interaction between cervical mucus and sperm close to the time of ovulation. It is possible that sperm may become immobilized upon contact with vaginal secretions or mucus. In the past, this test was conducted by asking the couple to come quickly to the clinic after intercourse, where a sample was taken from the woman. Fortunately, we have moved beyond that method: today, we separately collect the cervical mucus from the woman, similar to a Pap smear, and the man provides a sperm sample—collected at home using any preferred method after 3-5 days of abstinence, and delivered to the clinic within 1-2 hours. The two samples are then combined under laboratory conditions: a smear is prepared and examined under a microscope to check for motile sperm. If only inactive sperm are observed, the PCT test is positive, indicating an incompatibility.

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