The causes of a couple’s fertilization problems are as common on the woman’s side as on the man’s side. Therefore, in the case of problems with getting pregnant, it is most often necessary to diagnose male and female infertility.

What are the most common causes of male infertility?

Based on ongoing research, the problem of male infertility may currently affect up to 10% of all individuals. The most frequent causes of male infertility are associated with poor semen quality, such as low sperm count, poor motility, or abnormal morphology of the sperm present in the ejaculate. Various factors can negatively impact semen quality. First of all, it can be due to congenital defects or acquired defects of the genital organs or hormonal disorders which can adversely affect the efficiency of the testicles. Systemic diseases, especially diabetes, thyroid diseases, and multiple sclerosis, can also affect sperm quality.

Additionally, a decline in sperm condition can be related to having mumps in childhood, complicated by orchitis. The reasons for deteriorating sperm quality, i.e. male infertility, also include unhealthy lifestyle, for example excessive alcohol consumption, chronic smoking, sedentary lifestyle, unhealthy diet, and obesity.

Male infertility diagnosis – tests

In order to precisely determine the causes of male infertility and choose the most appropriate treatment method to aid the couple in achieving the desired pregnancy, it is necessary to perform relevant tests beforehand.

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Semen analysis

The basic method for assessing male fertility is semen analysis. Through this, we can obtain information on whether there are any anomalies or morphological disorders related to the number, motility and other abnormalities of sperm and seminal fluid. Basic semen tests at OVIklinika are performed using a computerized semen analyser.

This assessment describes general semen parameters, such as liquefaction time, volume, viscosity, appearance of ejaculate, pH, percentage of live and motile sperm, number of sperm per 1 ml of semen, total number of sperm in the ejaculate, and presence or degree of sperm agglutination. Additional specialized semen tests at OVIklinika include sperm DNA fragmentation analysis (see below), evaluation of anti-sperm antibodies, and the peroxidase test. The detailed scope of necessary semen tests is determined during consultations with our specialists.

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Sperm DNA fragmentation test

The sperm DNA fragmentation test plays a significant role in determining causes of infertility. When the sperm DNA fragmentation is high (high levels of DNA damage), the conception still can take place, however embryo development may cease before its implantation. Even if implantation occurs, the risk of early miscarriage is very high. Checking the level of sperm DNA fragmentation can clarify previously unidentified infertility causes in many cases.

How is the sperm DNA fragmentation test performed?

The collected semen is frozen in liquid nitrogen. Before assessing sperm DNA fragmentation using a flow cytometer (the most accurate device for this type of analysis), the sample is thawed and prepared. The results of the sperm DNA fragmentation test are available after 2 weeks.

TESA/PESA

The TESA/PESA procedure (Testicular Sperm Aspiration/Percutaneous Epididymal Sperm Aspiration) is a short procedure performed by reproductive specialists or urologists collaborating with our center. It involves inserting a needle directly into the testicle (TESA) or the epididymis (PESA) to obtain sperm when no sperm is found in the semen. This procedure lasts about 20 minutes and is performed under short intravenous anaesthesia. The fluid obtained from the testicle or the epididymis during the procedure is immediately checked by an embryologist for the presence of sperm. Sperm cells obtained during the procedure are secured in a special cryoprotectant and frozen in liquid nitrogen. If sperm retrieval is unsuccessful during PESA or TESA procedures, it may be possible during testicular sperm extraction (biopsy) offered by OVIklinika. If TESA proves to be ineffective, a microTESE is recommended.